Ecchordosis physaliphora: a cautionary tale

2019 ◽  
Vol 134 (1) ◽  
pp. 46-51
Author(s):  
C Georgalas ◽  
D Terzakis ◽  
M Tsikna ◽  
Z Alatzidou ◽  
S de Santi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Complete Resolution ◽  
Benign Lesion ◽  
Flap Reconstruction ◽  
Cautionary Tale ◽  
Nasoseptal Flap ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Ecchordosis Physaliphora ◽  
Craniospinal Axis

AbstractBackgroundEcchordosis physaliphora is a congenital, benign lesion originating from notochordal remnants along the craniospinal axis, most frequently located at the level of the clivus and sacrum. Sometimes ecchordosis physaliphora is difficult to recognise and treat, with a total of twenty-six cases described in the literature.MethodsThis study reports on three cases of previously undiagnosed ecchordosis physaliphora presenting with cerebrospinal fluid rhinorrhoea and meningitis.ConclusionEndoscopic transclival or transsphenoid surgery including three-layer (fat, fascia and nasoseptal flap) reconstruction was used in all cases with complete resolution of the symptoms.

Complications of Nasoseptal Flap Reconstruction

2016 ◽  
Vol 77 (S 02) ◽  
Author(s):  
Carl Snyderman ◽  
Joseph Chabot ◽  
Nicholas Rowan ◽  
Eric Wang ◽  
Paul Gardner ◽  
...  
Keyword(s):  
Flap Reconstruction ◽  
Nasoseptal Flap

scholarly journals Overshunting-Related Cervical Myelopathy Causing Progressive Gait Disturbance: A Case Report

2021 ◽  
pp. 312-317
Author(s):  
Eva Vister ◽  
Sebastiaan Hammer ◽  
Rudolf W.M. Keunen ◽  
Astrid L. Rijssenbeek ◽  
Niels A. van der Gaag
Keyword(s):  
Cerebrospinal Fluid ◽  
Cervical Myelopathy ◽  
Complete Resolution ◽  
Late Complication ◽  
Gait Disturbance ◽  
Shunt Revision ◽  
Proper Treatment ◽  
Cervical Stenosis ◽  
Vp Shunt ◽  
Associated Symptoms

A complication of ventriculoperitoneal (VP) shunting is overdrainage or overshunting of cerebrospinal fluid, which can cause formation of hygroma but in rare cases also cervical myelopathy at a later stage. In this article, we describe a very late complication of VP shunting. We present a 75-year-old man, previously given a VP shunt at the age of 46, who developed a progressive gait disturbance and ataxia of the limbs after 27 years. MRI showed a cervical stenosis and myelopathy as a result of venous engorgement due to chronic overshunting of the VP shunt. Revision of the VP shunt resulted in complete resolution of his neurological symptoms and the cervical myelopathy. Cervical myelopathy due to chronic overshunting is a rare and potentially very late complication of a VP shunt. Our case underlines the importance of awareness of this complication while proper treatment can reverse the associated symptoms fully.

scholarly journals Cerebrospinal Fluid Rhinorrhoea in Pituitary Tumours

1980 ◽  
Vol 73 (4) ◽  
pp. 244-254 ◽  
Author(s):  
I E Cole ◽  
Malcolm Keene
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Tumours ◽  
Pituitary Fossa ◽  
Muscle Graft ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Csf Rhinorrhoea

Three cases of CSF rhinorrhoea due to pituitary tumours are reported and the literature reviewed. The treatment of choice appears to be trans-sphenoidal exploration of the pituitary fossa with insertion of a free muscle graft followed by radiotherapy. The probability of the tumour being a prolactin-secreting adenoma is discussed.

scholarly journals Pediatric skull base reconstruction: case report of a tunneled temporoparietal fascia flap

2016 ◽  
Vol 17 (3) ◽  
pp. 371-377 ◽  
Author(s):  
Jeffrey C. Rastatter ◽  
Patrick C. Walz ◽  
Tord D. Alden
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Nasoseptal Flap ◽  
Pediatric Case ◽  
Clival Chordoma ◽  
Temporoparietal Fascia ◽  
Temporoparietal Fascia Flap ◽  
Fluid Leak ◽  
Fascia Flap

The authors of this report present a pediatric case involving the use of a tunneled temporoparietal fascia flap to reconstruct a skull base defect for a multiply recurrent clival chordoma and cerebrospinal fluid leak, demonstrate the surgical technique through illustrations and intraoperative photos, and review the pertinent literature. A 9-year-old female patient underwent extensive clival chordoma resection via both the endoscopic and open approaches, which ultimately exhausted the bilateral nasoseptal flaps and other intranasal reconstructive options. Following proton beam radiation and initiation of chemotherapy, tumor recurrence was managed with further endoscopic resection, which was complicated by a recalcitrant cerebrospinal fluid leak. A tunneled temporoparietal fascia flap was used to provide vascular tissue to augment an endoscopic repair of the leak and reconstruction of the skull base. While the nasoseptal flap remains the workhorse for many pediatric and adult endoscopic skull base reconstructions, the tunneled temporoparietal fascia flap has a demonstrated efficacy in adults when the nasoseptal flap and other intranasal flaps are unavailable. This report documents a pediatric case, serving as a step toward establishing this technique in the pediatric population.

Extradural cartilage inlay graft in cerebrospinal fluid fistula repair

2010 ◽  
Vol 124 (12) ◽  
pp. 1294-1297 ◽  
Author(s):  
P Thulasi Das ◽  
D Balasubramanian
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Success Rate ◽  
Bony Defect ◽  
Cerebrospinal Fluid Fistula ◽  
Fistula Repair ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Skull Base Defects ◽  
Fluid Fistula

AbstractObjective:To present our experience in managing cerebrospinal fluid rhinorrhoea using the cartilage inlay (underlay) technique to repair skull base defects larger than 4 mm.Study design:Retrospective study involving patients presenting with cerebrospinal fluid rhinorrhoea between 1994 and 2008.Setting:Patients were treated in a tertiary referral centre for nose and sinus diseases. Patients' medical records were reviewed and analysed.Results:A total of 62 patients were operated upon using a cartilage inlay technique to repair bony skull base defects ranging in size from 4 to 20 mm (widest diameter). Of these 62 patients, 16 constituted revisions of earlier procedures undertaken elsewhere. The success rate of the technique was 100 per cent. Patient follow up ranged from six months to 16 years, with a median follow up of 15 months. Three patients had minor post-operative sinus infections; no serious complications were encountered.Conclusion:Extradural cartilage inlay appears to be an effective technique in the management of cerebrospinal fluid rhinorrhoea, especially for large defects and revision procedures. To our knowledge, the described patients represent the largest reported series of cerebrospinal fluid rhinorrhoea cases managed using the cartilage inlay technique. We believe that the crucial factors in our high success rate for cerebrospinal fluid fistula repair are: precise identification of the bony defect; meticulous preparation of the graft bed; careful elevation of the dura; judicious use of just enough graft tissue; and adequate graft support.

scholarly journals Cerebrospinal fluid rhinorrhoea following transsphenoidal surgery for pituitary adenoma: experience in a Chinese centre

2017 ◽  
Vol 37 (4) ◽  
pp. 303-307
Author(s):  
C. Zhang ◽  
X. Ding ◽  
Y. Lu ◽  
L. Hu ◽  
G. Hu
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Transsphenoidal Surgery ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Sono Stati ◽  
Fattori Di Rischio ◽  
Adenoma Ipofisario

Lo scopo del presente studio è stato quello di chiarire i fattori di rischio della rinoliquorrea a seguito di un approccio transfenoidale e di discuterne la prevenzione e il trattamento. Abbiamo revisionato retrospettivamente 474 casi consecutivi di adenoma ipofisario trattati con 485 procedure chirurgiche per via transfenoidale da Gennaio 2008 a Dicembre 2011 nel nostro dipartimento. Abbiamo analizzato l’incidenza di fuoriuscita di liquor cefalorachidiano intraoperatoriamente e nel postoperatorio, e la riuscita di varie strategie di riparazione. Abbiamo riscontrato fuoriuscita di liquor intraoperatoriamente in 85 casi (17.9%) e postoperatoriamente in 13 casi (2.7%). Sette dei 13 pazienti con rinoliquorrea postoperatoria non avevano mostrato fuoriuscita di liquor intraoperatoriamente; tre di questi pazienti avevano adenomi secernenti ADH. Dei rimanenti 6 pazienti con fuoriuscita di liquor sia intra che postoperatoria, 2 erano stati trattati per prolattinoma gigante e invasivo e 2 erano già stati sottoposti in passato a chirurgia trasnfenoidale. In 8 pazienti la fuoriuscita è stata risolta mediante puntura lombare, drenaggio lombare, riposo in posizione semi-reclinata o altri trattamenti conservativi. Due casi sono stati trattati mediante schiuma di gelatina e colla di fibrina utilizzando un approccio transfenoidale e due con grasso autologo e ricostruzione del pavimento della sella utilizzando un approccio transnasale endoscopico. Dopo essere stato sottoposto a due tentativi di riparazione per via transasale, un paziente è stato trattato con successo mediante un ulteriore drenaggio subaracnoideo. In conclusone le procedure che fanno uso di schiuma di gelatina, colla di fibrina e impianti di grasso autologo sono efficaci ai fini del trattamento della rinoliquorrea postoperatoria in pazienti sottoposti a chirurgia transfenoidale. Quando viene rilevata una perdita di liquido cefalorachidiano in corso di chirurgia transfenoidale, un’appropriata ricostruzione del pavimento della sella e un follow up a lungo termine sono necessari.

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