scholarly journals Contemporary Trends in the Management of Posttraumatic Cerebrospinal Fluid Leaks

2018 ◽  
Vol 11 (1) ◽  
pp. 071-077 ◽  
Author(s):  
Moustafa Mourad ◽  
Jared C. Inman ◽  
David M. Chan ◽  
Yadranko Ducic
Keyword(s):  
Cerebrospinal Fluid ◽  
Contemporary Literature ◽  
Comprehensive Review ◽  
Diagnosis And Management ◽  
Cerebrospinal Fluid Leaks ◽  
Csf Leaks

The objective of this review is to provide an overview on the diagnosis and management of traumatic cerebrospinal fluid (CSF) leaks. This comprehensive review explores controversies associated with the management of CSF leaks as well as a review of the most contemporary literature. The scope of this article covers both traumatic CSF leaks of the middle and anterior cranial fossae.

Significance of Empty Sella in Cerebrospinal Fluid Leaks

2003 ◽  
Vol 128 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Rodney J. Schlosser ◽  
William E. Bolger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Sella Turcica ◽  
Radiographic Finding ◽  
Empty Sella ◽  
Senior Author ◽  
Csf Leak ◽  
Benign Intracranial Hypertension ◽  
Cerebrospinal Fluid Leaks ◽  
Csf Leaks

OBJECTIVE: The role of elevated cerebrospinal fluid (CSF) pressures in the pathophysiology of various CSF leaks is not clear. Empty sella syndrome (ESS) is a radiographic finding that can be associated with elevated CSF pressures and may represent a radiographic indicator of intracranial hypertension. We present our experience with CSF leaks of various causes, the prevalence of ESS in the spontaneous and nonspontaneous categories, and the potential pathophysiology and unique management issues of the spontaneous CSF leak group. METHODS: We conducted a retrospective review of medical records, imaging studies, and surgical treatment of CSF leaks in patients treated by the senior author. RESULTS: Sixteen patients with spontaneous CSF leaks and 12 patients with nonspontaneous CSF leaks were surgically treated from 1996 through 2002. In the spontaneous group, 15 patients had complete imaging of the sella turcica. Ten had completely empty sellae and 5 had partially empty sellae, for a total of 100% (15 of 15). In the nonspontaneous group, 9 patients had complete imaging of the sella. Only 11% (1 of 9) had a partially empty sella and that was a congenital leak. Comparison of proportions between these 2 groups was significant ( P = 0.01). The spontaneous group consisted primarily of obese, middle-aged females (13 of 16 patients). CONCLUSION: Empty sella probably represents a sign of elevated intracranial pressure that leads to idiopathic, spontaneous CSF leaks. Spontaneous CSF leaks are strongly associated with the radiographic finding of an empty sella and are more common in obese females, similar to benign intracranial hypertension. This unique population may require more aggressive surgical and medical treatment to prevent recurrent or multiple leaks.

A physiological sealant for cerebrospinal fluid leaks

1977 ◽  
Vol 46 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Gerald D. Silverberg ◽  
Christina B. Harbury ◽  
Edward Rubenstein
Keyword(s):  
Cerebrospinal Fluid ◽  
Histological Examination ◽  
Content Type ◽  
Cerebrospinal Fluid Leaks ◽  
The Brain ◽  
Fine Print ◽  
Csf Leaks

✓ A combination of concentrated platelets, thrombin, and fibrinogen was used to adhere a pericranial graft to surgically produced cerebrospinal fluid (CSF) fistulas in dogs. This sealant successfully stopped leakage of CSF in all fistulas produced in both acute and chronic preparations. All control animals leaked CSF acutely. In chronic control animals the CSF leaks sealed spontaneously but the grafts were not well incorporated. Histological examination of the grafts and underlying brain showed no injury to the brain or meningeal vessel from exposure to the platelet glue. Good fibrous union of the grafts to the dura was confirmed.

Radionuclide cisternography in the diagnosis and management of cerebrospinal fluid leaks: the test of choice

1987 ◽  
Vol 146 (2) ◽  
pp. 82-84 ◽  
Author(s):  
Barry M. Flynn ◽  
S. Patrick Butler ◽  
Richard J. Quinn ◽  
Andrew F. McLaughlin ◽  
George J. Bautovich ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Diagnosis And Management ◽  
Radionuclide Cisternography ◽  
Cerebrospinal Fluid Leaks

scholarly journals A Modified Footplate for the Kerrison Rongeur

2010 ◽  
Vol 4 (1) ◽  
Author(s):  
Alim P. Mitha ◽  
Mohamed S. Ahmad ◽  
Sarah J. Cohen ◽  
Janet S. Lieberman ◽  
Martin R. Udengaard ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Soft Tissue ◽  
Spinal Surgery ◽  
Significant Issue ◽  
Bone Removal ◽  
Cutting Surface ◽  
Cerebrospinal Fluid Leaks ◽  
Dural Tears ◽  
Csf Leaks ◽  
Tissue Compression

Use of the Kerrison rongeur for bone removal in spinal surgery is associated with dural tears and cerebrospinal fluid (CSF) leaks. We report a modification of the Kerrison rongeur footplate designed to reduce the risk of dural tears. A novel footplate was designed by incorporating the following parameters: (1) tapering the footplate to deflect soft tissue downward during positioning of the rongeur underneath the bone, and (2) making the footplate longer and wider than the cutting element to prevent soft tissue from entering into the cutting surface. Stereolithography models of the modified footplate were made and tested in a cadaver. A stainless steel modified footplate was then incorporated into an existing Kerrison rongeur as a working prototype, and tested in 20 laminectomy cases to clinically validate its design. The modified footplate prevented soft tissue from entering the cutting surface of the Kerrison rongeur in the manner intended by its design. No dural tears or CSF leaks were encountered in any instance. Potential soft tissue compression caused by an increase in footplate dimensions was not a significant issue in the rongeur size tested. This modification, however, might not be practical in rongeurs larger than 3 mm. The risk of dural tears and cerebrospinal fluid leaks in spinal surgery may be reduced by this footplate modification of the Kerrison rongeur. Soft tissue compression may limit the incorporation of this modification to rongeurs of 3 mm or smaller. The promising results warrant further tests with a wider range of sizes.

Cerebrospinal Fluid Leaks and Encephaloceles of Temporal Bone Origin: Nuances to Diagnosis and Management

2015 ◽  
Vol 83 (4) ◽  
pp. 560-566 ◽  
Author(s):  
Dhruve S. Jeevan ◽  
D. Ryan Ormond ◽  
Ana H. Kim ◽  
Lawrence Z. Meiteles ◽  
Katrina R. Stidham ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Diagnosis And Management ◽  
Cerebrospinal Fluid Leaks

scholarly journals Case Report: An Intracranial Complication of COVID-19 Nasopharyngeal Swab

2021 ◽  
Vol 5 (3) ◽  
pp. 341-344
Author(s):  
Alexandria Holmes ◽  
Bryant Allen
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Acute Onset ◽  
Csf Leak ◽  
Nasopharyngeal Swab ◽  
Unique Case ◽  
Cerebrospinal Fluid Leaks ◽  
Streptococcal Meningitis ◽  
Persistent Headache ◽  
Csf Leaks

Introduction: Cerebrospinal fluid (CSF) leaks are often the result of trauma or recent surgical procedures; however, a subset can develop from non-traumatic etiologies. Cerebrospinal fluid leaks from congenital and spontaneous encephaloceles can be clinically occult and have devastating consequences if undetected for prolonged periods of time. This report highlights a unique case of meningitis after CSF leak caused by ruptured congenital meningocele during a routine nasopharyngeal swab.  Case Report: A 54-year-old female with diagnosed CSF leak presented to the emergency department (ED) with acute onset of severe headache, and neck and back pain. Prior to this presentation, the patient had experienced two months of persistent headache and rhinorrhea since her coronavirus disease 2019 (COVID-19) nasopharyngeal swab. As part of her outpatient workup, an otolaryngology consultation with subsequent beta-2 transferrin testing and magnetic resonance imaging was performed and she was diagnosed with a CSF leak from ruptured congenital meningocele. On ED presentation, she was afebrile, but with mild tachycardia, leukocytosis, and meningismus. Lumbar puncture revealed acute streptococcal meningitis. This patient’s meningitis developed due to prolonged occult CSF leak after her COVID-19 nasopharyngeal swab ruptured a pre-existing congenital meningocele.  Conclusion: Nasopharyngeal swabs are being performed much more frequently due to the COVID-19 pandemic. All front-line providers should be aware of the potential presence and rupture of congenital meningoceles in patients who have undergone recent nasopharyngeal swab when risk-stratifying for potential CSF leak and meningitis.

scholarly journals Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

2017 ◽  
Vol 7 (27) ◽  
pp. 143-151
Author(s):  
Elena Patrascu ◽  
Claudiu Manea ◽  
Codrut Sarafoleanu
Keyword(s):  
Cerebrospinal Fluid ◽  
Treatment Options ◽  
Bed Rest ◽  
Future Trend ◽  
Csf Leak ◽  
High Resolution Computed Tomography ◽  
Intracranial Complications ◽  
Cerebrospinal Fluid Leaks ◽  
Dural Lesion ◽  
Csf Leaks

Abstract A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the skull base and it is usually characterized by discharge of cerebrospinal fluid from the nose. Cerebrospinal fluid leaks may have many etiologies, the most common being trauma. The most common site of dural lesion is the cribriform plate of the ethmoid. Diagnosis can be achieved by a multitude of techniques, high-resolution computed tomography being the modality of choice and it may be completed with magnetic resonance imaging or cisternography. Treatment may be either conservative, either surgical, related to the cause, the site and the duration of CSF leak. Conservative treatment usually includes strict bed rest, elevated bed head and no straining, nose blowing or stretching, with resolution of the majority of traumatic CSF leaks in seven days. Surgical treatment consists of a variety of approaches (intracranial/extracranial, open/endoscopic). The future trend is represented by minimally invasive endoscopic approaches, with a success rate of almost 90%; however, open transcranial or extracranial interventions still have indications in the surgical management. CSF leaks must be correctly diagnosed and treated, because the risk of intracranial complications increases 10-fold when the leakage persists.

Treatment of Cerebrospinal Fluid Leaks and Gram-negative Bacillary Meningitis with Large Doses of Intrathecal Amikacin and Systemic Antibiotics

Neurosurgery ◽  
1986 ◽  
Vol 18 (4) ◽  
pp. 402-406 ◽  
Author(s):  
Verne E. Gilbert ◽  
Joe D. Beals ◽  
Stephen E. Natelson ◽  
William A. Tyler
Keyword(s):  
Cerebrospinal Fluid ◽  
Back Pain ◽  
Side Effects ◽  
Bactericidal Activity ◽  
Low Dose ◽  
Intrathecal Injection ◽  
Gram Negative ◽  
Cerebrospinal Fluid Leaks ◽  
Systemic Antibiotics ◽  
Csf Leaks

Abstract Six patients with cerebrospinal fluid (CSF) leaks and gram-negative bacillary meningitis (GNBM) were treated with large does of intrathecal amikacin (20 to 40 mg daily) and systemic antibiotics, Bactericidal activity was measured in the CSF of each patient, and the dose of intrathecal amikacin was increased if bactericidal activity was absent. Five of six patients had no bactericidal activity with systemic antibiotics alone and/or low dose intrathecal amikacin. All six patients were cured, and three of four patients with vertebral lesions had cessation of CSF leaks within 72 hours of the start of intrathecal amikacin. Intrathecal treatment for 7 to 10 days was adequate for five patients; the CSF of all patients was sterile within 72 hours, and all had a 90% reduction of pleocytosis in the CSF within 96 hours. One patient had radicular back pain after each intrathecal injection, but other side effects were not observed. These findings indicate that CSF leaks associated with GNBM can be effectively treated with large doses of intrathecal amikacin plus systemic antibiotics.

scholarly journals Sandwich wound closure reduces the risk of cerebrospinal fluid leaks in posterior fossa surgery

2016 ◽  
Vol 6 (2) ◽  
Author(s):  
Verena Heymanns ◽  
Abidemi W. Oseni ◽  
Ameer Alyeldien ◽  
Homajoun Maslehaty ◽  
Richard Parvin ◽  
...  
Keyword(s):  
New York ◽  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Wound Closure ◽  
Posterior Fossa Surgery ◽  
Dural Closure ◽  
Csf Leakage ◽  
Cerebrospinal Fluid Leaks ◽  
Closure Method ◽  
Csf Leaks

Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

Complications of Hydroxyapatite Use for Transnasal Closure of Cerebrospinal Fluid Leaks

2002 ◽  
Vol 16 (6) ◽  
pp. 337-341 ◽  
Author(s):  
James A. Stankiewicz ◽  
Abhay M. Vaidya ◽  
James M. Chow ◽  
Guy Petruzzelli
Keyword(s):  
Cerebrospinal Fluid ◽  
Paranasal Sinuses ◽  
Revision Surgery ◽  
Sphenoid Sinus ◽  
Nasal Sinus ◽  
Bone Replacement ◽  
Cerebrospinal Fluid Leaks ◽  
Hydroxyapatite Cement ◽  
Adequate Tissue ◽  
Csf Leaks

Background Hydroxyapatite cement (HAC) was first introduced in the 1980s as a new method for bone replacement. However, it has not been recommended for use in areas exposed to air. Despite this, surgeries have been performed using HAC to close nasal/sinus cerebrospinal fluid (CSF) leaks or in the treatment of encephaloceles. Methods This study retrospectively documented four patients in whom HAC was used for closure of ethmoid and sphenoid sinus CSF leaks. Results This study showed that exposed hydroxyapatite could be extremely problematic resulting in scarring, chronic granulation, infection, and prolonged healing. Oftentimes, revision surgery was necessary to help control the reaction to hydroxyapatite. Conclusion Because of the frequent complications occurring with use of hydroxyapatite in the paranasal sinuses, its use should be limited to selected individuals in whom difficulty in achieving closure of the CFS leak could be anticipated and in whom adequate tissue coverage could be provided.

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