Evaluation of Endoscopic Transnasal versus Non-endoscopic Routes as Surgical Treatment of Cerebrospinal Fluid Rhinorrhea

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Ashraf Mohamed Farrag ◽  
Talaat Ali Hassan El Samnni ◽  
Tamer Abdul Wahab El Sabri Abou El Ezz ◽  
Mohamed Naguib Mohamed El Sayed
Keyword(s):  
Cerebrospinal Fluid ◽  
Meta Analysis ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage ◽  
Fluid Leak ◽  
The Brain ◽  
Better Than

Abstract Introduction Cerebrospinal fluid (CSF) leak happens when there is an abnormal connection between the brain cavity inside and environment outside. It is important to establish a good barrier between the brain tissue and the nose to prevent cerebrospinal fluid leak and protect the brain from exposure to infection. which can be done either by endoscopic or non-endoscopic surgical repair. Patients and methods The aim of this work is to evaluate the effectiveness of endoscopic and non-endoscopic repair of CSF leakage in patients suffering from CSF rhinorrhea. The search retrieved 1693 unique records. We then retained 89 potentially eligible records for full-texts screening. Finally, 11 studies (Total No. of patients = 355) were included in the present systematic review and meta-analysis. Results CSF rhinorrhea resolved in endoscopic surgery group giving a success rate of 88.8%to 100%. recurrence rate is 2% to 12.2% and postoperative complications occurred in 5% to 16.7%. Conclusion The endoscopic approach is highly effective, better than non-endoscopic route and is associated with low morbidity for the management of CSF rhinorrhea .

The Use of Methylene Blue Staining Test in Determining the CSF Leaks Location of the Anterior Skull Base

2018 ◽  
Vol 69 (6) ◽  
pp. 1376-1377
Author(s):  
Razvan Hainarosie ◽  
Teodora Ghindea ◽  
Irina Gabriela Ionita ◽  
Mura Hainarosie ◽  
Cristian Dragos Stefanescu ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Cerebrospinal Fluid ◽  
Intrathecal Injection ◽  
Diagnostic Procedures ◽  
Blue Staining ◽  
Csf Leak ◽  
Glucose Content ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage

Cerebrospinal fluid rhinorrhea represents drainage of cerebrospinal fluid into the nasal cavity. The first steps in diagnosing CSF rhinorrhea are a thorough history and physical examination of the patient. Other diagnostic procedures are the double ring sign, glucose content of the nasal fluid, Beta-trace protein test or beta 2-transferrin. To establish the exact location of the defect imagistic examinations are necessary. However, the gold standard CSF leakage diagnostic method is an intrathecal injection of fluorescein with the endoscopic identification of the defect. In this paper we analyze a staining test, using Methylene Blue solution, to identify the CSF leak�s location.

scholarly journals Iatrogenic cerebrospinal fluid leak after repeated nasal swab tests for COVID-19: illustrative case

2021 ◽  
Vol 2 (17) ◽  
Author(s):  
Johnson Ku ◽  
Chieh-Yi Chen ◽  
Jason Ku ◽  
Hsuan-Kan Chang ◽  
Jau-Ching Wu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Nasal Cavity ◽  
Nasal Swab ◽  
Cerebrospinal Fluid Leak ◽  
Cribriform Plate ◽  
Csf Leak ◽  
Illustrative Case ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Csf Leakage

BACKGROUND Nasal swab tests are one of the most essential tools for screening coronavirus disease 2019 (COVID-19). The authors report a rare case of iatrogenic cerebrospinal fluid (CSF) leak from the anterior skull base after repeated nasal swab tests for COVID-19, which was treated with endoscopic endonasal repair. OBSERVATIONS A 41-year-old man presented with clear continuous rhinorrhea through his left nostril for 5 days after repeated nasal swabbing for COVID-19. There were no obvious risk factors for spontaneous CSF leak. Computed tomography cisternography showed contrast accumulation in the left olfactory fossa and along the left nasal cavity. Such findings aligned with a preliminary diagnosis of CSF leakage through the left cribriform plate. Magnetic resonance imaging confirmed the presence of a CSF fistula between his left cribriform plate and superior nasal concha. The patient underwent endoscopic endonasal repair. CSF rhinorrhea ceased after the surgery, and no recurrence was noted during the 12-week postoperative follow-up period. LESSONS Although rare, iatrogenic CSF leakage can be a serious complication following COVID-19 nasal swab tests, especially when infection may cause significant neurological sequelae. Healthcare providers should become familiar with nasal cavity anatomy and be well trained in performing nasal swab tests.

scholarly journals A Case of Petrous Apex Meningocele: Unusual Presentation of Cerebrospinal Fluid Leak Following Adenoidectomy

2020 ◽  
Vol 27 (2) ◽  
pp. 135-139
Author(s):  
Byung Kil Kim ◽  
Yujin Heo ◽  
Doo-Sik Kong ◽  
Sang Duk Hong
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Petrous Apex ◽  
Diagnostic Process ◽  
Recurrent Meningitis ◽  
Csf Rhinorrhea ◽  
Leakage Site ◽  
Fluid Leak

Cerebrospinal fluid (CSF) leak is possible and can be a cause of recurrent bacterial meningitis. Petrous apex meningocele (PAM) is mostly asymptomatic and is often found during incidental imaging tests. We experienced a case of CSF rhinorrhea with recurrent meningitis in bilateral PAM after adenoidectomy. This report highlights the diagnostic process of CSF leak, identification of leakage site, and surgical approach to petrous apex lesions.

Prevention of Cerebrospinal Fluid Rhinorrhea After Transsphenoidal Surgery by Collagen Fleece Coated With Fibrin Sealant Without Autologous Tissue Graft or Postoperative Lumbar Drainage

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons130-ons137 ◽  
Author(s):  
Jin Mo Cho ◽  
Jung Yong Ahn ◽  
Jong Hee Chang ◽  
Sun Ho Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Fibrin Sealant ◽  
Transsphenoidal Surgery ◽  
Csf Leak ◽  
Autologous Tissue ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Tissue Graft ◽  
Csf Leakage ◽  
Sellar Floor

Abstract BACKGROUND: Autologous tissue grafting and postoperative lumbar cerebrospinal fluid (CSF) drainage (PLD) have been used to prevent CSF rhinorrhea after transsphenoidal surgery. OBJECTIVE: To describe the technical details and efficacy of our techniques of using collagen fleece coated with fibrin sealant (TachoComb, Nycomed, Linz, Austria) instead of an autologous tissue graft and refraining from the use of PLD. METHODS: We retrospectively reviewed 307 consecutive patients who underwent a transsphenoidal surgery for pituitary adenoma from November 2005 to February 2008. Among them, 90 cases of intraoperative CSF leaks were repaired with TachoComb without an autologous tissue graft or PLD. The repair procedures were tailored according to CSF leakage type, and we used only Bioglue (Cryolife Inc, Atlanta, Georgia) for sellar floor reconstruction. RESULTS: The overall rate of CSF rhinorrhea was 2.2% (2 of 90 cases). The 2 cases of CSF rhinorrhea resulted from large arachnoid defects, and there were no adverse effects from TachoComb such as transmission of viral disease or infection. CONCLUSION: Our technique is an alternative method to the traditional autologous tissue graft technique. PLD is not an essential procedure for the prevention of CSF rhinorrhea if the intraoperative CSF leak is completely sealed off during the transsphenoidal surgery. However, in cases of large arachnoid defects, aggressive repair of the arachnoid defect and sellar floor reconstruction with bone or bony substitutes should be considered in conjunction with our methods.

scholarly journals Idiopathic Cerebrospinal Fluid Oculorrhea: An Unusual Case Report

2016 ◽  
Vol 9 (2) ◽  
pp. 87-89
Author(s):  
Arvind Soni ◽  
Anchal Duggal
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Case Report ◽  
Unusual Case ◽  
Csf Leak ◽  
Csf Rhinorrhea ◽  
Csf Leakage ◽  
Brain And Spinal Cord ◽  
The Brain ◽  
Unusual Case Report

ABSTRACT A cerebrospinal fluid (CSF) leak is an escape of the fluid that surrounds the brain and spinal cord. Any tear or hole in the membrane that surrounds the brain and spinal cord (dura) can allow the fluid that surrounds those organs to leak. Most commonly, the leak is known to occur from the nose (CSF rhinorrhea) or through the ears (CSF otorrhea). Also, etiology is posttraumatic in majority. However, idiopathic CSF leakage from the eyes is extremely uncommon. How to cite this article Soni A, Duggal A. Idiopathic Cerebrospinal Fluid Oculorrhea: An Unusual Case Report. Clin Rhinol An Int J 2016;9(2):87-89.

scholarly journals Postoperative Cerebrospinal Fluid Leak after Septoplasty: A Potential Complication of Occult Anterior Skull Base Encephalocele

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0043 ◽  
Author(s):  
Resha S. Soni ◽  
Osamah J. Choudhry ◽  
James K. Liu ◽  
Jean Anderson Eloy
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Skull Base ◽  
Intracranial Abscess ◽  
Ethmoid Bone ◽  
Csf Rhinorrhea ◽  
Csf Leakage ◽  
Skull Base Defect ◽  
Fluid Leak

Postoperative cerebrospinal fluid (CSF) rhinorrhea after septoplasty is a known entity resulting from errors in surgical technique and improper handling of the perpendicular plate of the ethmoid bone. When these occur, urgent management is necessary to prevent deleterious sequelae such as meningitis, intracranial abscess, and pneumocephalus. Encephaloceles are rare occurrences characterized by herniation of intracranial contents through a skull base defect that can predispose patients to CSF rhinorrhea. In this report, we present a case of CSF rhinorrhea occurring 2 weeks after septoplasty likely from manipulation of an occult anterior skull base encephalocele. To our knowledge, no previous similar case has been reported in the literature. Otolaryngologists should be aware of the possibility of occult encephaloceles while performing septoplasties because minimal manipulation of these entities may potentially result in postoperative CSF leakage.

scholarly journals Non-Traumatic Cerebrospinal Fluid Leak from a Sphenoid Sinus Midline Roof Defect Previously Managed as Allergic Rhinitis

2019 ◽  
Vol 34 (1) ◽  
pp. 48-51
Author(s):  
Jan Paul D. Formalejo ◽  
Jay Pee M. Amable
Keyword(s):  
Allergic Rhinitis ◽  
Cerebrospinal Fluid ◽  
Sphenoid Sinus ◽  
Cerebrospinal Fluid Leak ◽  
University Hospital ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Postnasal Drip ◽  
Life Threatening ◽  
Fluid Leak

Objective: To present a case of a non-traumatic cerebrospinal fluid (CSF) rhinorrhea from a midline sphenoid sinus roof that presented as a persistent postnasal drip and was previously managed as allergic rhinitis for 43 years.   Methods:             Design:           Case Report             Setting:           Tertiary Private University Hospital             Participants:   One   Results: A 58-year-old obese and hypertensive man presented with persistent post nasal drip and intermittent clear watery rhinorrhea. He had been managed as a case of allergic rhinitis for 43 years and was maintained on nasal steroid sprays without relief. Nasal endoscopy revealed pulsating clear watery discharge from the sphenoid ostium. On trans-sphenoidal surgery, a midline sphenoid sinus roof defect was sealed using a Hadad-Bassagasteguy flap.   Conclusion: CSF rhinorrhea is uncommon and may mimic more common diseases such as allergic rhinitis. Because misdiagnosis can then lead to life threatening complications, physicians should be vigilant when seeing patients with clear watery rhinorrhea to be able to arrive at a proper diagnosis and provide prompt treatment.   Keywords: cerebrospinal fluid rhinorrhea; cerebrospinal fluid leak; sphenoid sinus midline roof defect

scholarly journals Cerebrospinal fluid leakage after cranial surgery in the pediatric population—a systematic review and meta-analysis

2021 ◽  
Author(s):  
Emma M. H. Slot ◽  
Kirsten M. van Baarsen ◽  
Eelco W. Hoving ◽  
Nicolaas P. A. Zuithoff ◽  
Tristan P. C van Doormaal
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Pediatric Population ◽  
Meta Analysis ◽  
Leakage Rate ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Cranial Surgery ◽  
Csf Leakage

Abstract Background Cerebrospinal fluid (CSF) leakage is a common complication after neurosurgical intervention. It is associated with substantial morbidity and increased healthcare costs. The current systematic review and meta-analysis aim to quantify the incidence of cerebrospinal fluid leakage in the pediatric population and identify its risk factors. Methods The authors followed the PRISMA guidelines. The Embase, PubMed, and Cochrane database were searched for studies reporting CSF leakage after intradural cranial surgery in patients up to 18 years old. Meta-analysis of incidences was performed using a generalized linear mixed model. Results Twenty-six articles were included in this systematic review. Data were retrieved of 2929 patients who underwent a total of 3034 intradural cranial surgeries. Surprisingly, only four of the included articles reported their definition of CSF leakage. The overall CSF leakage rate was 4.4% (95% CI 2.6 to 7.3%). The odds of CSF leakage were significantly greater for craniectomy as opposed to craniotomy (OR 4.7, 95% CI 1.7 to 13.4) and infratentorial as opposed to supratentorial surgery (OR 5.9, 95% CI 1.7 to 20.6). The odds of CSF leakage were significantly lower for duraplasty use versus no duraplasty (OR 0.41 95% CI 0.2 to 0.9). Conclusion The overall CSF leakage rate after intradural cranial surgery in the pediatric population is 4.4%. Risk factors are craniectomy and infratentorial surgery. Duraplasty use is negatively associated with CSF leak. We suggest defining a CSF leak as “leakage of CSF through the skin,” as an unambiguous definition is fundamental for future research.

Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: Learning from Our Failures

2001 ◽  
Vol 15 (5) ◽  
pp. 333-342 ◽  
Author(s):  
Paolo Castelnuovo ◽  
Silvia Mauri ◽  
Davide Locatelli ◽  
Enzo Emanuelli ◽  
Giovanni Delù ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Csf Leak ◽  
Graft Material ◽  
Literature Analysis ◽  
Endoscopic Repair ◽  
Common Procedure ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea

Endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea is becoming a common procedure. The purpose of this study was to perform a literature analysis centering cases of treatment failure and to review our 31 cases with a 1-year minimum follow-up. An extensive search of the literature was conducted, which focused on success rate, follow-up, diagnostic techniques, graft material used, failure rate, and comments on failures. A retrospective analysis of our 31 patients was carried out, and all cases were treated with the endoscopic approach with a 1-year minimum follow-up. From the literature analysis, the median success rate at the first endoscopic attempt is 90%. Our success rate was 87.1%. Failures were analyzed. A unique protocol for CSF leak diagnosis does not exist; we suggest our diagnostic algorithm. Graft material used depends on the authors’ experience, and based on this review of cases to date, did not significantly influence the success rate. The analysis of cases of failure shows that the majority of authors omit details. More research is needed to improve prevention of failures.

Sternberg's Canal and Defect: Is the Lateral Craniopharyngeal Canal a Source of Spontaneous Cerebrospinal Fluid Leak? Anatomic and Radiological Analysis in Pediatric and Adult Populations

2021 ◽  
Author(s):  
Adedamola Adepoju ◽  
Lucas P Carlstrom ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Carlos Diogenes Pinheiro-Neto ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Adult Population ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Superior Orbital Fissure ◽  
Old Patients ◽  
Visual Illustration ◽  
Craniopharyngeal Canal ◽  
High Incidence ◽  
Fluid Leak

Abstract BACKGROUND The lateral craniopharyngeal or Sternberg's canal (SC) originates from superior orbital fissure (SOF) and traverses the sphenoid body into the nasopharynx. A remnant of the canal, Sternberg's defect (SD), has been debated as a source of cerebrospinal fluid (CSF) leak. The canal was described in 1888, and there is limited accurate visual illustration in the literature. OBJECTIVE To provide a detailed anatomic and radiological illustration of the canal in pediatric and adult population including the mechanism undermining the incidence of the canal, and the possibility of the canal as a source of CSF leak. METHODS A total of 195 high-resolution computed tomographies (CT) of patients (50 3-yr-old, 20 5-yr-old, and 125 adults) and 43 dry adult skulls (86 sides) were analyzed for a canal matching the description of the SC. RESULTS A SC was identified in 86% of the 3-yr-old and 40% of 5-yr–old patients. The diameter and length were 2.12 mm and 12 mm, respectively. The incidence of the canal decreased with age as sinus pneumatization extended into the sphenoid sinus. Only 0.8% of the adult skull on CT had the canal. The canal was not present on the dry adult skulls examination, but SD was found in 4.65%. CONCLUSION SC exists with high incidence in the pediatric group. Sinus pneumatization obliterates the canal in the adult population, leaving a defect in 4.65% of cases, which given the location and related anatomic structures, is unlikely to be a source of CSF leak.

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