scholarly journals Recurrent spontaneous CSF rhinorrhea: combined endo-nasal endoscopic repair with lumbo-peritoneal shunt insertion

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Ahmed Y. Soliman ◽  
Kamal Ebeid ◽  
Amr Abu Elfadle
Keyword(s):  
Sleep Apnea Syndrome ◽  
Csf Shunt ◽  
High Morbidity ◽  
Recurrence Rates ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Shunt Procedure ◽  
The Mean ◽  
The Impact ◽  
Csf Leaks

Abstract Background Spontaneous cerebrospinal fluid (CSF) leaks are associated with high morbidity and recurrence rates. Most cases had increased intracranial pressure (ICP) on presentation. There is still controversy regarding the use of lumbo-peritoneal shunt to prevent its recurrence. Aim This study was conducted to evaluate the impact of lumbo-peritoneal CSF shunt following the initial as well as recurrent repair of spontaneous CSF leaks to avoid recurrence. Methods A retrospective cohort study reviewed patients with recurrent spontaneous CSF leaks over a 4-year period. All patients had increased ICP and were subjected to endoscopic repair and lumbo-peritoneal shunt procedure. Results Eighteen patients were included in this study. Most patients were obese (BMI = 33.6 ± 1.8 kg/m2) women (88.9%), with sleep apnea syndrome (77.8%). All patients presented with headache and visual complaints. Meningitis was recorded in two patients (11.1%). The most common sites of leakage were the cribriform (66.7%), followed by both cribriform and ethmoidal (16.7%), sphenoid (11.1%), and ethmoidal (5.6%) bones. The mean defect size was 5.1 ± 1.1 mm. About one third of cases had multiple defects. Encephalocele and meningocele were encountered in 61.1% and 66.7% of cases, respectively. The mean preoperative CSF pressure was 36.5 ± 1.7 mm H2O. Lumbo-peritoneal shunt was inserted for all our patients. The failure rate of repair was 11.1%. Conclusion Success rate is higher in patients with spontaneous CSF leaks and CSF hypertension treated by lumbo-peritoneal shunt. Future prospective studies with larger sample sizes should confirm the efficacy and safety of this management plan.

scholarly journals Racial and socioeconomic disparities in outcomes following pediatric cerebrospinal fluid shunt procedures

2015 ◽  
Vol 15 (6) ◽  
pp. 560-566 ◽  
Author(s):  
Frank J. Attenello ◽  
Alvin Ng ◽  
Timothy Wen ◽  
Steven Y. Cen ◽  
Nerses Sanossian ◽  
...  
Keyword(s):  
Health Care ◽  
Socioeconomic Status ◽  
Population Level ◽  
Socioeconomic Disparities ◽  
Csf Shunt ◽  
Health Care Outcomes ◽  
Shunt Procedure ◽  
Level Data ◽  
Csf Shunting ◽  
The Impact

OBJECT Racial and socioeconomic disparities within the US health care system are a growing concern. Despite extensive research and efforts to narrow such disparities, minorities and economically disadvantaged patients continue to exhibit inferior health care outcomes. Disparities in the delivery of pediatric neurosurgical care are understudied. Authors of this study examine the impact of race and socioeconomic status on outcomes following pediatric CSF shunting procedures. METHODS Discharge information from the 2000, 2003, 2006, and 2009 Kids' Inpatient Database for individuals (age < 21 years) with a diagnosis of hydrocephalus who had undergone CSF shunting procedures was abstracted for analysis. Multivariate logistic regression analyses, adjusting for patient and hospital factors and annual CSF shunt procedure volume, were performed to evaluate the effects of race and payer status on the likelihood of inpatient mortality and nonroutine hospital discharge (that is, not to home). RESULTS African American patients (p < 0.05) had an increased likelihood of inpatient death and nonroutine discharge compared with white patients. Furthermore, Medicaid patients had a significantly higher likelihood of nonroutine discharge (p < 0.05) as compared with privately insured patients. CONCLUSIONS Findings in this study, which utilized US population-level data, suggest the presence of racial and socioeconomic status outcome disparities following pediatric CSF shunting procedures. Further studies on health disparities in this population are warranted.

scholarly journals Study of the Effects of Sleep Apnea Syndrome on the Paraclinical Parameters of Balance Exploration

2021 ◽  
Vol 2 (10) ◽  
pp. 915-919
Author(s):  
David Cabello Garrido ◽  
Guillaume Buiret
Keyword(s):  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Primary Objective ◽  
The Other ◽  
Ocular Reflex ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Vestibulo Ocular Reflex ◽  
The Mean ◽  
The Impact

Aim: To evaluate the impact of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) on posturographic parameters. Objective: The primary objective was to evaluate whether the mean gain of the Visually Vestibulo-Ocular Reflex VVOR), the parameter most likely to be modified in case of central damage, decreased in patients diagnosed with OSAHS. The secondary objective was to verify if the other parameters of videonystagmography and posturography varied according to the presence or not of OSAHS. Materials and Methods: Retrospective analysis of posturographic parameters of patients previously tested by polygraphy (whether or not they had OSAHS). Results: In the 66 patients included, the mean VVOR gains did not differ significantly between the "no OSAHS" vs. "OSAHS" groups (respectively 0.88 vs. 0.71, p = 0.1224). None of the other parameters measured, such as the mean caloric deficits, the mean weights of vestibular, visual and somesthetic afferents measured by posturography, the mean gains of the vestibulo-ocular reflex, and the frequency of falls on the posturograph, had a statistically different distribution according to the presence or absence of OSAHS. Conclusion: We did not show any significant difference in posturographic parameters according to the presence or absence of OSAHS, in particular the absence of vestibular and/or central involvement.

P78 CRITICAL APPRAISAL OF THE IMPACT OF SURGICAL REPAIR OF TYPE II - IV PARAOESOPHAGEAL HERNIA ON PULMONARY IMPROVEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
K Kamarajah Sivesh ◽  
Boyle Charlie ◽  
Madhavan Anantha ◽  
Navidi Maziar ◽  
W Phillips Alexander
Keyword(s):  
Systematic Review ◽  
Surgical Repair ◽  
Meta Analysis ◽  
High Morbidity ◽  
Type Ii ◽  
Recurrence Rates ◽  
Conversion Rates ◽  
Patient Reported ◽  
Paraoesophageal Hernia ◽  
The Impact

Abstract Aim This systematic review and meta-analysis aimed at characterising impact of PEH repair on patient reported improvement in pulmonary symptoms Background Paraoesophageal hernia (PEH) comprising Type II - IV hiatal hernia often present with pulmonary symptoms such as shortness of breath. However, impact of surgical repair on improvement in pulmonary symptoms is unclear Methods This systematic review identified studies reported pulmonary symptoms in patients with undergoing surgical repair for Type II - IV PEH. Primary outcome was improvement in pulmonary symptoms. Secondary outcomes were improvement in other patient-reported outcomes such as heartburn, regurgitation, chest pain, and dysphagia and intraoperative and postoperative outcomes. Results This systematic review identified 27 studies, of which 21 studies were included in final meta-analysis. There was significant improvement in patient reported pulmonary symptoms following PEH repair (OR: 8.40, CI95%: 4.91 - 14.35, p<0.001), with improvement in all types of PEH. This was noticed in both patients who had noticed pulmonary symptoms prior to surgery and those that did not complain of these symptoms. Conclusion PEH repair is a major upper gastrointestinal procedure, which may be associated with high morbidity. However, pulmonary impairment from PEH warrant surgical repair with acceptable low laparoscopic conversion rates, morbidity, mortality and recurrence rates.

Endoscopic Closure of CSF Rhinorrhea: 193 cases in 21 years

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P76-P76
Author(s):  
Caroline Amber Banks ◽  
David W Kennedy ◽  
James N Palmer ◽  
Alexander G Chiu ◽  
Bert W O'Malley ◽  
...  
Keyword(s):  
Success Rate ◽  
Large Series ◽  
Csf Leak ◽  
Graft Material ◽  
Recurrence Rates ◽  
Csf Rhinorrhea ◽  
Endoscopic Closure ◽  
History Of ◽  
Csf Leaks

Objective Over the past 2 decades, endoscopic repair of cerebrospinal fluid (CSF) leaks has become a routine treatment. The goal of this study is to describe endoscopic closure of a large series of traumatic and spontaneous CSF leaks over a 21-year period, focusing on perioperative management, surgical technique, and long-term outcomes. Methods Retrospective chart review of CSF leak patients treated by the senior author and at the Hospital of the University of Pennsylvania from 1987 to 2008. The data analyzed included BMI, etiology, defect location, graft material, presence of encephalocele, use of lumbar drain, history of meningitis, evidence of intracranial hypertension, recurrence rates, and follow-up. Results 193 cases were identified. Follow-up ranging from 1 month to 9 years (mean 20 months) was available on 166 patients. The etiology was spontaneous in 77 patients (40%), traumatic in 109 (56%), and congenital in 7 patients (4%). The average BMI of spontaneous CSF leak patients (35) was significantly greater (p<0.001) than both traumatic (30) and congenital patients (23). Defects were most commonly located in the sphenoid sinus (n = 62, 32%) and the ethmoid roof (n = 60, 31%). The initial success rate was 88% (n = 170) and the overall success rate was 98% (n = 190). 45 patients (23%) had a history of meningitis, and 4 patients (2%) developed meningitis after repair. Conclusions The overall success rate (98%) and low incidence of morbidity in this large series strongly support the endoscopic approach as standard of care for CSF leak closure.

Endoscopic repair of frontal sinus cerebrospinal fluid leaks

2005 ◽  
Vol 119 (9) ◽  
pp. 709-713 ◽  
Author(s):  
B A Woodworth ◽  
R J Schlosser ◽  
J N Palmer
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
Outflow Tract ◽  
Endoscopic Approach ◽  
Surgical Trauma ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Frontal Recess ◽  
Csf Leaks

Objective: To describe endoscopic management of frontal sinus cerebrospinal fluid (CSF) leaks.Study design: Retrospective.Methods: We reviewed all frontal sinus CSF leaks treated using an endoscopic approach at ourinstitutions from 1998 to 2003. CSF leaks originated immediately adjacent to or within the frontal recess or frontal sinus proper for inclusion in the study. Data collected included demographics, presenting signs and symptoms, site and size of skull-base defect, surgical approach, repair technique, and clinical follow up.Results: Seven frontal sinus CSF leaks in six patients were repaired endoscopically. Average age of presentation was 45 years (range 25–65 years). Aetiology was idiopathic (three), congenital (one), accidental trauma (one), and surgical trauma (two). All patients presented with CSF rhinorrhea; two patients presented with meningitis. Four defects originated in the frontal recess, while two others involved the posterior table and frontal sinus outflow tract. Four patients had associated encephaloceles. We performed endoscopic repair in all six patients withone patient requiring an adjuvant osteoplastic flap without obliteration. All repairs were successful at the first attempt with a mean follow up of 13 months. All frontal sinuses remained patent on both post-operative endoscopic and radiographic exam.Conclusions: Endoscopic repair of frontal sinus CSF leaks and encephaloceles can be an effective method if meticulous attention is directed toward preservation of the frontal sinus outflow tract, thus avoiding an osteoplastic flap and obliteration. The major limiting factor for an endoscopic approach is extreme extension superiorly or laterally within the posterior table beyond the reach of current instrumentation.

scholarly journals Transnasal Endoscopic Cerebrospinal Fluid Rhinorrhea Repair: Our Experience of 35 Cases

2014 ◽  
Vol 7 (2) ◽  
pp. 47-51 ◽  
Author(s):  
Mohnish Grover ◽  
Pawan Singhal ◽  
Shashank Nath Singh ◽  
Man Prakash Sharma ◽  
Avani Jain
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Endoscopic Techniques ◽  
The Past ◽  
Intracranial Complications ◽  
Csf Leaks

ABSTRACT Cerebrospinal fluid rhinorrhea results from a breakdown of barriers between the subarachnoid space and aerodigestive tract. Because of the risk of potential intracranial complications, all persistent cerebrospinal fluid (CSF) leaks should be repaired. Over the past few decades, with the advances in endoscopic techniques, the surgical management of CSF rhinorrhea has changed significantly. CSF leak repair has advanced from the conventional open intracranial approaches by neurosurgeons to the transnasal endoscopic ones by otorhinolaryngologists. In this study, 35 patients with CSF leaks underwent endoscopic repair with a 94.3% first attempt success rate, and 100% overall success rate. There were no major intraoperative or postoperative complications. To conclude, the endoscopic approach has a high success rate with minimal morbidity and has therefore, become the preferred method. How to cite this article Jain A, Singhal P, Sharma MP, Singh SN, Grover M. Transnasal Endoscopic Cerebrospinal Fluid Rhinorrhea Repair: Our Experience of 35 Cases. Clin Rhinol An Int J 2014;7(2):47-51.

scholarly journals Postoperative audiovestibular assessment of obstructive sleep apnea patients

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Hesham Saad Kouzo ◽  
Mohamed Aziz Mohamed Talaat ◽  
Ahmed Yassin Bahgat ◽  
Hazem Ahmed Mousa Zamel ◽  
Mirhan Khamis Eldeeb
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Spontaneous Nystagmus ◽  
Vestibular Evoked Myogenic Potential ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Brainstem Response ◽  
The Mean ◽  
The Impact

Abstract Background In obstructive sleep apnea syndrome, the impact of hypoxia on different body systems is of utmost importance. Brainstem is greatly sensitive to the effects of hypoxia including auditory and vestibular nuclei. Our aim in the current study is to evaluate hypoxic effect of OSAS on the audiovestibular system using auditory brainstem response, cervical vestibular evoked myogenic potential, and video nystagmography and to determine whether this effect is reversible postoperatively. Results In OSAS patients, the mean absolute and interpeak latencies of ABR were significantly prolonged compared to controls and remained so postoperatively. No statistically significant difference between pre- and postoperative values was found. The differences in the mean latencies of P1 and N1 of the cVEMP responses between the two groups were insignificant. However, there was a significant difference in P1N1 amplitude. On the other hand, the difference in the mean amplitude of the P1N1 wave in the study group postoperatively was not significant. The VNG results included bilateral canal paresis in four, unilateral in two, and spontaneous nystagmus in two patients. Also, two patients showed pursuit abnormality and two had saccadic abnormality which did not improve postoperatively. Conclusions Patients with moderate to severe OSAS experience both auditory and vestibular deficits which do not reverse 3 months after corrective surgery.

scholarly journals The Impact of a Hospital-Based Awareness Program on the Knowledge of Patients About Breast Cancer and Cancer Cervix

2019 ◽  
Vol 4 (1) ◽  
pp. 20
Author(s):  
Azza Mohamed Elsayed Atwa ◽  
Hanan Elzeblawy Hassan ◽  
Safaa Ibrahim Ahmed
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
University Hospital ◽  
High Morbidity ◽  
Cancer Cervix ◽  
Awareness Program ◽  
Different Populations ◽  
The Mean ◽  
The Impact ◽  
Interview Questionnaire

Background: Breast cancer and cancer cervix contribute to high morbidity and mortality rates among women worldwide. Appropriate knowledge of both cancers can help in early detection and management. Aim: This study aimed to assess the effect of a hospital-based awareness program on the knowledge of patients attending some outpatient clinics in Sohag University Hospital regarding the 2 cancers. Subjects and Methods: The program was held in Sohag University Hospital on 150 female patients during the period between August and October 2018. The knowledge of the patients about the risk factors, symptoms, screening, and management of both cancers was first assessed using an interview questionnaire. Then, the awareness program included 4 sessions and every session discussed only 1 aspect of knowledge regarding both cancers. Later, patients were assessed again using the same questionnaire and the improvement was determined. Results: The mean age of the participating patients was 29.6 ± 6.7 years, 74.7% could read and write, and 85.3% were married. Only education was associated with better knowledge about breast cancer (p = 0.002) and cancer cervix (p = 0.007). Thanks to the program, the percent of patients with optimal knowledge of breast cancer improved from 14.7% to 50% (p < 0.001). This percent distributed as follows; risk factors 10% to 50% (p < 0.001), manifestations 20% to 60% (p < 0.001), screening 4% to 7% (р < 0.001), and management 24.8% to 63% (p < 0.001). Regarding cancer cervix, the improvement was as follows; total knowledge 13.3% to 46.2% (p < 0.001), risk factors 8% to 50% (p < 0.001), manifestations 12.2% to 50% (р < 0.001), screening 15% to 40% (р < 0.001), and management 18.2% to 44.8% (р < 0.001). Conclusion and Recommendations: Patients had suboptimal knowledge about breast cancer and cancer cervix. However, the program achieved remarkable successes in improving the knowledge of patients. Future programs on a wider scale and different populations should be considered.

Efficacy of Perioperative Lumbar Drainage following Endonasal Endoscopic Cerebrospinal Fluid Leak Repair: A Meta-analysis

2016 ◽  
Vol 156 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Omar H. Ahmed ◽  
Sonya Marcus ◽  
Jenna R. Tauber ◽  
Binhuan Wang ◽  
Yixin Fang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Anterior Skull Base ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Lumbar Drainage ◽  
Csf Leaks

Objective Perioperative lumbar drain (LD) use in the setting of endoscopic cerebrospinal fluid (CSF) leak repair is a well-established practice. However, recent data suggest that LDs may not provide significant benefit and may thus confer unnecessary risk. To examine this, we conducted a meta-analysis to investigate the effect of LDs on postoperative CSF leak recurrence following endoscopic repair of CSF rhinorrhea. Data Sources A comprehensive search was performed with the following databases: Ovid MEDLINE (1947 to November 2015), EMBASE (1974 to November 2015), Cochrane Review, and PubMed (1990 to November 2015). Review Method A meta-analysis was performed according to PRISMA guidelines. Results A total of 1314 nonduplicate studies were identified in our search. Twelve articles comprising 508 cases met inclusion criteria. Overall, use of LDs was not associated with significantly lower postoperative CSF leak recurrence rates following endoscopic repair of CSF rhinorrhea (odds ratio: 0.89, 95% confidence interval: 0.40-1.95) as compared with cases performed without LDs. Subgroup analysis of only CSF leaks associated with anterior skull base resections (6 studies, 153 cases) also demonstrated that lumbar drainage did not significantly affect rates of successful repair (odds ratio: 2.67, 95% confidence interval: 0.64-11.10). Conclusions There is insufficient evidence to support that adjunctive lumbar drainage significantly reduces postoperative CSF leak recurrence in patients undergoing endoscopic CSF leak repair. Subgroup analysis examining only those patients whose CSF leaks were associated with anterior skull base resections demonstrated similar results. More level 1 and 2 studies are needed to further investigate the efficacy of LDs, particularly in the setting of patients at high risk for CSF leak recurrence.

Asteroid and Comet Impact Speeds upon Mars: Significance for Panspermia and the Supply of Organics

1997 ◽  
Vol 161 ◽  
pp. 197-201 ◽  
Author(s):  
Duncan Steel
Keyword(s):  
Probability Distributions ◽  
Regions Of Interest ◽  
Significant Fraction ◽  
Organic Chemicals ◽  
Impact Speed ◽  
The Mean ◽  
The Impact

AbstractWhilst lithopanspermia depends upon massive impacts occurring at a speed above some limit, the intact delivery of organic chemicals or other volatiles to a planet requires the impact speed to be below some other limit such that a significant fraction of that material escapes destruction. Thus the two opposite ends of the impact speed distributions are the regions of interest in the bioastronomical context, whereas much modelling work on impacts delivers, or makes use of, only the mean speed. Here the probability distributions of impact speeds upon Mars are calculated for (i) the orbital distribution of known asteroids; and (ii) the expected distribution of near-parabolic cometary orbits. It is found that cometary impacts are far more likely to eject rocks from Mars (over 99 percent of the cometary impacts are at speeds above 20 km/sec, but at most 5 percent of the asteroidal impacts); paradoxically, the objects impacting at speeds low enough to make organic/volatile survival possible (the asteroids) are those which are depleted in such species.

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