Cerebrospinal Fluid-Related Complications With Autologous Duraplasty and Arachnoid Sparing in Type I Chiari Malformation

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS156-ONS161 ◽  
Author(s):  
Caitlin E. Hoffman ◽  
Mark M. Souweidane
Keyword(s):  
Cerebrospinal Fluid ◽  
Retrospective Chart Review ◽  
Cerebrospinal Fluid Leak ◽  
Morbidity Rate ◽  
Type I ◽  
Symptomatic Disease ◽  
Aggressive Surgical Approach ◽  
The Mean ◽  
Postoperative Hydrocephalus ◽  
Fluid Leak

Abstract Objective: Although there is a current consensus that Type I Chiari malformations (CM-I) should be treated only in the setting of symptomatic disease, significant controversy surrounds the most appropriate surgical procedure. Recent enthusiasm for osseous decompression without duraplasty is supported by the purportedly lower morbidity of this approach. Precise rates of morbidity with duraplasty, however, have not been reported. This study is intended to assess the cerebrospinal fluid-related morbidity associated with a patient population treated uniformly with autologous duraplasty for symptomatic CM-I. Methods: A review of one surgeon's practice (MMS) from 1997 to 2007 identified patients treated for symptomatic CM-I with osseous decompression and autologous duraplasty. A retrospective chart review was then performed for these patients with an emphasis on cerebrospinal fluid-related complications. Results: Forty patients were treated for CM-I with decompression and autologous duraplasty. Twenty-four patients presented with a preoperative syrinx. The mean age was 13.3 years, and the median age was 12.9 years (range, 3.3–45.8 yr). The mean follow-up period was 11.4 months (range, 1–101 mo). There was no mortality associated with the procedure. Clinical response was observed in 91.8% of patients, with 70.2% experiencing complete symptomatic resolution and 21.6% experiencing partial improvement. Two patients (5.4%) had persistent symptomatic syringomyelia requiring syringosubarachnoid shunting. There was an overall morbidity rate of 2.5% due to one pseudomeningocele treated with a single percutaneous tap. There were no incidences of cerebrospinal fluid leak, meningitis, or postoperative hydrocephalus. Conclusion: The cerebrospinal fluid-related morbidity associated with autologous duraplasty for CM-I in a uniformly treated population is negligible. These results challenge the current rationale for a less aggressive surgical approach to CM-I.

scholarly journals Surgical Approach to Frontal and Ethmoid Sinus Osteomas: The Experience of 2 Metropolitan Italian Hospitals

2021 ◽  
pp. 014556132110168
Author(s):  
Antonio Minni ◽  
Luca Roncoroni ◽  
Fabrizio Cialente ◽  
Federica Zoccali ◽  
Andrea Colizza ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Approach ◽  
Cerebrospinal Fluid Leak ◽  
Ethmoid Sinus ◽  
Endoscopic Approach ◽  
Open Approach ◽  
The Mean ◽  
Ethmoid Sinuses ◽  
Fluid Leak

Objectives: The aim of this study was to report the surgical management experience of patients with osteomas of the frontal and ethmoid sinuses performed in 2 metropolitan Italian hospitals between 2012 and 2019. Methods: A retrospective chart review of cases of frontal and ethmoid osteomas from the Ca’ Granda Niguarda Hospital of Milan and the Policlinico Umberto I University Hospital of Rome was performed. All patients underwent preoperative computed tomography and, when orbital or intracranial extension was suspected, magnetic resonance imaging. Surgical treatment was performed according to Chiu classification. Results: A total of 38 cases of frontal and ethmoid sinus osteomas were included in the study; 22 patients were men and 16 were women. The mean age at diagnosis was 49 years. Seven (18.4%) patients were treated using an open approach; 3 (7.9%) patients underwent open and endoscopic approach; the remaining 28 (73.7%) patients were treated with endoscopic approach. Seven (18.4%) patients had a cerebrospinal fluid leak intraoperatively and were treated with the placement of tissue graft through the defect. The mean follow-up time was 18 months; no recurrence was observed at 12-month follow-up. Conclusion: Osteomas of the frontal and ethmoid sinuses can be treated using different techniques, mostly endoscopically. The choice of surgical approach (endoscopic vs open) depends on the location and size of the osteoma, anatomical size, characteristic of the sinus, surgeon’s experience, and available existing technical facilities. Cerebrospinal fluid leak is a possible complication of surgery.

scholarly journals Spontaneous cerebrospinal fluid leak from the optic canal

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774828
Author(s):  
Kyle Hannabass ◽  
Jeb M Justice
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Retrospective Chart Review ◽  
Cerebrospinal Fluid Leak ◽  
Optic Nerve Sheath ◽  
Anatomic Site ◽  
Endoscopic Closure ◽  
Nerve Sheath ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

Objective: To present a case of successful repair of a spontaneous cerebrospinal fluid leak in a previously unreported anatomic site. Methods: Retrospective chart review. Results: A 48-year-old woman developed a spontaneous cerebrospinal fluid leak from the optic nerve sheath and underwent a multilayer endoscopic closure with no damage to the optic nerve. Conclusion: Endoscopic surgeons can successfully repair cerebrospinal fluid leaks from the optic nerve sheath without causing loss of vision.

scholarly journals Postoperative Cerebrospinal Fluid Leak Rates with Subfascial Epidural Drain Placement after Intentional Durotomy in Spine Surgery

2016 ◽  
Vol 6 (8) ◽  
pp. 780-785 ◽  
Author(s):  
Tianyi Niu ◽  
Derek S. Lu ◽  
Andrew Yew ◽  
Darryl Lau ◽  
Haydn Hoffman ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Retrospective Chart Review ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Cutaneous Fistula ◽  
Wound Drain ◽  
Management Method ◽  
Drain Placement ◽  
Fluid Leak

Study Design Retrospective chart review. Objective Postoperative cerebrospinal fluid (CSF) leak is a known complication of intraoperative durotomy. Intraoperative placement of subfascial epidural drains following primary dural repair has been proposed as a potential management strategy to prevent formation of CSF cutaneous fistula and symptomatic pseudomeningocele. Here we describe our experience with subfascial drain after intentional durotomy. Methods Medical records of patients who underwent placement of subfascial epidural drains during spinal procedures with intentional intraoperative durotomies over a 4-year period at two institutions were retrospectively reviewed. Primary outcomes of interest were postoperative CSF cutaneous fistula or symptomatic pseudomeningocele formation. Results Twenty-five patients were included. Mean length of follow-up was 9.5 months. Twelve patients (48%) underwent simultaneous arthrodesis. The average duration of the drain was 5.3 days with average daily output of 126.5 mL. Subgroup analyses revealed that average drain duration for the arthrodesis group was 6.33 days, which is significantly greater than that of the nonfused group, which was 3.7 days ( p = 0.016). Similarly, the average daily drain output for the arthrodesis subgroup at 153.1 mL was significantly higher than that of the nonfused subgroup (86.8 mL, p = 0.04). No patient developed postoperative CSF cutaneous fistula or symptomatic pseudomeningocele or had negative sequelae associated with overdrainage of CSF. One patient had a delayed wound infection. Conclusions The intraoperative placement of subfascial epidural drains was not associated with postoperative development of CSF cutaneous fistula, symptomatic pseudomeningocele, overdrainage, or subdural hematoma in the cases reviewed. Subfascial closed wound drain placement is a safe and efficacious management method after intentional spinal durotomies. It is particularly helpful in those who undergo simultaneous arthrodesis, as those patients have statistically higher daily drain output and longer drain durations.

Endoscopic Management of the Cerebrospinal Fluid Leak

Skull Base ◽  
2009 ◽  
Vol 19 (S 02) ◽  
Author(s):  
E. Pasquini ◽  
G. Tenti ◽  
C. Bordonaro ◽  
P. Farneti ◽  
V. Sciarretta ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Endoscopic Management ◽  
Fluid Leak

scholarly journals Crayon in the Orbit and Sinuses in a Pediatric Patient

2021 ◽  
pp. 014556132110185
Author(s):  
Michela Borrelli ◽  
Kristen A. Echanique ◽  
Jeffrey Koempel ◽  
Elisabeth H. Ference
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Pediatric Patient ◽  
Cerebrospinal Fluid Leak ◽  
Ethmoid Sinus ◽  
Rare Occurrence ◽  
Lamina Papyracea ◽  
The Right ◽  
Fluid Leak ◽  
Type Of Injury

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.

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