Study on spontaneous cerebrospinal fluid rhinorrhoea: its aetiology and management

2005 ◽  
Vol 119 (1) ◽  
pp. 12-15 ◽  
Author(s):  
C J Dunn ◽  
A Alaani ◽  
A P Johnson
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Intervention ◽  
Surgical Techniques ◽  
Queen Elizabeth Hospital ◽  
Study Group ◽  
Common Features ◽  
Csf Rhinorrhoea ◽  
The Common ◽  
Csf Leaks

The aim of this study was to identify the common features in a study group of patients with spontaneous cerebrospinal fluid (CSF) rhinorrhoea, to develop a hypothesis to explain the cause of this condition and to investigate the outcome of surgical techniques adopted to repair the leak. In this retrospective study the authors have reviewed all the cases of spontaneous CSF leaks attending and receiving treatment from the otolaryngology department of Queen Elizabeth Hospital, Birmingham, from 1992 to 2002.Of 34 patients with CSF leaks, 15 were spontaneous in nature and formed the study group. Of these 15 patients, 14 were female; with ages ranging from 37 to 70 years and a median age of 50 years. All the female patients were overweight with a body mass index (BMI) >24.9 and, of these, nine were considered obese with a BMI >30. It was attempted to identify common factors in the study group and it was evident that female sex, obesity and age played a key role in this condition.The follow-up period ranged from two to 98 months. Thirteen patients were asymptomatic but two patients remained symptomatic, one of these despite repeated surgical intervention.

scholarly journals Study on Spontaneous Cerebrospinal Fluid (CSF) Rhinorrhoea: A Birmingham Experience

2013 ◽  
Vol 24 (1) ◽  
pp. 40-43
Author(s):  
Mohammad Saleh Uddin Sayed ◽  
Chris J Dunn ◽  
A Alaani ◽  
Alan Johnson
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Techniques ◽  
Queen Elizabeth Hospital ◽  
Study Group ◽  
Csf Rhinorrhoea ◽  
The Common ◽  
Medicine Today ◽  
Age Range ◽  
Csf Leaks

Spontaneous Cerebrospinal fluid (CSF) rhinorrhoea is not very common. The aim of this study is to identify the common features in the study group of patients with spontaneous CSF rhinorrhoea, to develop a hypothesis to explain the cause of this condition and to investigate the outcome of surgical techniques adopted to repair the leak. In this retrospective study we have reviewed all the cases of spontaneous CSF leaks attending and receiving treatment from the Department of ENT at Queen Elizabeth Hospital, Birmingham, from 1992 to 2002. Among the total number of 34 patients with CSF leaks, 15 were spontaneous in nature and formed our study group, of these 15 patients 14 were female; with age range from 37 to 70 years and a median age of 50 years. All the female patients were obese with a body mass index higher than normal range. We tried to identify common factors in the study group and it was evident that female sex, obesity and age play a key role in this condition. Follow up period ranged from 2 to 98 months and thirteen patients were asymptomatic but two patients remained symptomatic, one of these despite repeated surgical intervention. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.14114 Medicine TODAY Vol.24(1) 2012 pp.40-43

Tension pneumocephalus with cerebrospinal fluid rhinorrhoea in a post craniotomy patient

2010 ◽  
Vol 9 (1) ◽  
pp. 13-14
Author(s):  
Nicholas H Smallwood ◽  
◽  
Sreenivasan Shiva ◽  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Features ◽  
Frontal Sinus ◽  
Surgical Intervention ◽  
Csf Leak ◽  
Dural Tear ◽  
Tension Pneumocephalus ◽  
Neurological Signs ◽  
Important Complication ◽  
Csf Rhinorrhoea

Tension pneumocephalus is an uncommon but important complication of neurosurgery, often requiring urgent surgical intervention. It should be considered in any patient presenting with neurological symptoms after recent craniotomy, particularly if they also have clinical features consistent with cerebrospinal fluid (CSF) leak. We describe a patient who presented four weeks post-craniotomy with fluctuating neurological signs and CSF rhinorrhoea, who made a full recovery following repair of a frontal sinus defect and dural tear.

Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

1998 ◽  
Vol 88 (2) ◽  
pp. 243-246 ◽  
Author(s):  
Wouter I. Schievink ◽  
Vittorio M. Morreale ◽  
John L. D. Atkinson ◽  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Intracranial Hypotension ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Content Type ◽  
Surgical Exploration ◽  
Fine Print ◽  
Csf Leaks

Object. Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. Methods. Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22–61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. Conclusions. All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3–58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

Abstract WP352: Clinical Outcomes of Patients Undergoing BrainPath-assisted Evacuation of Intracerebral Hematomas

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Min Lang ◽  
Alex M Witek ◽  
Nina Z Moore ◽  
Mark D Bain
Keyword(s):  
Clinical Outcomes ◽  
Medical Management ◽  
Surgical Intervention ◽  
Cleveland Clinic ◽  
Surgical Techniques ◽  
Surgical Morbidity ◽  
Prospective Data ◽  
Minimally Invasive Access ◽  
Better Than

Introduction: Multiple clinical trials have failed to show that surgical intervention leads to better outcomes than medical management for patients with intracerebral hemorrhage (ICH). Newer and less invasive surgical techniques have been reported to be safe and technically effective for evacuation of ICH. The purpose of this study is to evaluate clinical outcomes following ICH evacuation using the BrainPath system (NICO, Indianapolis, IN), a tool that allows minimally invasive access to the subcortical space. Methods: IRB-approved prospective data were collected on patients who underwent ICH evacuation using BrainPath at the Cleveland Clinic from August 2013 to April 2016. Glasgow Coma Score (GCS) was collected upon admission and discharge. NIH stroke score (NIHSS) and modified Rankin score (mRS) were collected upon admission and discharge, and at the 3- and 6-month months follow-up visits. Results: Thirty-five patients underwent BrainPath-assisted ICH evacuation, with a mean age of 57 ± 16 years and average ICH volume of 50.4 ± 23.5mL. Complications included two patients requiring re-operation due to hematoma re-accumulation (6%), both of whom had serum creatinine greater than 1.5, and one case of wound infection (3%). Eight (23%) patients died during the follow-up period, of which four (11%) died within 30 days of hemorrhage. GCS was 10.1 ± 3.7 on admission and improved to 11.9 ± 2.9 at discharge. NIHSS of surviving patients at pre-operation, discharge, 3-month follow-up, and 6-month follow-up were 18.6 ± 7.7 (n=35), 19.0 ± 8.7 (n=26), 7.8 ± 5.9 (n=19), and 3.7 ± 3.8 (n=12), respectively. mRS at pre-hemorrhage baseline, 3-month follow-up, and 6-month follow-up was 0.7 ± 1.2 (n=35), 4.3 ± 1.5 (n=30), and 3.9 ± 1.9 (n=26), respectively. Conclusions: Evacuation of ICH using BrainPath is associated with acceptable rates of surgical morbidity. The 30-day mortality rate was better than expected based on admission ICH scores. Patients showed improvement in GCS between admission and discharge, and they showed improvement in NIHSS and mRS at three and six months postoperatively. A comparative study is needed to investigate whether surgical evacuation using this technique results in improved clinical outcomes compared to medical management.

scholarly journals THE PLACE OF VASCULAR SURGERY IN TREATMENT OF DIABETIC PATIENTS

2012 ◽  
Vol 67 (1) ◽  
pp. 27-30
Author(s):  
А. V. Pokrovskiy
Keyword(s):  
Surgical Intervention ◽  
Surgical Techniques ◽  
Vascular Complications ◽  
Lower Limbs ◽  
Diabetic Patients ◽  
Critical Ischemia ◽  
X Ray ◽  
Latent Stage ◽  
Main Tendency

This article is dedicated to diagnostics, prevention and surgical treatment of vascular complications of diabetes mellitus, particularly prevention of ischemic strokes and treatment of critical ischemia of lower limbs. The main tendency in treatment of brachiocephalic artery lesions nowadays is a surgical intervention in the latent stage of the disease. X-ray endovascular surgical techniques are being increasingly used to treat lesions of lower limbs arteries. Limb preservation is impossible without cooperation of many specialists. It’s essential to perform careful out-patient follow up of the patient after vascular reconstructive surgery.

Paediatric hydrocephalus

2019 ◽  
pp. 1023-1036
Author(s):  
Matt Bailey ◽  
Chris Parks ◽  
Conor L. Malucci
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Procedures ◽  
Surgical Techniques ◽  
Disease Process ◽  
Surgical Care ◽  
Csf Shunts ◽  
Classification Management ◽  
Technological Improvements ◽  
Csf Production

Paediatric hydrocephalus is the commonest disorder to be managed by paediatric neurosurgeons. Rather than representing a single disease process, hydrocephalus can result from a variety of different pathological processes or insults that culminate in an imbalance of cerebrospinal fluid (CSF) production and absorption. If left untreated, the majority of cases are fatal, but with appropriate surgical management most patients survive, with some leading normal lives into adulthood. The mainstay of treatment is with CSF shunts, but with technological improvements in imaging and surgical techniques an increasing number are being successfully treated with neuroendoscopic procedures. The disorder can be complex to manage, with many patients requiring multiple surgical procedures and lifelong follow-up. This chapter gives an overview of paediatric hydrocephalus, its causes and classification, management with shunts and endoscopy, description of surgical techniques, and the outcomes of surgical care.

The endoscopic treatment of cerebrospinal fluid rhinorrhoea: the Nottingham experience

1997 ◽  
Vol 111 (2) ◽  
pp. 125-128 ◽  
Author(s):  
R. G. M. Hughes ◽  
N. S. Jones ◽  
I. J. A. Robertson
Keyword(s):  
Cerebrospinal Fluid ◽  
Subsequent Treatment ◽  
Endoscopic Approach ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Closure Rate ◽  
Endoscopic Techniques ◽  
Csf Rhinorrhoea ◽  
Skull Base Defect

AbstractThe conventional neurosurgical management of cerebrospinal fluid (CSF) rhinorrhoea has been by intracranial access. Otorhinolaryngologists have undertaken extracranial approaches where access has been possible, and more recently an endoscopic approach has been advocated. We report 17 patients with confirmed CSF rhinorrhoea treated with endoscopic techniques between 1993 and 1996. Follow-up ranged from four to 32 months and showed an overall closure rate of 16 out of 17 patients with no complications. No patient undergoing primary endoscopic repair developed anosmia. The use of fluorescein helped localize the site of the CSF leak in four patients in whom the computed tomography (CT) scan had not identified the site of the defect.We conclude that the endoscope is a valuable tool in the evaluation and subsequent treatment of CSF rhinorrhoea. Where the skull base defect is accessible to the endoscope, we propose that an endoscopic approach should be considered as the preferred method.

scholarly journals Results of Winograd technique (wedge resection of the toenail and nail bed) in ingrown toe nail

2019 ◽  
Vol 6 (7) ◽  
pp. 2349 ◽  
Author(s):  
Aftab Ahmad Khan ◽  
Shiv Kumar
Keyword(s):  
Surgical Intervention ◽  
District Hospital ◽  
Wedge Resection ◽  
Surgical Techniques ◽  
Safe Procedure ◽  
Recurrence Rates ◽  
Nail Bed ◽  
A Prospective Study ◽  
Late Stages

Background: Ingrown toe nail is a very common condition affecting toes which causes significant morbidity. Most common reasons are improper nail trimming or a tight show wear. Early stages can be managed conservatively by warm soaks, antibiotics and analgesics, however late stages need surgical intervention. Numerous surgical techniques have been described for this condition.Methods: A prospective study was carried out in District hospital Doda from November 2015 to November 2017. Wedge resection of the toe nail and nail bed (Winograd technique) was used. Recurrence rates, complications and patient satisfaction was noted at the end of follow up at one year.Results: We operated 29 toes in 23 patients. We had 3 (10.34%) recurrences out of 29 toes operated, 2 (6.89%) patients got secondarily infected. The overall satisfaction rate in our series was 69.56%.Conclusions: Winograd technique is an easy and safe procedure, however chances of recurrence and cosmetic disfigurement should be explained to the patient during consent. 

scholarly journals Endoscopic Repair of Spontaneous Cerebrospinal Fluid Leaks in the Lateral Recess of the Sphenoid Sinus

2022 ◽  
pp. 019459982110684
Author(s):  
Zhenxiao Huang ◽  
Qian Huang ◽  
Shunjiu Cui ◽  
E. Qiu ◽  
Junfang Xian ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Sphenoid Sinus ◽  
Surgical Repair ◽  
University Hospital ◽  
Preoperative Imaging ◽  
Imaging Evaluation ◽  
Lateral Recess ◽  
Approach Group ◽  
Csf Leaks

Objective This study aimed to assess the effectiveness of 3 endoscopic endonasal approaches for the management of cerebrospinal fluid (CSF) leaks and meningoencephaloceles in the lateral recess of the sphenoid sinus (LRSS). Study Design Retrospective study. Setting University hospital. Methods This study retrospectively reviewed 49 patients with CSF leaks and meningoencephaloceles in the LRSS. Three endoscopic surgical repair approaches were indicated based on 5 different Rhoton’s types of the LRSS. The postoperative symptoms, complications, and follow-up outcomes were investigated and evaluated. Results The success rate of endoscopic surgical repair was 100% at a median follow-up of 75.06 (12-203.4) months. Endoscopic approaches to the LRSS included the prelacrimal recess (PLR) (18.37%), transsphenoidal (18.37%), and transpterygoid approaches (64.26%). All patients in the PLR approach (PLRA) group and most of the patients in the transpterygoid approach group had a full lateral type LRSS. Hypoesthesia and dry eyes were reported in 5 patients (55.56%) and 1 (11.12%) patient, respectively, from the PLRA group and in 6 (19.35%) and 5 (16.12%) patients, respectively, from the transpterygoid approach group. Conclusions Endoscopic closure is a safe and effective method for the treatment of CSF leaks and meningoencephaloceles in the LRSS. The transpterygoid approach and PLRA offer adequate exposure of the LRSS with extensive lateral pneumatization or a full LRSS. The endoscopic route of the PLRA is more direct than that of the transpterygoid approach. Careful preoperative imaging evaluation is crucial while selecting the optimal surgical approach for the repair of a skull base defect.

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.

Sign in / Sign up

Export Citation Format

Share Document