scholarly journals Clinical and Radiological Study of Patients With Skull Base Fracture After Head Injury

2021 ◽  
Vol 57 (3) ◽  
pp. 192
Author(s):  
Puguh Oktavian ◽  
Achmad Chusnu Romdhoni ◽  
Linda Dewanti ◽  
Asra Al Fauzi
Keyword(s):  
Skull Base ◽  
Brain Abscess ◽  
Traffic Accidents ◽  
Brain Injuries ◽  
Clinical Manifestations ◽  
Cerebrospinal Fluid Leakage ◽  
Skull Base Fracture ◽  
Csf Leakage ◽  
Severe Tbi ◽  
The Many

Traumatic brain injury (TBI) is the largest contributor to morbidity and mortality in various parts of the world. Skull base fracture (SBF) is one of the many manifestations that can occur in cases of mild to severe TBI. With varying patterns of TBI, it was necessary to review the characteristics of SBF, clinical manifestations, cerebrospinal fluid leakage, and complications. The data were taken from the medical records of SBF patients who were treated at RSUD (Regional Public Hospital) Dr. Soetomo in the period January 2014 - July 2019. Then, the data obtained were written on the collection sheet and analyzed descriptively using RKward. It was found that SBF most often occurs due to severe TBI (60.14%). 77.7% of SBF patients were male and 35.1% of all patients aged 15-24 years. The most frequent cause was traffic accidents (86.5%). The anterior cranial fossa (ACF) was the most frequently fractured part of the skull base (30.4%). There was a significant relationship between the severity of TBI with the occurrence of CSF leakage and complications. About 33 patients (22.3%) had complications such as pneumocephalus and 9 patients (6.1%) had meningitis. Complications in the form of brain abscess and hydrocephalus in 1 (0.7%) patient each. SBF often occurred in men of productive age 15-24 years. The ACF was the most frequently fractured part. The majority were caused by traffic accidents accompanied by severe brain injuries. The most common complications were pneumocephalus, meningitis, brain abscess, and hydrocephalus.

scholarly journals Positional Relationship Between Lacrimal Sac and Skull Base: Implication of Risk of Cerebrospinal Fluid Leakage During Dacryocystorhinostomy

2021 ◽  
Author(s):  
Shinjiro Kono ◽  
Aric Vaidya ◽  
Munekazu Naito ◽  
Takashi Nakano ◽  
Makoto Ito ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Drainage System ◽  
Cerebrospinal Fluid Leakage ◽  
Lacrimal Sac ◽  
Maxillary Bone ◽  
Tomographic Images ◽  
Computed Tomographic ◽  
Csf Leakage ◽  
Ethmoid Sinuses

Abstract Cerebrospinal fluid (CSF) leakage is a rare but severe complication during dacryocystorhinostomy (DCR). Understanding the details of the anatomy of the lacrimal drainage system and skull base is essential to avoid this complication. We examined the positional relationship between the lacrimal sac and skull base using 16 cadavers (22 sides) and computed tomographic images taken in 81 patients (81 sides). Consequently, the frontal sinus intervened between the lacrimal sac and skull base in 81.8–90.1% of cases. The lacrimal sac fundus and posterior lacrimal crest were far from the skull base/cribriform plate, and the skull base above the lacrimal sac was considerably thick. These results indicate that the risk of skull base injury and following CSF leakage during DCR is extremely low. However, surgeons should be cautious of this complication by indirect injury due to a twisting movement of a bone rongeur applied to the maxillary bone during the creation of a bony window in patients with no interposition of the frontal and ethmoid sinuses between the lacrimal sac and skull base.

scholarly journals Penetrating Anterior Skull Base Fracture Inflicted by a Cow’s Horn

2016 ◽  
Vol 07 (S 01) ◽  
pp. S106-S108 ◽  
Author(s):  
Adomas Bunevicius ◽  
Karolis Bareikis ◽  
Laimutis Kalasauskas ◽  
Arimantas Tamasauskas
Keyword(s):  
Skull Base ◽  
Head Injuries ◽  
Prophylactic Antibiotic ◽  
Csf Leak ◽  
Skull Base Fracture ◽  
Male Farmer ◽  
Increased Risk ◽  
Csf Leakage ◽  
Eye Damage ◽  
Dural Tears

ABSTRACTFarm workers are at increased risk for animal-inflicted head injuries that are associated with significant morbidity and occasionally may be fatal. These injuries may cause permanent eye damage with or without concomitant skull base fracture. Here, we present a male farmer who suffered a cow attack that resulted in perforating orbital injury with comminuted frontobasal cranial fracture caused by a cow’s horn. The next day, the patient developed nasal and orbital cerebrospinal fluid (CSF) leak. Computed Tomography cisternography revealed CSF leakage to frontal and maxillary sinuses. The patient was treated using prophylactic antibiotic therapy, lumbar drainage, and underwent craniotomy for debridement and dural tear plastic. Post operative course was uneventful and there were no signs of CSF leak 1 year after the surgery. The case illustrates unusual injury inflicted by a cow’s horn and underscores the importance of careful investigation for underlying skull base fracture and CSF leakage in patients sustaining perforating orbital injuries. Adequate and timely management of dural tears is associated with favorable outcomes.

scholarly journals Persistent posttraumatic cerebrospinal fluid leakage

2000 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Jonathan A. Friedman ◽  
Michael J. Ebersold ◽  
Lynn M. Quast
Keyword(s):  
Cerebrospinal Fluid ◽  
Antibiotic Prophylaxis ◽  
Skull Base ◽  
Frontal Sinus ◽  
Surgical Intervention ◽  
Prophylactic Antibiotic ◽  
Cerebrospinal Fluid Leakage ◽  
Additional Surgery ◽  
Csf Leakage ◽  
Csf Leaks

Object Persistent posttraumatic cerebrospinal fluid (CSF) leakage frequently complicates skull base fractures. Although many CSF leaks will cease without treatment, patients with CSF leaks that persist greater than 24 hours may be at increased risk for meningitis, and many will require surgical intervention. The authors reviewed their 15-year experience with posttraumatic CSF leaks that persisted longer than 24 hours. Methods The authors reviewed the medical records of 51 patients treated between 1984 and 1998 with CSF leaks that persisted for 24 hours or longer after traumatic head injury. In 27 patients (55%) spontaneous resolution of CSF leakage occurred at an average of 5 days posttrauma. In 23 patients (45%) surgery was required to resolve the leakage. Eight patients (16%) with occult CSF leaks presented with recurrent meningitis at an average of 6.5 years post-trauma. Forty-three (84%) patients with CSF leaks sustained a skull fracture, most commonly involving the frontal sinus, whereas parenchymal brain injury or extraaxial hematoma was demonstrated in only 18 patients (35%). Delayed CSF leaks, with an average onset of 13 days posttrauma, were observed in eight patients (16%). Among patients with clinically evident CSF leakage, the frequency of meningitis was 10% with antibiotic prophylaxis, and 21% without antibiotic prophylaxis. Thus, prophylactic antibiotic administration halved the risk of meningitis. A variety of surgical approaches was used, and no significant neurological morbidity occurred. Three (13%) of 23 surgically treated patients required additional surgery to treat continued CSF leakage. Conclusions A significant proportion of patients with CSF leaks that persist greater than 24 hours will require surgical intervention. Prophylactic antibiotic therapy may be effective in this group of patients. Patients with skull base or frontal sinus fractures should be followed to detect the occurrence of delayed leakage. Surgery-related outcome is excellent.

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.

CT-Guided Autologous Blood Patch for High-Level Cervical Cerebrospinal Fluid Leakage: Imaging Characteristics and Treatment Safety and Efficiency

2021 ◽  
pp. 1-7
Author(s):  
Xiaofeng He ◽  
Yueyong Xiao ◽  
Xiao Zhang ◽  
Xiaobo Zhang ◽  
Xin Zhang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Space ◽  
Autologous Blood ◽  
Cerebrospinal Fluid Leakage ◽  
Imaging Features ◽  
Ct Guided ◽  
Iodinated Contrast ◽  
Blood Patch ◽  
Csf Leakage ◽  
High Level

<b><i>Introduction:</i></b> Epidural blood patches (EBPs) are rarely performed at the high-level cervical levels. The aim of the study was to investigate the imaging features, safety, and effectiveness of CT-guided percutaneous EBPs for high-level cervical cerebrospinal fluid (CSF) leakage. <b><i>Methods:</i></b> Twenty-five patients with spontaneous high-level (C1–C3) CSF leakage on MRI and CT imaging, including 2 patients with intracranial epidural hematoma caused by CSF, were treated with EBP. Two needles were inserted into the C1–3 bilateral epidural space. The needle location was confirmed by injection of both 3–5mL sterile air and a diluted iodinated contrast agent to delineate its spatial diffusion. The patient’s blood 11.1 ± 3.1 mL was slowly injected to make a patch; the distribution in epidural space was monitored with intermittent CT scanning. <b><i>Results:</i></b> The typical manifestation of CSF leakage was the high signal outside the C1–3 cervical dura on MR T2W fat inhibition images and low density in cervical muscle space on CT images. Twenty patients suffered from headaches and were able to sit and walk 24 h after the operation. Four patients, with partial relief of headache and a small but persistent CSF leakage, were re-treated with EBS. One patient underwent a third operation because of a persistent CSF leakage on MRI. <b><i>Conclusions:</i></b> Imaging of water at the surrounding epidural space of high cervical level is a typical feature of dural rupture on both MRI and CT. CT-guided EBP is safe and efficient for the high-level cervical CSF leakage, especially for cases in which conservative treatments failed.

Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases

1998 ◽  
Vol 88 (2) ◽  
pp. 237-242 ◽  
Author(s):  
John L. D. Atkinson ◽  
Brian G. Weinshenker ◽  
Gary M. Miller ◽  
David G. Piepgras ◽  
Bahram Mokri
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Chiari I Malformation ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Content Type ◽  
Intracranial Hypotension Syndrome ◽  
Csf Leakage ◽  
Chiari I ◽  
Fine Print

Object. Spontaneous spinal cerebrospinal fluid (CSF) leakage with development of the intracranial hypotension syndrome and acquired Chiari I malformation due to lumbar spinal CSF diversion procedures have both been well described. However, concomitant presentation of both syndromes has rarely been reported. The object of this paper is to present data in seven cases in which both syndromes were present. Three illustrative cases are reported in detail. Methods. The authors describe seven symptomatic cases of spontaneous spinal CSF leakage with chronic intracranial hypotension syndrome in which magnetic resonance (MR) images depicted dural enhancement, brain sagging, loss of CSF cisterns, and acquired Chiari I malformation. Conclusions. This subtype of intracranial hypotension syndrome probably results from chronic spinal drainage of CSF or high-flow CSF shunting and subsequent loss of brain buoyancy that results in brain settling and herniation of hindbrain structures through the foramen magnum. Of 35 cases of spontaneous spinal CSF leakage identified in the authors' practice over the last decade, MR imaging evidence of acquired Chiari I malformation has been shown in seven. Not to be confused with idiopathic Chiari I malformation, ideal therapy requires recognition of the syndrome and treatment directed to the site of the spinal CSF leak.

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