scholarly journals An Unusual Case of Delayed Recurrent Traumatic Cerebrospinal Fluid Rhinorrhea

2020 ◽  
Author(s):  
Xiaofei Liu ◽  
Ping Chen ◽  
Bing Wang
Keyword(s):  
Cerebrospinal Fluid ◽  
Good Choice ◽  
Bony Defect ◽  
Dural Defect ◽  
Csf Rhinorrhea ◽  
Invasive Approach ◽  
Fascial Flap ◽  
Anterior Cranial Base ◽  
Csf Leakage ◽  
The Right

Abstract Background: Dural and bony defects mostly occur in the same position in the cerebrospinal fluid (CSF) rhinorrhea of anterior cranial base fractures, and a few cases of delayed CSF leakage after repair are also reported.Case presentation: We report a case in which a pedicled temporoparietal fascial flap was used to repair the comminuted fracture of the anterior skull base with CSF leakage. Delayed CSF leakage occurred 45 days after the operation. A minimally invasive approach through an eyebrow incision was performed for reoperation, it was found that the bony defect was located in the right frontal sinus and the dural defect was located in the right ethmoid plate. Conclusions: This case suggests that delayed traumatic CSF rhinorrhea after reconstructive surgery is more complex than usual, and appropriate approach should be adopted to repair the dural and bony defects, the transeyebrow approach is a good choice.

scholarly journals Minimally Invasive Repair of a Delayed Recurrent Traumatic Cerebrospinal Fluid Rhinorrhea: A Case Report of Dislocation of the Bony and Dural Defects

2020 ◽  
Author(s):  
Xiaofei Liu ◽  
Ping Chen ◽  
Bing Wang
Keyword(s):  
Cerebrospinal Fluid ◽  
Minimally Invasive ◽  
Bony Defect ◽  
Dural Defect ◽  
Csf Rhinorrhea ◽  
Invasive Approach ◽  
Fascial Flap ◽  
Anterior Cranial Base ◽  
Csf Leakage ◽  
The Right

Abstract Background：Dural and bony defects mostly occur in the same position in the cerebrospinal fluid（CSF）rhinorrhea of anterior cranial base fractures,and a few cases of delayed CSF leakage after repair are also reported.Case presentation：We report a case in which a pedicled temporoparietal fascial flap was used to repair the comminuted fracture of the anterior skull base with CSF leakage. Delayed CSF leakage occurred 45 days after the operation.A minimally invasive approach through an eyebrow incision was performed for reoperation,it was found that the bony defect was located in the right frontal sinus and the dural defect was located in the right ethmoid plate. Conclusions:This case suggests that delayed traumatic CSF rhinorrhea after reconstructive surgery is more complex than usual,and appropriate approach should be adopted to repair the dural and bony defects , the transeyebrow approach is a good choice.

Extracranial Approaches to the Repair of Cerebrospinal Fluid Rhinorrhea

1992 ◽  
Vol 71 (7) ◽  
pp. 311-313 ◽  
Author(s):  
David T. Daly ◽  
William M. Lydiatt ◽  
Frederic P. Ogren ◽  
Gary F. Moore
Keyword(s):  
Cerebrospinal Fluid ◽  
Conservative Management ◽  
Imaging Techniques ◽  
Bony Defect ◽  
Dural Defect ◽  
Recurrent Meningitis ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Continuous Drainage ◽  
The Common

This paper presents a review of the extracranial evaluation and treatment of cerebrospinal fluid (CSF) rhinorrhea. Diagnosis with attention to a careful history and physical with maneuvers which exacerbate drainage and thorough physical exam along with imaging techniques are discussed. The common etiologies of CSF rhinorrhea including trauma, spontaneous leakage, tumor, and iatrogenic injury are included. Management consists of conservative measures including the avoidance of straining maneuvers which increases intracranial pressure. Periodic drainage of CSF via lumbar puncture or continuous drainage via flow-regulated systems may also be of benefit in attempts of conservative management. Failure of conservative management, constant leakage, pneumocephalus, and recurrent meningitis are indicators for surgical repairs. Ethmoid-cribiform plate region repairs are generally approached by external ethmoidectomy and the development of mucoperiosteal flaps from various donor sites which are then rotated to the leak area to seal the defect. Frontal sinus leaks are usually repaired via an osteoplastic flap technique with direct repair of the dural defect or the use of fascial graft tucked under the bony defect, then obliterated with abdominal fat. CSF rhinorrhea presents a diagnostic and surgical challenge to the otolaryngologist. After diagnosis and localization, operative repair using extracranial approaches is accepted as the initial method of intervention in these cases.

Lymphangioma of the skull base bones leading to cerebrospinal fluid rhinorrhea

2008 ◽  
Vol 2 (4) ◽  
pp. 273-276 ◽  
Author(s):  
Eiji Ito ◽  
Kiyoshi Saito ◽  
Tetsuya Nagatani ◽  
Masaaki Teranishi ◽  
Yuzuru Kamei ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Skull Base ◽  
Histopathological Examination ◽  
Bone Destruction ◽  
Lytic Lesion ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage ◽  
The Right

Lymphangioma localized to the bones of the skull base is rare. The authors report herein the case of a 5-year-old boy who presented with lymphangioma of the bone, localized to the skull base and leading to cerebrospinal fluid (CSF) rhinorrhea with meningitis. Neuroimaging demonstrated lytic destruction with a cyst in the right middle skull base. The patient was successfully treated with resection of the tumor and prevention of CSF leakage. Histopathological examination revealed a lymphangioma. An enlarging lymphangioma can lead to bone destruction. A differential diagnosis of a lytic lesion for a cyst at the skull base is important for proper case management.

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.

Clipping Technique for the Repair of the Intraoperative Cerebrospinal Fluid Leakage during Transsphenoidal Pituitary Tumor Surgery

2019 ◽  
Vol 17 (4) ◽  
pp. 382-388
Author(s):  
Eui Hyun Kim ◽  
Ju Hyung Moon ◽  
Sun Ho Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Anterior Pituitary ◽  
Pituitary Function ◽  
Cerebrospinal Fluid Leakage ◽  
Arachnoid Membrane ◽  
Csf Rhinorrhea ◽  
Csf Leakage ◽  
Anterior Pituitary Function ◽  
Clipping Technique

Abstract BACKGROUND During transsphenoidal surgery (TSS) for a pituitary adenoma with a large suprasellar extension, cerebrospinal fluid (CSF) leakage commonly develops from a defect in the arachnoid recess or the arachnoid membrane. OBJECTIVE To evaluate the usefulness of a newly developed clipping technique for the repair of intraoperative CSF leakage. METHODS Between September 2012 and November 2016, 698 patients with pituitary adenoma were operated on with TSS. Intraoperative CSF leakage was encountered in 301 patients (43.1%). The clipping technique was used to repair CSF leakage in 144 patients: from the arachnoid recess in 100 patients and from the arachnoid membrane in 44 patients. The clipping technique used titanium clips and a newly designed clip applier. We evaluated anterior pituitary function of the patients whose CSF leakage was closed by clipping, and compared this with function in another patient group treated with different repair techniques. RESULTS We successfully applied clip technique in 140 out of 144 patients. This clipping technique was faster and easier for repairing CSF leakage than our previously published suture technique. In our early series, 4 patients developed unexpected CSF rhinorrhea after TSS. We found no difference in anterior pituitary function between a clipping group and others. Although titanium clip was identified on postoperative MRI, its metallic scattered artifact was very minimal and did not hinder the detection of possible remnant and recurrent tumors. CONCLUSION This clipping technique is a very simple and reliable method for repairing intraoperative CSF leakage when properly applied with caution.

U-shaped Dural Flap: A Simple Method for Transcranial Skull Base Defect Repair—Technical Report

2019 ◽  
Vol 80 (05) ◽  
pp. 396-398
Author(s):  
Cagatay Ozdol ◽  
Kamran Aghayev
Keyword(s):  
Skull Base ◽  
Artery Aneurysm ◽  
Dural Defect ◽  
Anterior Clinoid Process ◽  
Simple Method ◽  
Csf Rhinorrhea ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Csf Leakage ◽  
Planum Sphenoidale

AbstractAccidental anterior skull base defects associated with surgery are difficult to treat. There are several methods for the repair, yet postoperative rhinorrhea can occur despite the closure. A 56-year-old female patient was admitted for the treatment of a paraclinoid internal carotid artery aneurysm. The surgery included removal of the anterior clinoid process, unroofing the optic canal, decompressing the optic nerve, and clipping the aneurysm. During the surgery, the planum sphenoidale was accidentally drilled and the nasal cavity exposed. The dural defect was repaired using a U-flap technique. No postoperative cerebrospinal fluid (CSF) rhinorrhea occurred in the patient, and she was discharged on postoperative day 3. On follow-up examination the patient did not have evidence of CSF leakage.

Endonasal Endoscopic Closure of Cerebrospinal Fluid Fistulas at the Anterior Cranial Base

1996 ◽  
Vol 105 (8) ◽  
pp. 620-623 ◽  
Author(s):  
Mislav Gjuric ◽  
Henning Keimer ◽  
Ulrich Goede ◽  
Malte Erik Wigand
Keyword(s):  
Cerebrospinal Fluid ◽  
Soft Tissue Injuries ◽  
Inferior Turbinate ◽  
Cranial Base ◽  
Csf Leak ◽  
Facial Soft Tissue ◽  
Csf Rhinorrhea ◽  
Endoscopic Closure ◽  
Anterior Cranial Base ◽  
Dural Tears

This study reports our indications and limits for endonasal endoscopic closure of dural defects with a cerebrospinal fluid (CSF) leak at the anterior cranial base, and demonstrates our surgical technique. Fifty-three patients with CSF rhinorrhea were reassessed for the success rate of closure of the CSF leak. Surgery was successful in 98%, and 68% of fistulas were closed endoscopically. A free graft of autogenous mucoperiosteum of the inferior turbinate was the most frequently used tissue for defect closure. The endonasal endoscopic route proved relatively safe for the closure of dural tears, irrespective of the cause, up to about 10 × 10 mm. It is characterized by minimal morbidity because of the preservation of sinus ventilation and bony structures, supraorbital nerves, and olfactory fibers. Defects larger in size, predominantly of traumatic origin, were closed via the transfacial approach. The decision on the surgical approach was additionally based on the extent of the facial soft tissue injuries and the localization of the leak.

scholarly journals Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248229
Author(s):  
Il Hwan Lee ◽  
Do Hyun Kim ◽  
Jae-Sung Park ◽  
Sin-Soo Jeun ◽  
Yong-Kil Hong ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Retrospective Chart Review ◽  
Pedicled Flap ◽  
Cerebrospinal Fluid Leakage ◽  
Dural Defect ◽  
Endoscopic Endonasal ◽  
Tertiary Referral Center ◽  
Fluid Leakage ◽  
Csf Leakage ◽  
Grade 3

Objectives We describe the strategy used to repair intraoperative leaks of various grades and define factors for preventing postoperative cerebrospinal fluid leakage (CSF) after surgery via the endoscopic endonasal transsphenoidal approach (EETA). Study design Retrospective chart review at a tertiary referral center. Methods Patients who underwent surgery via EETA from January 2009 to May 2020 were retrospectively reviewed. Intraoperative CSF leakage was graded 0–3 in terms of the dural defect size; various repairs were used depending on the grade. Results A total of 777 patients underwent 869 operations via EETA; 609 (70.1%) experienced no intraoperative CSF leakage (grade 0) but 260 (29.9%) did. Leakage was of grade 1 in 135 cases (15.5%), grade 2 in 83 (9.6%), and grade 3 in 42 (4.8%). In 260 patients with intraoperative CSF leakage, a buttress was wedged into the sellar defect site in 178 cases (68.5%) and a pedicled flap was placed in 105 cases (40.4%). Autologous fat (108 cases, 41.5%) and a synthetic dural substitute (91 cases, 35%) were used to fill the dead space of the sellar resection cavity. Postoperative CSF leakage developed in 21 patients: 6 of grade 1, 7 of grade 2, and 8 of grade 3. Buttress placement significantly decreased postoperative leakage in grade 1 patients (p = 0.041). In patients of perioperative leakage grades 2 and 3, postoperative CSF leakage was significantly reduced only when both fat and a buttress were applied (p = 0.042 and p = 0.043, respectively). Conclusion A buttress prevented postoperative CSF leakage in grade 1 patients; both fat and buttress were required by patients with intraoperative leakage of grades 2 and 3.

scholarly journals TRANSCRANIAL DURAL REPAIR;

2017 ◽  
Vol 24 (08) ◽  
pp. 1232-1236
Author(s):  
Sohail Amir ◽  
Maimoona Qadir ◽  
Muhammad Usman
Keyword(s):  
Cerebrospinal Fluid ◽  
Road Traffic ◽  
Csf Leak ◽  
Dural Defect ◽  
Dural Repair ◽  
Csf Rhinorrhea ◽  
Mri Brain ◽  
Fascia Lata Graft ◽  
Minimum Age ◽  
Subfrontal Approach

Objectives: To determine efficacy of transcranial dural repair in managementof early traumatic cerebrospinal fluid (CSF) rhinorrhea by measuring the rate of resolution ofrhinorrhea following repair. Material and Study Design: Descriptive study. Period: 18 monthsfrom March 2014 to September 2015. Setting: Department of Neurosurgery Naseer Teachinghospital Peshawar. Methods: 30 patients, all head injury patients with CSF rhinorrhea of eithergender and any age, reporting to Accident and emergency department were included in thestudy. MRI Brain T2 Weighted in prone position done in all cases to identify the dural rent.Transcranial intradural repair was done through subfrontal approach. Post op complicationswere documented and follow at two months. Results: In this study 30 patients with cerebrospinalfluid (CSF) leak were observed. The minimum age was 8 years and the maximum was 59 years.23 (76.6%) were male and 7 (23.3%) were female. 18 (60%) patients have CSF rhinorrhea dueto road traffic accident, 7 (23.3%) patient with history of fall, while 5 (6.6%) patient were in othercategory. MRI brain T-2 Weighted done in all patient to identify the dural defect. The surgicalapproach was intradural in all of the 30 (100%) patients having fascia lata graft in 28 (93.3%)patients and pericranium in 2 (7%) patients to cover the defect properly. Among the immediatecomplications 3 (10%) patients had recurrent CSF leak, 2(6.6%) had meningitis, 5 (16.6%)had Pneumoencephalus while 3(10%) patients had other complications like subarachnoidhemorrhage, wound infection etc. The overall success rate was 90%. Conclusion: It isconcluded that in post traumatic cerebrospinal fluid (CSF) rhinorrhea, if the defect in dura isdemonstrated it must be repaired as soon as possible in order to prevent fulminant meningitis.

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