scholarly journals Sinking Skin Flap Syndrome and Paradoxical Herniation Provoked by a Malfunction of External Lumbar Drainage and CSF Leak

2019 ◽  
Vol 19 (3) ◽  
pp. 103-110
Author(s):  
M Hanko ◽  
P Snopko ◽  
R Opsenak ◽  
M Benco ◽  
R Richterova ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Decompressive Craniectomy ◽  
Skin Flap ◽  
Drainage System ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Lumbar Drainage ◽  
Cerebral Herniation ◽  
Fluid Leak ◽  
External Lumbar Drainage

Abstract The sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. It is defined as a neurological deterioration accompanied by a flat or concave deformity of the craniectomy-related skin flap. The underlying brain parenchyma is distorted correspondingly with its blood flow and metabolism being impaired and cerebrospinal fluid hydrodynamics being disturbed, thus causing cerebral dysfunction and neurological symptomatology. The most important options for reversal of this syndrome include Trendelenburg position, maintaining of the cerebrospinal fluid balance, and cranioplasty as a definite solution. We present a patient who underwent a decompressive craniectomy complicated by a cerebrospinal fluid leak in the operative wound treated by means of an external lumbar drainage. Subsequently he developed the sinking skin flap syndrome and a paradoxical cerebral herniation after the drainage system malfunction with a massive cerebrospinal fluid leak at the site of the lumbar drain insertion parallel to the drain itself. His symptoms were, however, successfully alleviated by a positional change, rehydration, and interruption of the lumbar drainage. This illustrational case suggests that clinicians should be aware that patients after decompressive craniectomy may develop a sinking skin flap syndrome as it may either represent an acute risk of a paradoxical brain herniation or complicate the further postoperative care if developed in a chronic way.

External lumbar drainage with volumetric continuing infusion pump in patients with cerebrospinal fluid leak. A case series

2017 ◽  
Vol 27 (1) ◽  
pp. 40-43 ◽  
Author(s):  
Ana Belén Manso Melgosa ◽  
Helena García Gutiérrez ◽  
Mónica Fernández Porras ◽  
Ana Berta Castrillo Manero ◽  
Belén Pérez Marijuán
Keyword(s):  
Cerebrospinal Fluid ◽  
Infusion Pump ◽  
Case Series ◽  
Cerebrospinal Fluid Leak ◽  
Lumbar Drainage ◽  
Fluid Leak ◽  
External Lumbar Drainage

Sternberg's Canal and Defect: Is the Lateral Craniopharyngeal Canal a Source of Spontaneous Cerebrospinal Fluid Leak? Anatomic and Radiological Analysis in Pediatric and Adult Populations

2021 ◽  
Author(s):  
Adedamola Adepoju ◽  
Lucas P Carlstrom ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Carlos Diogenes Pinheiro-Neto ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Adult Population ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Superior Orbital Fissure ◽  
Old Patients ◽  
Visual Illustration ◽  
Craniopharyngeal Canal ◽  
High Incidence ◽  
Fluid Leak

Abstract BACKGROUND The lateral craniopharyngeal or Sternberg's canal (SC) originates from superior orbital fissure (SOF) and traverses the sphenoid body into the nasopharynx. A remnant of the canal, Sternberg's defect (SD), has been debated as a source of cerebrospinal fluid (CSF) leak. The canal was described in 1888, and there is limited accurate visual illustration in the literature. OBJECTIVE To provide a detailed anatomic and radiological illustration of the canal in pediatric and adult population including the mechanism undermining the incidence of the canal, and the possibility of the canal as a source of CSF leak. METHODS A total of 195 high-resolution computed tomographies (CT) of patients (50 3-yr-old, 20 5-yr-old, and 125 adults) and 43 dry adult skulls (86 sides) were analyzed for a canal matching the description of the SC. RESULTS A SC was identified in 86% of the 3-yr-old and 40% of 5-yr–old patients. The diameter and length were 2.12 mm and 12 mm, respectively. The incidence of the canal decreased with age as sinus pneumatization extended into the sphenoid sinus. Only 0.8% of the adult skull on CT had the canal. The canal was not present on the dry adult skulls examination, but SD was found in 4.65%. CONCLUSION SC exists with high incidence in the pediatric group. Sinus pneumatization obliterates the canal in the adult population, leaving a defect in 4.65% of cases, which given the location and related anatomic structures, is unlikely to be a source of CSF leak.

scholarly journals A Case of Petrous Apex Meningocele: Unusual Presentation of Cerebrospinal Fluid Leak Following Adenoidectomy

2020 ◽  
Vol 27 (2) ◽  
pp. 135-139
Author(s):  
Byung Kil Kim ◽  
Yujin Heo ◽  
Doo-Sik Kong ◽  
Sang Duk Hong
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Petrous Apex ◽  
Diagnostic Process ◽  
Recurrent Meningitis ◽  
Csf Rhinorrhea ◽  
Leakage Site ◽  
Fluid Leak

Cerebrospinal fluid (CSF) leak is possible and can be a cause of recurrent bacterial meningitis. Petrous apex meningocele (PAM) is mostly asymptomatic and is often found during incidental imaging tests. We experienced a case of CSF rhinorrhea with recurrent meningitis in bilateral PAM after adenoidectomy. This report highlights the diagnostic process of CSF leak, identification of leakage site, and surgical approach to petrous apex lesions.

scholarly journals Cerebrospinal Fluid Leak during Stapes Surgery: Gushing Leaks and Oozing Leaks, Two Different Phenomena

2017 ◽  
Vol 96 (8) ◽  
pp. 302-308 ◽  
Author(s):  
Juan Luis Quesada ◽  
Giovanni Cammaroto ◽  
Lilla Bonanno ◽  
Francesco Galletti ◽  
Pedro Quesada
Keyword(s):  
Cerebrospinal Fluid ◽  
Statistical Analysis ◽  
Postoperative Complications ◽  
Multicenter Study ◽  
Cerebrospinal Fluid Leak ◽  
Stapes Surgery ◽  
Csf Leak ◽  
Clinical Evaluations ◽  
Hearing Outcomes ◽  
Fluid Leak

Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients—23 men and 15 women, aged 23 to 71 years (mean: 47)—who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications.

scholarly journals Visualized Ethmoid Roof Cerebrospinal Fluid Leak during Frontal Balloon Sinuplasty

2018 ◽  
Vol 97 (8) ◽  
pp. E34-E38 ◽  
Author(s):  
Navdeep R. Sayal ◽  
Eytan Keidar ◽  
Shant Korkigian
Keyword(s):  
Cerebrospinal Fluid ◽  
Balloon Dilation ◽  
Major Complication ◽  
Cerebrospinal Fluid Leak ◽  
Collagen Matrix ◽  
Sinus Surgery ◽  
Csf Leak ◽  
Safe Alternative ◽  
Revision Sinus Surgery ◽  
Fluid Leak

Balloon sinus dilation (BSD) is generally accepted as a safe alternative to traditional sinus surgery. It is a unique technique designed to potentially minimize complications associated with traditional functional endoscopic sinus surgery (FESS). We present a case in which a 65-year-old man experienced a cerebrospinal fluid (CSF) leak in the ethmoid roof that was visualized instantly after balloon dilation in a revision sinus surgery. In this case report, we discuss the causes of CSF leaks and explain in detail the immediate endoscopic repair with a collagen matrix. Also, literature is reviewed on the safety of BSD versus traditional FESS. Postoperative-ly, the patient has been without CSF leak and remains symptom free. CSF leak is a rare but major complication during both FESS and BSD. As BSD use increases, its complication profile will become clearer when used alone, in conjunction with FESS, and/or during revision surgery. Although BSD is considered a benign procedure, one should be cautious when using it in revision sinus surgery.

Cervical Subarachnoid Drain for the Treatment of Cerebrospinal Fluid Leak: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Roberto J Perez-Roman ◽  
Timur Urakov
Keyword(s):  
Cerebrospinal Fluid ◽  
Conservative Management ◽  
Surgical Repair ◽  
Cerebrospinal Fluid Leak ◽  
Effective Alternative ◽  
Csf Leak ◽  
Common Phenomenon ◽  
Neurosurgical Procedure ◽  
Cerebrospinal Fluid Diversion ◽  
Fluid Leak

Abstract Cerebrospinal fluid (CSF) leak is a common phenomenon encountered by the neurosurgeon. It is most commonly come across after a neurosurgical procedure, but it can be seen idiopathically. Treatment usually ranges from conservative management through cerebrospinal fluid diversion to direct surgical repair. Continuous CSF drainage provides a path for diversion and allowing the site of the dural injury to heal effectively.1 Cervical subarachnoid drain is a safe and effective alternative when lumbar access is contraindicated or not achievable.2 Here we present a case of a 22-yr-old female with progressive symptomatic positional headaches due to a CSF leak from a prior deformity surgery treated with a cervical subarachnoid drain after a failed attempt at a direct repair. This 2-dimensional video illustrates the technique used for the placement of a cervical subarachnoid drain for the treatment of symptomatic CSF leak.  Patient consented to the procedure and for the publication of their image.

Ventral spinal cerebrospinal fluid leak as the cause of persistent post–dural puncture headache in children

2013 ◽  
Vol 11 (1) ◽  
pp. 48-51 ◽  
Author(s):  
Wouter I. Schievink ◽  
M. Marcel Maya
Keyword(s):  
Cerebrospinal Fluid ◽  
Dural Puncture ◽  
Surgical Repair ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Dural Defect ◽  
Digital Subtraction ◽  
Post Dural Puncture Headache ◽  
Digital Subtraction Myelography ◽  
Fluid Leak

Headache occurs after dural puncture in about 1%–25% of children who undergo the procedure—a rate similar to that seen in adults. Persistence of post–dural puncture headache in spite of bed rest, increased fluid intake, and epidural blood patch treatment, however, is rare. The authors reviewed the medical records and imaging studies of all patients 19 years of age or younger who they evaluated between 2001 and 2010 for intracranial hypotension, and they identified 8 children who had persistent post–dural puncture headache despite maximal medical treatment and placement of epidural blood patches. A CSF leak could be demonstrated radiologically and treated surgically in 3 of these patients, and the authors report these 3 cases. The patients were 2 girls (ages 14 and 16 years) who had undergone lumbar puncture for evaluation of headache and fever and 1 boy (age 13 years) who had undergone placement of a lumboperitoneal shunt using a Tuohy needle for treatment of pseudotumor cerebri. The boy also had undergone a laminectomy and exploration of the posterior dural sac, but no CSF leak could be identified. All 3 patients presented with new-onset orthostatic headaches, and in all 3 cases MRI demonstrated a large ventral lumbar or thoracolumbar CSF collection. Conventional myelography or digital subtraction myelography revealed a ventral dural defect at L2–3 requiring surgical repair. Through a posterior transdural approach, the dural defect was repaired using 6-0 Prolene sutures and a dural substitute. Postoperative recovery was uneventful, with complete resolution of orthostatic headache and of the ventral cerebrospinal fluid leak on MRI. The authors conclude that persistent postdural puncture headache requiring surgical repair is rare in children. They note that the CSF leak may be located ventrally and may require conventional or digital subtraction myelography for exact localization and that transdural repair is safe and effective in eliminating the headaches.

scholarly journals Management of cerebrospinal fluid leak from cervical gunshot wounds with external ventricular drainage: a small case series

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Clifford L Crutcher ◽  
John M Wilson ◽  
Kevin D Morrow ◽  
Jessica A Shields ◽  
Lindsay M Lasseigne ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
External Ventricular Drain ◽  
Treatment Algorithm ◽  
Case Series ◽  
Cerebrospinal Fluid Leak ◽  
Gunshot Wounds ◽  
External Ventricular Drainage ◽  
Csf Leak ◽  
Fluid Leak ◽  
Csf Leaks

Abstract Historically, the surgical management of gunshot wounds to the spine has been controversial. Repair of a persistent cerebrospinal fluid (CSF) leak is a generally agreed upon indication. The management of such CSF leaks typically involves lumbar drainage or direct surgical repair. Here, the authors report two cases of CSF diversion with an external ventricular drain (EVD) in patients with cervical gunshot wounds. Both patients had spinal canal obliteration or physiologic myelographic block at or below the level of injury. To the best of the author’s knowledge, these are the first two reports of successful EVD treatment of persistent CSF leaks related cervical gunshot wounds. The authors also propose a CSF treatment algorithm for cervical gunshot wounds that includes EVD.

scholarly journals Repair of Cerebrospinal Fluid Leak After Functional Endoscopy Sinus Surgery

2017 ◽  
Vol 1 (5) ◽  
Author(s):  
Mohamad I Sapta ◽  
Teresa L Wargasetia
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Sinus Surgery ◽  
Cerebrospinal Fluid Leak ◽  
Lamina Cribrosa ◽  
Clinical Findings ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Csf Leak ◽  
Computed Tomography Scanning ◽  
Fluid Leak

Cerebrospinal fluid (CSF) leak is one of Functional Endoscopic Sinus Surgery (FESS)complications. Since 2001, it was reported that there is one case of CSF leak as FESScomplication in ENT-HN Department, Faculty of Medicine, Maranatha Christian University -Immanuel Hospital in Bandung. The purpose of this case report is present clinical findings andmanagement of CSF leak as FESS complication. A-45 year old male with headache as chiefcomplain after undergone FESS five days before. There was a clear rhinorrhea running frompatient’s right nose. In nasoendoscopic examination, it was showed there was a defect in laminacribrosa. The result of paranasal sinus computed tomography scanning showed an air columnin brain ventricular system. The defect in lamina cribrosa was repaired by transnasalendoscopic using materials such as surgicel, cartilages, and fat tissues. The conclusion is weroll out one case about repair of CSF leak as a FESS complication and it was done with a goodresult.Keywords: cerebrospinal fluid leak, functional endoscopic sinus surgery

Sign in / Sign up

Export Citation Format

Share Document