Microscopic Endonasal Surgery for Repair of CSF Leaks

This manuscript will detail our experience using a microscopic endonasal surgery (MES) approach in the repair of spontaneous, traumatic, and/or iatrogenic cerebrospinal fluid (CSF) fistula into the ethmoid and sphenoid sinuses. The location of the fistula in 22 patients was determined by a direct endoscopic or microscopic visualization, intrathecal fluorescein, or computed tomography (CT) with metrizamide. Several of these patients had been treated unsuccessfully with previous neurosurgical, intracranial, and extracranial approaches to stop the leak. The CSF fistulas in all these patients were repaired with a MES approach, packing the leak with either a septal mucosal graft, or abdominal fat and fascia, and no external incisions were utilized. Furthermore, this approach allowed for an overall closure rate of 95% and offered a direct means to locate the fistula at the time of surgery. It also allowed for precise placement of grafts to cover the defect, an opportunity to perform bimanual dissection, and in general afforded an excellent field of vision.

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Oropharyngeal CSF Leak Secondary to Anterior Cervical Discectomy and Fusion

Case Reports in Otolaryngology ◽

10.1155/2018/7629184 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Wyatt J. Weinheimer ◽

Justin G. Rowley ◽

Randal Otto ◽

John Floyd ◽

Philip G. Chen

Keyword(s):

Cerebrospinal Fluid ◽

Differential Diagnosis ◽

Endoscopic Surgery ◽

Fusion Imaging ◽

Anterior Cervical Discectomy ◽

Csf Leak ◽

Cervical Discectomy ◽

Csf Fistula ◽

Second Procedure ◽

Csf Leaks

We present a case of an oropharyngeal cerebrospinal fluid (CSF) fistula in a patient that presented with headache, rhinorrhea, and pneumocephalus years after an anterior cervical discectomy and fusion. Imaging suggested a defect in the fovea ethmoidalis, but endoscopic surgery revealed the defect in the oropharynx. A second procedure was performed to remove the spinal hardware and repair the leak. This case is not only unique in the literature but also highlights the importance of maintaining a broad differential diagnosis to include rare complications and shows that despite dramatic improvements in imaging, locating CSF leaks still presents a challenge.

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Intrathecal Preoperative Contrast Enhanced Computed Tomography (CT) and Intraoperative Fluorescein Dye for Cerebrospinal Fluid (CSF) Leaks

The Laryngoscope ◽

10.1002/lary.20469 ◽

2009 ◽

Vol 119 (S1) ◽

pp. S150-S150

Author(s):

John W. Werning ◽

Stephen B. Lewis ◽

Jeffrey Bennett

Keyword(s):

Computed Tomography ◽

Cerebrospinal Fluid ◽

Contrast Enhanced ◽

Fluorescein Dye ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography ◽

Csf Leaks

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Bilateral cerebrospinal fluid rhinorrhoea

The Journal of Laryngology & Otology ◽

10.1258/0022215001904897 ◽

2000 ◽

Vol 114 (2) ◽

pp. 137-138 ◽

Cited By ~ 12

Author(s):

James D. Ramsden ◽

Rogan Corbridge ◽

Grant Bates

Keyword(s):

Cerebrospinal Fluid ◽

Surgical Treatment ◽

Surgical Approach ◽

Subarachnoid Space ◽

Complication Rates ◽

Endoscopic Repair ◽

Csf Fistula ◽

Cerebrospinal Fluid Rhinorrhoea ◽

Csf Rhinorrhoea ◽

Csf Leaks

Cerebrospinal fluid (CSF) rhinorrhoea is leakage of fluid from the subarachnoid space to the frontal, sphenoidal or ethmoidal sinuses, and may occur spontaneously. The authors present the first reported case of bilateral spontaneous CSF rhinorrhoea. Bony defects on both sides of the cribriform plate were identified using endoscopic and radiological techniques, and the CSF fistula was closed endoscopically. The aetiology, diagnosis and contemporary surgical treatment of spontaneous CSF leaks is discussed. Endoscopic repair was successful in this case, and in view of the high success and low reported complication rates this surgical approach should be considered for treatment of spontaneous CSF rhinorrhoea.

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Primary Spontaneous Cerebrospinal Fluid Leaks Located at the Clivus

Allergy & Rhinology ◽

10.2500/ar.2013.4.0053 ◽

2013 ◽

Vol 4 (2) ◽

pp. ar.2013.4.0053 ◽

Cited By ~ 14

Author(s):

Thibaut Van Zele ◽

Adriano Kitice ◽

Eduardo Vellutini ◽

Leonardo Balsalobre ◽

Aldo Stamm

Keyword(s):

Cerebrospinal Fluid ◽

Intraoperative Complications ◽

Reconstruction Technique ◽

Retrospective Case ◽

Closure Rate ◽

Transnasal Approach ◽

Duration Of Symptoms ◽

Csf Rhinorrhea ◽

Presenting Symptoms ◽

Csf Leaks

Transclival meningoceles and primary spontaneous cerebrospinal fluid (CSF) leaks at the clivus are extremely rare lesions and only few of them have been reported in the literature. We report here six cases of transclival primary spontaneous CSF leaks through the clivus. A retrospective case study was performed. We reviewed six cases involving sinonasal CSF leaks located at the clivus treated between 1997 and 2009. Presenting symptoms, duration of symptoms, defect size, site of defect, surgical approach and technique of defect closure, intraoperative complications, postoperative complications, and recurrences are discussed. All CSF leaks were located in the upper central part of the clivus. two of six patients showed signs of increased intracranial pressure (ICP) including arachnoid pits and/or empty sella. For three patients a purely transnasal approach was used with multilayer reconstruction using a nonvascularized graft, and three patients underwent a transnasal transseptal approach with a multilayer reconstruction, with nasoseptal flap. No recurrences of CSF leaks at clivus or other sites were observed to date with a mean follow-up of 10.3 years (range, 3–15 years). Spontaneous CSF rhinorrhea located at the clivus is an extremely rare condition. To date, only eight cases have been described. Here, we report the largest group of six consecutive cases. Irrespective of the used reconstruction technique in all cases a 100% closure rate was achieved. However, identification of increased ICP is an essential aspect and this condition should be treated either medically or surgically.

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Diagnosis of cerebral hemorrhage before the era of computed tomography

Orvosi Hetilap ◽

10.1556/oh.2013.29739 ◽

2013 ◽

Vol 154 (44) ◽

pp. 1743-1746

Author(s):

Gergely Hofgárt ◽

Rita Szepesi ◽

Bertalan Vámosi ◽

László Csiba

Keyword(s):

Computed Tomography ◽

Cerebrospinal Fluid ◽

Positive Predictive Value ◽

Predictive Value ◽

Hemorrhagic Stroke ◽

Cranial Computed Tomography ◽

Cerebral Stroke ◽

Daily Routine ◽

Stroke Patients ◽

The Difference

Introduction: During the past decades there has been a great progress in neuroimaging methods. Cranial computed tomography is part of the daily routine now and its use allows a fast diagnosis of parenchymal hemorrhage. However, before the availability of computed tomography the differentiation between ischemic and hemorrhagic stroke was based on patient history, physical examination, percutan angiography and cerebrospinal fluid sampling, and the clinical utility could be evaluated by autopsy of deceased patients. Aim: The authors explored the diagnostic performance of cerebrospinal fluid examination for the diagnosis of ischemic and hemorrhagic stroke. Method: Data of 200 deceased stroke patients were retrospectively evaluated. All patients had liquor sampling at admission and all of them had brain autopsy. Results: Bloody or yellowish cerebrospinal fluid at admission had a positive predictive value of 87.5% for hemorrhagic stroke confirmed by autopsy, while clear cerebrospinal fluid had positive predictive value of 90.7% for ischemic stroke. Patients who had clear liquor, but autopsy revealed hemorrhagic stroke had higher protein level in the cerebrospinal fluid, but the difference was not statistically significant (p = 0.09). Conclusions: The results confirm the importance of pathological evaluation of the brain in cases deceased from cerebral stroke. With this article the authors wanted to salute for those who contributed to the development of the Hungarian neuropathology. In this year we remember the 110th anniversary of the birth, and the 60th anniversary of the death of professor Kálmán Sántha. Professor László Molnár would be 90 years old in 2013. Orv. Hetil., 154 (44), 1743–1746.

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Hepatic steatosis in Cushing's syndrome: a radiological assessment using computed tomography

Acta Endocrinologica ◽

10.1530/eje.0.1490543 ◽

2003 ◽

Vol 149 (6) ◽

pp. 543-548 ◽

Cited By ~ 91

Author(s):

AG Rockall ◽

SA Sohaib ◽

D Evans ◽

G Kaltsas ◽

AM Isidori ◽

...

Keyword(s):

Computed Tomography ◽

Hepatic Steatosis ◽

Cushing’S Syndrome ◽

Negative Correlation ◽

Visceral Fat ◽

Subcutaneous Fat ◽

Significant Negative Correlation ◽

Cushing's Syndrome ◽

Abdominal Fat ◽

Visceral Fat Area

OBJECTIVE: Hepatic steatosis may occur in association with insulin resistance and obesity, two features commonly seen in Cushing's syndrome (CS). The aim of this report is to assess the prevalence of hepatic steatosis in patients with active CS using computed tomography (CT) and to identify any associations between hepatic steatosis, endocrine and biochemical variables and body fat distribution. PATIENTS AND MEASUREMENTS: We identified 50 patients with active CS in whom appropriate CT was available to allow measurement of liver and spleen attenuation. In 26 patients, abdominal fat measurements were also available. Serum markers of CS and liver function tests were recorded. RESULTS: Ten of 50 patients had a liver-to-spleen CT attenuation ratio (L/S) of less than 1, indicating hepatic steatosis. There was a significant negative correlation between both liver attenuation and L/S ratio with total abdominal fat area, visceral fat area, the percentage of visceral fat and the visceral to subcutaneous fat ratio; the strongest negative correlation was found between visceral fat area and L/S ratio (r=-0.638, P<0.001, n=26). L/S ratio positively correlated with alkaline phosphatase levels (r=+0.423, P=0.044, n=23) but with no other serum marker of CS activity or liver enzyme. CONCLUSIONS: We have demonstrated hepatic steatosis on CT in 20% of patients with active CS. The presence of hepatic steatosis was significantly correlated with total abdominal fat area and visceral fat area.

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The Effect of Fasting Month of Ramadan on the Abdominal Fat Distribution: Assessment by Computed Tomography

The Tohoku Journal of Experimental Medicine ◽

10.1620/tjem.204.179 ◽

2004 ◽

Vol 204 (3) ◽

pp. 179-187 ◽

Cited By ~ 41

Author(s):

Aylin Yucel ◽

Bumin Degirmenci ◽

Murat Acar ◽

Ramazan Albayrak ◽

Alpay Haktanir

Keyword(s):

Computed Tomography ◽

Fat Distribution ◽

Abdominal Fat

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Subclinical rhythmic electrographic discharge in adults: an atypical evolution

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1995000200014 ◽

1995 ◽

Vol 53 (2) ◽

pp. 266-269 ◽

Cited By ~ 5

Author(s):

Délrio F. Silva ◽

Edmar Zanoteli ◽

Márcia Marques Lima ◽

Renato Anghinah ◽

José Geraldo C. Lima

Keyword(s):

Computed Tomography ◽

Cerebrospinal Fluid ◽

Transient Ischemic Attack ◽

Computed Tomography Scan ◽

Ischemic Attack ◽

Tomography Scan

The subclinical rhythmic electrographic discharge in adults (SREDA) has been rarely reported. We describe the case of a 71 year-old man with transient ischemic attack, whose EEG showed an atypical evolution of this uncommon pattern. The computed tomography scan and cerebrospinal fluid were normal. We are not aware of any other report in the literature with this atypical evolution of SREDA.

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Ventricle Boundary in CT: Partial Volume Effect and Local Thresholds

International Journal of Biomedical Imaging ◽

10.1155/2010/674582 ◽

2010 ◽

Vol 2010 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Ihar Volkau ◽

Fiftarina Puspitasari ◽

Wieslaw L. Nowinski

Keyword(s):

Computed Tomography ◽

Cerebrospinal Fluid ◽

Grey Matter ◽

Ground Truth ◽

Gaussian Mixture ◽

Volume Effect ◽

Partial Volume Effect ◽

Partial Volume ◽

Image Histogram ◽

Global Threshold

We present a mathematical frame to carry out segmentation of cerebrospinal fluid (CSF) of ventricular region in computed tomography (CT) images in the presence of partial volume effect (PVE). First, the image histogram is fitted using the Gaussian mixture model (GMM). Analyzing the GMM, we find global threshold based on parameters of distributions for CSF, and for the combined white and grey matter (WGM). The parameters of distribution of PVE pixels on the boundary of ventricles are estimated by using a convolution operator. These parameters are used to calculate local thresholds for boundary pixels by the analysis of contribution of the neighbor pixels intensities into a PVE pixel. The method works even in the case of an almost unimodal histogram; it can be useful to analyze the parameters of PVE in the ground truth provided by the expert.

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