Vascularized temporoparietal fascial flap for the treatment of a traumatic cerebrospinal fluid fistula in the middle cranial fossa

2009 ◽  
Vol 111 (2) ◽  
pp. 393-395 ◽  
Author(s):  
Mahmoud Taha ◽  
Thomas Carroll ◽  
Jeremy McMahon
Keyword(s):  
Cerebrospinal Fluid ◽  
Middle Cranial Fossa ◽  
Cerebrospinal Fluid Fistula ◽  
Pedicle Flap ◽  
Csf Fistula ◽  
Fascial Flap ◽  
Csf Leakage ◽  
Cranial Fossa ◽  
Fluid Fistula

The temporoparietal fascial flap (TPFF) is a vascularized pedicle flap commonly used in head and neck reconstructions. The authors describe the use of a TPFF in repairing a large traumatic middle cranial fossa CSF fistula via a middle cranial fossa approach. During the 18-month follow-up, the patient had no further CSF leakage or meningitis. The use of a TPFF for the repair of a traumatic CSF fistula has not been described in the literature. The authors recommend the use of a TPFF in treating recurrent or large middle cranial fossa CSF fistulas. The flap provides a well-vascularized thin layer that can be ideal in middle cranial fossa repair, and its proximity to the operation site is perfect as well.

Cerebrospinal Fluid Fistula Involving the Sphenoid Sinus

Neurosurgery ◽  
1987 ◽  
Vol 20 (1) ◽  
pp. 31-32 ◽  
Author(s):  
Martin Christie
Keyword(s):  
Cerebrospinal Fluid ◽  
Computerized Tomography ◽  
Sphenoid Sinus ◽  
Middle Cranial Fossa ◽  
Cerebrospinal Fluid Fistula ◽  
Lateral Extension ◽  
Cranial Fossa ◽  
Fluid Fistula

Abstract A case of posttraumatic delayed cerebrospinal fluid fistula from the middle cranial fossa to a lateral extension of the sphenoid sinus is reported. The advantages in demonstrating this unusual set of circumstances by computerized tomography are discussed.

Extradural cartilage inlay graft in cerebrospinal fluid fistula repair

2010 ◽  
Vol 124 (12) ◽  
pp. 1294-1297 ◽  
Author(s):  
P Thulasi Das ◽  
D Balasubramanian
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Success Rate ◽  
Bony Defect ◽  
Cerebrospinal Fluid Fistula ◽  
Fistula Repair ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Skull Base Defects ◽  
Fluid Fistula

AbstractObjective:To present our experience in managing cerebrospinal fluid rhinorrhoea using the cartilage inlay (underlay) technique to repair skull base defects larger than 4 mm.Study design:Retrospective study involving patients presenting with cerebrospinal fluid rhinorrhoea between 1994 and 2008.Setting:Patients were treated in a tertiary referral centre for nose and sinus diseases. Patients' medical records were reviewed and analysed.Results:A total of 62 patients were operated upon using a cartilage inlay technique to repair bony skull base defects ranging in size from 4 to 20 mm (widest diameter). Of these 62 patients, 16 constituted revisions of earlier procedures undertaken elsewhere. The success rate of the technique was 100 per cent. Patient follow up ranged from six months to 16 years, with a median follow up of 15 months. Three patients had minor post-operative sinus infections; no serious complications were encountered.Conclusion:Extradural cartilage inlay appears to be an effective technique in the management of cerebrospinal fluid rhinorrhoea, especially for large defects and revision procedures. To our knowledge, the described patients represent the largest reported series of cerebrospinal fluid rhinorrhoea cases managed using the cartilage inlay technique. We believe that the crucial factors in our high success rate for cerebrospinal fluid fistula repair are: precise identification of the bony defect; meticulous preparation of the graft bed; careful elevation of the dura; judicious use of just enough graft tissue; and adequate graft support.

Endoscopic Reconstruction of the Middle Cranial Fossa Through a Subtemporal Keyhole Using a Pedicled Deep Temporal Fascial Flap

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons157-ons162 ◽  
Author(s):  
Mika Komatsu ◽  
Fuminari Komatsu ◽  
Antonio Di Ieva ◽  
Tooru Inoue ◽  
Manfred Tschabitscher
Keyword(s):  
Skull Base ◽  
Middle Cranial Fossa ◽  
Pedicled Flap ◽  
Temporal Muscle ◽  
Temporal Fascia ◽  
Fresh Cadaver ◽  
Fascial Flap ◽  
Csf Leakage ◽  
Cranial Fossa ◽  
Temporal Fascial Flap

Abstract BACKGROUND: Reconstruction of the skull base is essential to prevent postoperative leakage of cerebrospinal fluid (CSF). However, a reliable method of reconstructing the middle cranial fossa via a subtemporal keyhole is not available. OBJECTIVE: To determine whether less invasive reconstruction of the middle cranial fossa under endoscopic guidance with a pedicled deep temporal fascia approach via a subtemporal keyhole is feasible and useful. METHODS: The middle cranial fossa in 4 fresh cadaver heads was reconstructed with a 4-mm 0° rigid endoscope. RESULTS: A subtemporal skin incision (subtemporal incision) was followed by 2 small skin incisions (temporal line incisions) made on the superior temporal line. The endoscope was inserted through the temporal line incisions, and then the deep temporal fascia was separated from the superficial temporal fascia and temporal muscle under endoscopic view. A pedicled flap was harvested from the subtemporal incision and applied to the middle cranial fossa after subtemporal keyhole craniotomy. The pedicled deep temporal fascial flap was flexible, long, and large enough to overlay skull base defects. CONCLUSION: This purely endoscopic technique using a pedicled deep temporal fascial flap provided reliable reconstruction of the middle cranial fossa through a subtemporal keyhole. This technique would also be applicable in preventing CSF leakage or treating traumatic, acquired nontraumatic, or congenital encephalocele in the middle cranial fossa.

scholarly journals Cerebrospinal fluid fistula management – border pathology ENT-neurosurgery

2015 ◽  
Vol 62 (3) ◽  
pp. 303-306
Author(s):  
Corneliu Toader ◽  
◽  
Mioriţa Toader ◽  
Mircea Drăghici ◽  
Alina Oprea ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Dominant Role ◽  
Diagnostic Methods ◽  
High Rate ◽  
Anatomical Location ◽  
Cerebrospinal Fluid Fistula ◽  
Csf Fistula ◽  
Rate Of Success ◽  
Fluid Fistula

The authors of this article mention the diagnostic methods, the surgery techniques and the postoperative care for the patients diagnosed with fistula of cerebrospinal fluid (CSF). The surgery cure depends on many factors, including here the etiology of the rhino-basis defect, intracranial pressure, anatomical location of the rhino-basis defect and it is strictly individualized, which depends on the success of all surgery procedures. ENT physicians, together with the neurosurgeons, were able to have a dominant role in the diagnostic evaluation and in the treatment of skull base pathology can give us a CSF fistula. Nasal endoscopy has revolutionized the treatment of CSF fistula, with a high rate of success.

scholarly journals The efficacy of an endoscopic endonasal approach in the repair of cerebrospinal fluid fistula: a clinical analysis

2019 ◽  
Vol 5 (4) ◽  
pp. 90
Author(s):  
Fulya Ozer ◽  
Can Alper Cagici ◽  
Cem Ozer ◽  
Cuneyt Yilmazer
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Approach ◽  
Graft Material ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Cerebrospinal Fluid Fistula ◽  
Endoscopic Repair ◽  
Endoscopic Endonasal ◽  
Csf Leakage ◽  
Fluid Fistula

<p class="abstract"><strong>Background:</strong> Cerebrospinal fluid (CSF) fistula is an abnormal CSF leakage due to bone and/or dural defect of the skull base and usually operated with endonasal endoscopic approach. The aim of this study was to determine the efficacy of an endonasal endoscopic approach in the repair of CSF leakage and to find the reasons of the recurrence of endoscopic procedure.</p><p class="abstract"><strong>Methods:</strong> The medical records of 24 patients that presented with the diagnosis of cerebrospinal fluid fistula and who had undergone endonasal endoscopic repair surgery were reviewed retrospectively.  </p><p class="abstract"><strong>Results:</strong> 13 patients (54.2%) were found to have spontaneous CSF fistulas without any history of trauma, while 11 patients (45.8%) had posttraumatic CSF fistulas. The mean body mass index (BMI) of patients was 31. 3 kg/m² (20.1-49.6). Nasal septal cartilage was used as a graft material in 19 patients (79%) while only fascia was used in 5 patients (21%). The evaluation of long-term results revealed recurrence in 4 patients (16.6%). Two of these patients required a second surgical repair.</p><p class="abstract"><strong>Conclusions:</strong> An endoscopic endonasal approach is a safe method with less morbidity and a reliable outcome in the repair of CSF fistulas. The most important causative factors in the recurrence of endoscopic repair of CSF leak might be to have high BMI and not to use multilayered graft material for closure of fistula.</p><p class="abstract"> </p>

scholarly journals Cerebrospinal fluid fistula as the presenting manifestation of pituitary adenoma: case report with a 4-year follow-up

2001 ◽  
Vol 59 (2A) ◽  
pp. 263-265 ◽  
Author(s):  
Ricardo Alexandre Hanel ◽  
Daniel Monte Serrat Prevedello ◽  
Alceu Correa ◽  
Affonso Antoniuk ◽  
João Cândido Araújo
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Sella Turcica ◽  
Rare Condition ◽  
Normal Serum ◽  
Cerebrospinal Fluid Fistula ◽  
Csf Rhinorrhea ◽  
Csf Leakage ◽  
Bony Erosion

We report the case of a young woman who presented with cerebrospinal fluid (CSF) rhinorrhea due to an undiagnosed and untreated pituitary adenoma. The tumor had extended well beyond sella turcica and caused bony erosion. The patient initially refused surgery and was treated with bromocriptine and a radiation therapy. CSF leakage did not improved and she was submitted to surgery by the transsphenoidal approach with removal of a tumor mass located in sphenoid sinus and sellar region. Origin of the leak was localized and repaired with fascia lata and a lumbar subarachnoid drain was left in place for 5 days. After 4 years she has normal serum PRL levels and no rhinorrhea. The management, complications and mechanisms involved in this rare condition are discussed.

scholarly journals Cerebrospinal Fluid Leak Rate after Vestibular Schwannoma Surgery via Middle Cranial Fossa Approach

2018 ◽  
Vol 80 (04) ◽  
pp. 437-440 ◽  
Author(s):  
Noga Lipschitz ◽  
Gavriel D. Kohlberg ◽  
Kareem O. Tawfik ◽  
Zoe A. Walters ◽  
Joseph T. Breen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Vestibular Schwannoma ◽  
Middle Cranial Fossa ◽  
Leak Rate ◽  
Gross Total Resection ◽  
Csf Leak ◽  
Tumor Diameter ◽  
Total Resection ◽  
Csf Leakage ◽  
Cranial Fossa

Objective Evaluate the cerebrospinal fluid (CSF) leak rate after the middle cranial fossa (MCF) approach to vestibular schwannoma (VS) resection. Design Retrospective case series. Setting Quaternary referral academic center. Participants Of 161 patients undergoing the MCF approach for a variety of skull base pathologies, 66 patients underwent this approach for VS resection between 2007 and 2017. Main Outcome Measure Postoperative CSF leak rate. Results There were two instances of postoperative CSF leak (3.0%). Age, gender, and BMI were not significantly associated with CSF leak. In the two cases with CSF leakage, tumors were isolated to the internal auditory canal (IAC) and both underwent gross total resection. Both CSF leaks were successfully treated with lumbar drain diversion. For the 64 cases that did not have a CSF leak, 51 were isolated to the IAC, 1 was located only in the cerebellopontine angle (CPA), and 12 were located in both the IAC and CPA. 62 patients underwent gross total resection and 2 underwent near-total resection. Mean maximal tumor diameter in the CSF leak group was 4.5 mm (range: 3–6 mm) versus 10.2 mm (range: 3–19 mm) in patients with no CSF leak (p = 0.03). Conclusions The MCF approach for VS resection is a valuable technique that allows for hearing preservation and total tumor resection and can be performed with a low CSF leakage rate. This rate of CSF leak is less than the reported rates in the literature in regard to both translabyrinthine and retrosigmoid approaches.

Meningitis following acute traumatic cerebrospinal fluid fistula

1970 ◽  
Vol 33 (3) ◽  
pp. 312-316 ◽  
Author(s):  
Edwin E. MacGee ◽  
Joseph C. Cauthen ◽  
Charles E. Brackett
Keyword(s):  
Cerebrospinal Fluid ◽  
Prophylactic Antibiotics ◽  
Present Series ◽  
Cerebrospinal Fluid Fistula ◽  
Csf Rhinorrhea ◽  
Content Type ◽  
Csf Fistula ◽  
Fluid Fistula ◽  
Fine Print

✓ The effect of prophylactic antibiotics in preventing meningitis are reviewed in 58 cases of acute traumatic cerebrospinal fluid (CSF) fistula. A summary of the literature plus data from the present series show a total of 402 cases of acute traumatic CSF fistula; there were 46 cases (14%) of meningitis in 325 patients receiving expectant antibiotics, and four cases (5%) in 77 patients treated without antibiotics. No statistically significant conclusion can be drawn from these data regarding the usefulness of expectant antibiotics in acute traumatic CSF rhinorrhea or otorrhea.

Sacral Fracture with Pseudomeningocele and Cerebrospinal Fluid Fistula: Case Report and Review of the Literature

Neurosurgery ◽  
1985 ◽  
Vol 16 (6) ◽  
pp. 843-846 ◽  
Author(s):  
Mark N. Hadley ◽  
Philip L. Carter
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Sacral Fracture ◽  
Diagnostic Evaluation ◽  
Sacral Vertebra ◽  
Review Of The Literature ◽  
Cerebrospinal Fluid Fistula ◽  
Csf Fistula ◽  
Presenting Symptoms ◽  
Fluid Fistula

Abstract A patient who sustained an isolated transverse sacral fracture is presented. A large ventral sacral pseudomeningocele with cerebrospinal fluid (CSF) fistula developed. Eighteen previous cases of traumatic pseudomeningocele have been documented. A review of those cases leads these authors to conclude that: (a) transverse sacral fractures are rare and have not been reported in association with a pseudomeningocele formation; (b) at the 4th sacral vertebra, this is the lowest reported pseudomeningocele; and (c) CSF fistula with sacral fracture is distinctly uncommon, reported in only one previous case. The presenting symptoms, diagnostic evaluation, treatment, and prognosis are discussed.

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