Is posttraumatic cerebrospinal fluid fistula a predictor of posttraumatic meningitis? A US Nationwide Inpatient Sample database study

2012 ◽  
Vol 32 (6) ◽  
pp. E4 ◽  
Author(s):  
Ashish Sonig ◽  
Jai Deep Thakur ◽  
Prashant Chittiboina ◽  
Imad Saeed Khan ◽  
Anil Nanda
Keyword(s):  
Cerebrospinal Fluid ◽  
Head Injury ◽  
Skull Base ◽  
Nationwide Inpatient Sample ◽  
Neurosurgical Procedures ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Factors Associated ◽  
Hospitalization Cost ◽  
Neurosurgical Intervention

Object Various factors have been reported in literature to be associated with the development of posttraumatic meningitis. There is a paucity of data regarding skull fractures and facial fractures leading to CSF leaks and their association with the development of meningitis. The primary objective of this study was to analyze the US Nationwide Inpatient Sample (NIS) database to elucidate the factors associated with the development of posttraumatic meningitis. A secondary goal was to analyze the overall hospitalization cost related to posttraumatic meningitis and factors associated with that cost. Methods The NIS database was analyzed to identify patients admitted to hospitals with a diagnosis of head injury from 2005 through 2009. This data set was analyzed to assess the relationship of various clinical parameters that may affect the development of posttraumatic meningitis using binary logistic regression models. Additionally, the overall hospitalization cost for the head injury patients who did not undergo any neurosurgical intervention was further categorized into quartile groups, and a regression model was created to analyze various factors responsible for escalating the overall cost of the hospital stay. Results A total of 382,267 inpatient admissions for head injury were analyzed for the 2005–2009 period. Meningitis was reported in 0.2% of these cases (708 cases). Closed skull base fractures, open skull base fractures, cranial vault fractures, and maxillofacial fractures were reported in 20,524 (5.4%), 1089 (0.3%), 5064 (1.3%), and 88,649 (23.2%) patients, respectively. Among these patients with fractures, meningitis was noted in 0.17%, 0.18%, 0.05%, and 0.10% admissions, respectively. Cerebrospinal fluid rhinorrhea was reported in 453 head injury patients (0.1%) and CSF otorrhea in 582 (0.2%). Of the patients reported to have CSF rhinorrhea, 35 (7.7%) developed meningitis, whereas in the cohort with CSF otorrhea, 15 patients (2.6%) developed meningitis. Cerebrospinal fluid rhinorrhea (p < 0.001, OR 22.8, 95% CI 15.6–33.3), CSF otorrhea (p < 0.001, OR 9.2, 95% CI 5.2–16.09), and major neurosurgical procedures (p < 0.001, OR 5.6, 95% CI 4.8–6.5) were independent predictors of meningitis. Further, CSF rhinorrhea (p < 0.001, OR 2.0, 95% CI 1.6–2.7), CSF otorrhea (p < 0.001, OR 2.3, 95% CI 1.9–2.7), and posttraumatic meningitis (p < 0.001, OR 3.1, 95% CI 2.5–3.8) were independent factors responsible for escalating the cost of head injury in cases not requiring any major neurosurgical intervention. Conclusions Cerebrospinal fluid rhinorrhea and CSF otorrhea are independent predictors of posttraumatic meningitis. Furthermore, meningitis and CSF fistulas may independently lead to significantly increased cost of hospitalization in head injury patients not undergoing any major neurosurgical intervention.

scholarly journals Delayed Presentation of Traumatic Cerebrospinal Fluid Rhinorrhea: Case Report and Literature Review

2015 ◽  
Vol 6 (3) ◽  
pp. ar.2015.6.0132 ◽  
Author(s):  
Richard A. Guyer ◽  
Justin H. Turner
Keyword(s):  
Cerebrospinal Fluid ◽  
Head Injury ◽  
Skull Base ◽  
Late Onset ◽  
Closed Head Injury ◽  
Csf Leak ◽  
Delayed Presentation ◽  
Traumatic Head Injury ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea

Cerebrospinal fluid (CSF) leak is one of several complications that can occur after traumatic skull base injury. Although most patients present soon after the injury occurs, some can present years later, with resulting morbidity and the need for additional procedures. We present a case of a patient with a sphenoid sinus CSF leak who presented 12 years after a closed head injury that included a sphenoethmoid skull base fracture. We also reviewed the literature on this topic, with a discussion of previous reports of CSF leaks that occurred months, years, or decades after trauma. A late onset CSF leak appears to be a rare but important complication of traumatic skull base injury. This case highlights the need for clinicians to remain vigilant to the possibility of delayed CSF rhinorrhea, even years after traumatic head injury.

Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures

2012 ◽  
Vol 32 (6) ◽  
pp. E3 ◽  
Author(s):  
Mateo Ziu ◽  
Jennifer Gentry Savage ◽  
David F. Jimenez
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Head Injuries ◽  
Anterior Skull Base ◽  
Surgical Approaches ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Diagnosis And Management ◽  
Increased Risk ◽  
Technical Advances

Cerebrospinal fluid rhinorrhea is a serious and potentially fatal condition because of an increased risk of meningitis and brain abscess. Approximately 80% of all cases occur in patients with head injuries and craniofacial fractures. Despite technical advances in the diagnosis and management of CSF rhinorrhea caused by craniofacial injury through the introduction of MRI and endoscopic extracranial surgical approaches, difficulties remain. The authors review here the pathophysiology, diagnosis, and management of CSF rhinorrhea relevant exclusively to traumatic anterior skull base injuries and attempt to identify areas in which further work is needed.

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.

Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea and Skull Base Defects: A Review of Twenty-Nine Cases

1994 ◽  
Vol 111 (5) ◽  
pp. 600-605 ◽  
Author(s):  
Edward E. Dodson ◽  
Charles W. Gross ◽  
Jason L. Swerdloff ◽  
L. Mark Gustafson
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Sinus Surgery ◽  
Neurosurgical Procedures ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Endoscopic Techniques ◽  
Time Period ◽  
Transnasal Endoscopic Repair ◽  
Skull Base Defects ◽  
Tissue Grafts

The management of cerebrospinal fluid rhinorrhea has historically plagued the neurosurgeon and the otolaryngologist—head and neck surgeon. Intracranial repair is still favored at many institutions, despite its inherent morbidity. Extracranial nonendoscopic techniques have been previously described but have not gained wide acceptance. More recently, several reports have been published describing a variety of endoscopic techniques in limited patient series used to manage cerebrospinal fluid rhinorrhea. We present our series of 29 patients with cerebrospinal fluid rhinorrhea, treated with endoscopic techniques between December 1989 and June 1993, with follow-up ranging from 3 to 43 months. This represents the largest reported series to date of patients treated with this technique. Our technique has evolved during this time period but centers around the use of free tissue grafts from various donor sites. The causes of the skull base defects in this series included neurosurgical procedures (9), functional endoscopic sinus surgery (8), and trauma (3). Defects occurred spontaneously in 9 cases. The fovea ethmoidalis and sphenoid sinus were the site in 11 and 12 cases, respectively, and the cribriform plate was involved in 6 cases. Cerebrospinal fluid rhinorrhea was documented by nasal endoscopy with or without intrathecal fluorescein, laboratory studies, computed tomography with or without contrast cisternography, and radioisotope cisternography in various combinations. Resolution of cerebrospinal fluid rhinorrhea was achieved in 22 of 29 patients (75.9%) with one endoscopic procedure and 25 of 29 patients (86.2%) after a second attempt. Four patients required neurosurgical intervention for recurrent cerebrospinal fluid rhinorrhea. Complications were minimal and were related primarily to the original pathology or procedure. Cerebrospinal fluid rhinorrhea can be managed safely and effectively with endoscopic techniques in a majority of cases, and the morbidity of open procedures can be avoided.

scholarly journals Minimally invasive endoscopic repair of refractory lateral skull base cerebrospinal fluid rhinorrhea: case report and review of the literature

2018 ◽  
Vol 44 (3) ◽  
pp. E8 ◽  
Author(s):  
Brandon Lucke-Wold ◽  
Erik C. Brown ◽  
Justin S. Cetas ◽  
Aclan Dogan ◽  
Sachin Gupta ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Minimally Invasive ◽  
Skull Base ◽  
Congenital Defects ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Lateral Skull Base ◽  
Csf Diversion ◽  
Csf Leaks

Cerebrospinal fluid (CSF) leaks occur in approximately 10% of patients undergoing a translabyrinthine, retrosigmoid, or middle fossa approach for vestibular schwannoma resection. Cerebrospinal fluid rhinorrhea also results from trauma, neoplasms, and congenital defects. A high degree of difficulty in repair sometimes requires repetitive microsurgical revisions—a rate of 10% of cases is often cited. This can not only lead to morbidity but is also costly and burdensome to the health care system. In this case-based theoretical analysis, the authors summarize the literature regarding endoscopic endonasal techniques to obliterate the eustachian tube (ET) as well as compare endoscopic endonasal versus open approaches for repair. Given the results of their analysis, they recommend endoscopic endonasal ET obliteration (EEETO) as a first- or second-line technique for the repair of CSF rhinorrhea from a lateral skull base source refractory to spontaneous healing and CSF diversion. They present a case in which EEETO resolved refractory CSF rhinorrhea over a 10-month follow-up after CSF diversions, wound reexploration, revised packing of the ET via a lateral microscopic translabyrinthine approach, and the use of a vascularized flap had failed. They further summarize the literature regarding studies that describe various iterations of EEETO. By its minimally invasive nature, EEETO imposes less morbidity as well as less risk to the patient. It can be readily implemented into algorithms once CSF diversion (for example, lumbar drain) has failed, prior to considering open surgery for repair. Additional studies are warranted to further demonstrate the outcome and cost-saving benefits of EEETO as the data until now have been largely empirical yet very hopeful. The summaries and technical notes described in this paper may serve as a resource for those skull base teams faced with similar challenging and otherwise refractory CSF leaks from a lateral skull base source.

Cerebrospinal Fluid Rhinorrhea 34 Years after Trauma: A Case Report and Review of the Literature

Neurosurgery ◽  
1984 ◽  
Vol 15 (5) ◽  
pp. 705-706 ◽  
Author(s):  
Tom Russell ◽  
Brian H. Cummins
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Head Injury ◽  
17Th Century ◽  
Review Of The Literature ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Intracranial Infection

Abstract Posttraumatic cerebrospinal fluid (CSF) rhinorrhea has been recognized since the 17th century, and its association with intracranial infection has been well documented. However, CSF rhinorrhea usually presents during the 1st month after trauma. Cases presenting more than 3 months after trauma are unusual. The authors report a case of CSF rhinorrhea that presented 34 years after head injury.

scholarly journals Management and outcome of post-traumatic cerebrospinal fluid rhinorrhea

2020 ◽  
Vol 8 (3) ◽  
pp. 937
Author(s):  
Nasiru Jinjiri Ismail ◽  
Ali Lasseini ◽  
Aliyu Muhammad Koko ◽  
Bello Bala Shehu
Keyword(s):  
Cerebrospinal Fluid ◽  
Head Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Sub Saharan Africa ◽  
Aetiological Factor ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Post Traumatic ◽  
Sub Saharan

Background: Post-traumatic cerebrospinal fluid (CSF) rhinorrhea are relatively uncommon neurosurgical condition that is associated with serious morbidity and life-threatening complications like meningitis. As such, it requires prompt and thorough evaluation and treatment. Is of note that, only few studies discussed CSF rhinorrhea in literature especially in sub-Saharan Africa. This study was designed to report outcomes of management of post-traumatic CSF rhinorrhea seen in our institution.Methods: Relevant data of all patients with post-traumatic CSF rhinorrhea managed from July 2015 to June 2019 were retrospectively reviewed.Results: Out of the total 1942 cases of head injury managed over the study period 20 cases (1%) were diagnosed with CSF rhinorrhea. The mean age of presentation was 30.5 years. All patients were male and road traffic accidents was the only aetiological factor noted. Majority of patients developed rhinorrhea after 48 hours of injury (12/20). Pneumocephalus was the commonest computerised tomographic scan finding and about 2/3rd of the patients required operative treatment by transcranial anterior cranial fossa repair (13/20). The remaining patients were managed non-operatively with acetazolamide, antihistamines, stool softeners and antibiotics. The outcome was generally good with no recurrence noted. The rate of mortality was 10% (2/20) and resulted from meningitis.Conclusions: Posttraumatic CSF rhinorrhea was seen in 1% of cases of head injury in our environment and affects males predominantly. Although, the outcome of treatments was good, 10% mortality caused by meningitis was recorded.

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.

Economic burden of readmission due to postoperative cerebrospinal fluid leak in Chinese patients

2020 ◽  
Vol 9 (16) ◽  
pp. 1105-1115
Author(s):  
Shuqing Wu ◽  
Xin Cui ◽  
Shaoyu Zhang ◽  
Wenqi Tian ◽  
Jiazhen Liu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Generalized Linear Models ◽  
Economic Burden ◽  
Linear Models ◽  
Chinese Patients ◽  
Cerebrospinal Fluid Leakage ◽  
Index Hospitalization ◽  
Real World Data ◽  
Factors Associated ◽  
Hospitalization Cost

Aim: This real-world data study investigated the economic burden and associated factors of readmissions for cerebrospinal fluid leakage (CSFL) post-cranial, transsphenoidal, or spinal index surgeries. Methods: Costs of CSFL readmissions and index hospitalizations during 2014–2018 were collected. Readmission cost was measured as absolute cost and as percentage of index hospitalization cost. Factors associated with readmission cost were explored using generalized linear models. Results: Readmission cost averaged US$2407–6106, 35–94% of index hospitalization cost. Pharmacy costs were the leading contributor. Generalized linear models showed transsphenoidal index surgery and surgical treatment for CSFL were associated with higher readmission costs. Conclusion: CSFL readmissions are a significant economic burden in China. Factors associated with higher readmission cost should be monitored.

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