Use of tissue adhesive in the surgical treatment of cerebrospinal fluid leaks

1973 ◽  
Vol 39 (3) ◽  
pp. 332-336 ◽  
Author(s):  
John A. Maxwell ◽  
Stephen I. Goldware
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Cerebrospinal Fluid Leak ◽  
Tissue Adhesive ◽  
Content Type ◽  
Local Toxicity ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak ◽  
Fine Print

✓ This report describes 12 cases of cerebrospinal fluid leak repaired with isobutyl 2-cyanoacrylate. We have found this tissue adhesive to be a valuable technical adjunct in the management of this problem and have not seen any general or local toxicity to the material.

Surgical treatment of spontaneous intracranial hypotension associated with a spinal arachnoid diverticulum

1994 ◽  
Vol 80 (4) ◽  
pp. 736-739 ◽  
Author(s):  
Wouter I. Schievink ◽  
Ronald Reimer ◽  
W. Neath Folger
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Content Type ◽  
Fluid Leak ◽  
Fine Print

✓ The authors present the case of a 22-year-old woman who developed spontaneous intracranial hypotension as a result of a cerebrospinal fluid leak from a thoracic extradural arachnoid diverticulum. The patient was successfully treated by ligation of the diverticulum. The entity of spontaneous intracranial hypotension and its relevance to neurosurgery are discussed.

Cerebral vasospasm following intracranial hypotension caused by cerebrospinal fluid leak from an incidental lumbar durotomy

2005 ◽  
Vol 102 (1) ◽  
pp. 152-155 ◽  
Author(s):  
Claudia Chaves ◽  
Stephen R. Freidberg ◽  
Grace Lee ◽  
Vasilios Zeris ◽  
Sarah Ries ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebral Vasospasm ◽  
Intracranial Hypotension ◽  
Unusual Case ◽  
Cerebrospinal Fluid Leak ◽  
Dural Tear ◽  
Content Type ◽  
Incidental Durotomy ◽  
Fluid Leak ◽  
Fine Print

✓ The authors report on the unusual case of a patient with intracranial hypotension following an incidental durotomy complicated by an extensive but reversible cerebral vasospasm. Despite the dural tear repair and correction of the intracranial hypotension, the vasospasm ran its course. The precise mechanism of the cerebral vasospasm in this patient is unclear.

scholarly journals Management of persistent cerebrospinal fluid leak using tissue adhesive

2015 ◽  
Vol 24 (1) ◽  
pp. 87-88
Author(s):  
J.R. Privratsky ◽  
S.L. McCartney ◽  
T.K. Allen ◽  
A.S. Habib
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Tissue Adhesive ◽  
Fluid Leak

Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

1998 ◽  
Vol 88 (2) ◽  
pp. 243-246 ◽  
Author(s):  
Wouter I. Schievink ◽  
Vittorio M. Morreale ◽  
John L. D. Atkinson ◽  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Intracranial Hypotension ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Content Type ◽  
Surgical Exploration ◽  
Fine Print ◽  
Csf Leaks

Object. Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. Methods. Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22–61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. Conclusions. All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3–58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

A physiological sealant for cerebrospinal fluid leaks

1977 ◽  
Vol 46 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Gerald D. Silverberg ◽  
Christina B. Harbury ◽  
Edward Rubenstein
Keyword(s):  
Cerebrospinal Fluid ◽  
Histological Examination ◽  
Content Type ◽  
Cerebrospinal Fluid Leaks ◽  
The Brain ◽  
Fine Print ◽  
Csf Leaks

✓ A combination of concentrated platelets, thrombin, and fibrinogen was used to adhere a pericranial graft to surgically produced cerebrospinal fluid (CSF) fistulas in dogs. This sealant successfully stopped leakage of CSF in all fistulas produced in both acute and chronic preparations. All control animals leaked CSF acutely. In chronic control animals the CSF leaks sealed spontaneously but the grafts were not well incorporated. Histological examination of the grafts and underlying brain showed no injury to the brain or meningeal vessel from exposure to the platelet glue. Good fibrous union of the grafts to the dura was confirmed.

“Gasket-seal” Watertight Closure in Minimal-access Endoscopic Cranial Base Surgery

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS342-ONS343 ◽  
Author(s):  
Lewis Z. Leng ◽  
Seth Brown ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Cranial Base ◽  
Minimal Access ◽  
Anterior Cranial Base ◽  
Tissue Sealant ◽  
Cerebrospinal Fluid Leaks ◽  
Cranial Base Surgery ◽  
Watertight Closure ◽  
Fluid Leak

Abstract Objective: Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented. Methods: To achieve watertight closure of the anterior cranial base, autologous fascia lata was used to create a “gasket seal” around a bone buttress, followed by application of a tissue sealant such as DuraSeal (Confluent Surgical, Inc., Waltham, MA). The gasket-seal closure was used to seal the anterior cranial base in a series of 10 patients with intradural surgery for suprasellar craniopharyngiomas (n = 5), planum meningiomas (n = 3), clival chordoma (n = 1), and recurrent iatrogenic cerebrospinal fluid leak (n = 1). Lumbar drains were placed intraoperatively in five patients and remained in place for 3 days postoperatively. Results: After a mean follow-up period of 12 months, there were no cerebrospinal fluid leaks. Conclusion: The gasket-seal closure is an effective method for achieving watertight closure of the anterior cranial base after endoscopic intradural surgery.

Recurrent spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study

2003 ◽  
Vol 99 (5) ◽  
pp. 840-842 ◽  
Author(s):  
Wouter I. Schievink ◽  
M. Marcel Maya ◽  
Mary Riedinger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Surgical Repair ◽  
Csf Leak ◽  
Content Type ◽  
Cerebrospinal Fluid Leaks ◽  
The Mean ◽  
A Prospective Study ◽  
Fine Print

Object. Intracranial hypotension due to a spontaneous spinal cerebrospinal fluid (CSF) leak is an increasingly recognized cause of postural headaches, but reliable follow-up data are lacking. The authors undertook a study to determine the risk of a recurrent spontaneous spinal CSF leak. Methods. The patient population consisted of a consecutive group of 18 patients who had been evaluated for consideration of surgical repair of a spontaneous spinal CSF leak. The mean age of the 15 women and three men was 38 years (range 22–55 years). The mean duration of follow up was 36 months (range 6–132 months). The total follow-up time was 654 months. A recurrent spinal CSF leak was defined on the basis of computerized tomography myelography evidence of a CSF leak in a previously visualized but unaffected spinal location. Five patients (28%) developed a recurrent spinal CSF leak; the mean age of these four women and one man was 36 years. A recurrent CSF leak developed in five (38%) of 13 patients who had undergone surgical CSF leak repair, compared with none (0%) of five patients who had been treated non-surgically (p = 0.249). The recurrent leak occurred between 10 and 77 months after the initial CSF leak, but within 2 or 3 months of successful surgical repair of the leak in all patients. Conclusions. Recurrent spontaneous spinal CSF leaks are not rare, and the recent successful repair of such a leak at another site may be an important risk factor.

Transsphenoidal microsurgery in the management of craniopharyngioma

1980 ◽  
Vol 52 (5) ◽  
pp. 661-666 ◽  
Author(s):  
Edward R. Laws
Keyword(s):  
Cerebrospinal Fluid ◽  
Visual Loss ◽  
Total Removal ◽  
Operative Death ◽  
Critical Feature ◽  
Content Type ◽  
Prior Therapy ◽  
Transsphenoidal Microsurgery ◽  
Cerebrospinal Fluid Leaks ◽  
Fine Print

✓ The rationale for the transsphenoidal approach in the surgical management of craniopharyngioma is presented, based on experience with 26 cases. In 14 patients without prior therapy, nine had “total” removal of the lesion, and only two had permanent postoperative diabetes insipidus. One operative death occurred in this group, and two patients had cerebrospinal fluid leaks. In 12 patients who had undergone prior craniotomy, successful palliation was accomplished, at least temporarily, in every case. Vision was improved postoperatively in 15 of the 16 patients who presented with visual loss. Enlargement of the sella by the tumor is the critical feature allowing for successful transsphenoidal management.

Immunisations and antibiotics in patients with anterior skull base cerebrospinal fluid leaks

2014 ◽  
Vol 128 (7) ◽  
pp. 626-629 ◽  
Author(s):  
J Rimmer ◽  
C Belk ◽  
V J Lund ◽  
A Swift ◽  
P White
Keyword(s):  
Cerebrospinal Fluid ◽  
Streptococcus Pneumoniae ◽  
Antibiotic Prophylaxis ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Prophylactic Antibiotics ◽  
Anterior Skull Base ◽  
Web Based ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

AbstractObjective:There are no UK guidelines for the use of antibiotics and/or immunisations in patients with an active anterior skull base cerebrospinal fluid leak. This study aimed to define current UK practice in this area and inform appropriate guidelines for ENT surgeons.Method:A web-based survey of all members of the British Rhinological Society was carried out and the literature in this area was reviewed.Results:Of those who responded to the survey, 14 per cent routinely give prophylactic antibiotics to patients with cerebrospinal fluid leaks, and 34.9 per cent recommend immunisation against at least one organism, most commonly Streptococcus pneumoniae (86.7 per cent).Conclusion:There is no evidence to support the use of antibiotic prophylaxis in patients with a cerebrospinal fluid leak. We propose that all such patients are advised to seek immunisation against pneumococcus, meningococcus and haemophilus.

Endoscopic modified Lothrop procedure for repair of lateral frontal sinus cerebrospinal fluid leak

2008 ◽  
Vol 123 (1) ◽  
pp. 145-147 ◽  
Author(s):  
J K Anverali ◽  
A A Hassaan ◽  
H A Saleh
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
World Literature ◽  
Cerebrospinal Fluid Leak ◽  
Lumbar Drain ◽  
Alternative Approach ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

AbstractObjective:To describe a previously unreported case of repair of a lateral frontal sinus cerebrospinal fluid leak, using the endoscopic modified Lothrop procedure.Method:Case report of new technique, with reference to the world literature.Results:An effective endoscopic, transnasal repair of a lateral frontal sinus cerebrospinal fluid leak was achieved in a 60-year-old man. The defect was closed with fat, fascia lata and free mucosal grafts. The left nasal cavity was packed and a lumbar drain left in situ post-operatively. The drain and packs were removed one week later and the patient discharged with no complications, and no recurrence at 12 months' follow up.Conclusion:Such cerebrospinal fluid leaks have traditionally been repaired using an external approach with osteoplastic flaps and obliteration of the sinus. We highlight the endoscopic modified Lothrop technique as an effective alternative approach to repair of cerebrospinal fluid leaks in poorly accessible areas of the frontal sinus.

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