Radionuclide cisternographic evaluation and follow-up of posttraumatic subconjunctival CSF loculation

1976 ◽  
Vol 44 (4) ◽  
pp. 496-499 ◽  
Author(s):  
James E. McLennan ◽  
J. Parker Mickle ◽  
Salvadore Treves
Keyword(s):  
Cerebrospinal Fluid ◽  
Postoperative Management ◽  
Content Type ◽  
Radionuclide Cisternography ◽  
Fluid Collections ◽  
Fine Print

✓ The case of a patient with massive, posttraumatic, subconjunctival cerebrospinal fluid collections is described in which diagnosis and postoperative management was simplified by serial radionuclide cisternography.

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.

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.

External hydrocephalus in adults

1996 ◽  
Vol 85 (6) ◽  
pp. 1143-1147 ◽  
Author(s):  
érico R. Cardoso ◽  
Romaine Schubert
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Animal Experiments ◽  
Great Resistance ◽  
Posthemorrhagic Hydrocephalus ◽  
Content Type ◽  
External Hydrocephalus ◽  
Csf Shunting ◽  
Fluid Collections ◽  
Fine Print

✓ The authors report three adult patients who developed a symptomatic extraaxial collection of cerebrospinal fluid (CSF) after an intracranial hemorrhage. The fluid shifted from the extraaxial into the ventricular space as the patients' symptoms progressed. The symptoms resolved after placement of a ventriculoperitoneal shunt. External hydrocephalus, which is frequently observed in children, had not yet been described in adults. It is important to differentiate chronic subdural collections from external hydrocephalus, because ventricular CSF shunting increases the former while it is the treatment for the latter. The authors believe that symptomatic extraaxial fluid collections developed in these three adults during the early phase of posthemorrhagic hydrocephalus because the ventricles presented great resistance to distention at the onset of hydrocephalus. Animal experiments have led to the same result.

A new radionuclide method for the diagnosis of posttraumatic cerebrospinal fistulas

1982 ◽  
Vol 57 (1) ◽  
pp. 92-98 ◽  
Author(s):  
Lysiane Mamo ◽  
Jean Cophignon ◽  
Alain Rey ◽  
Claude Thurel
Keyword(s):  
Cerebrospinal Fluid ◽  
Computerized Tomography ◽  
Gamma Camera ◽  
Sitting Position ◽  
Content Type ◽  
Radionuclide Cisternography ◽  
Radionuclide Tracer ◽  
Fine Print

✓ The authors describe their technique for identifying and localizing posttraumatic cerebrospinal fluid fistulas. The method entails injection of radionuclide tracer into the subarachnoid frontal space with the patient in a sitting position followed by gamma camera scintigraphic recordings. The results in 308 patients are presented; these are compared with those of suboccipital radionuclide cisternography in 40 cases and metrizamide computerized tomography cisternography in nine cases. Transient complications occurred in only three patients.

Precise anatomic localization of atraumatic sphenoethmoidal cerebrospinal fluid rhinorrhea by metrizamide CT cisternography

1980 ◽  
Vol 53 (2) ◽  
pp. 222-228 ◽  
Author(s):  
Thomas P. Naidich ◽  
Christopher J. Moran
Keyword(s):  
Cerebrospinal Fluid ◽  
Ct Cisternography ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Single Procedure ◽  
Osseous Defect ◽  
Metrizamide Ct Cisternography ◽  
Anatomic Localization ◽  
Fine Print

✓ Metrizamide computerized tomographic cisternography (MCTC) has proved 100% successful in documenting the precise anatomic location of the dural osseous defect in three patients with sphenoethmoidal rhinorrhea. In each patient, direct surgical approach to the site indicated by MCTC terminated the leakage in a single procedure. Clinical evaluation has disclosed no renewed leakage during a follow-up period from 6 to 18 months.

Long-term results of praziquantel therapy in neurocysticercosis

1987 ◽  
Vol 66 (3) ◽  
pp. 359-363 ◽  
Author(s):  
Clemente Robles ◽  
Ana Maria Sedano ◽  
Noe Vargas-Tentori ◽  
Sonia Galindo-Virgen
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Tissue Damage ◽  
Long Term Results ◽  
Content Type ◽  
Low Concentration ◽  
Praziquantel Treatment ◽  
Fine Print

✓ The long-term results of praziquantel therapy in 141 patients with neurocysticercosis are presented. Seventy-five patients (53%) were considered to be cured because the cysts or nodules disappeared or became calcified following praziquantel treatment and the patients were asymptomatic at the end of a 5-year follow-up period. An additional 35 patients (24.8%) improved clinically and radiographically. The intraventricular Cysticercus cysts of five patients in this group were not affected by praziquantel and had to be surgically removed. The remaining 31 patients (21.9%) were unchanged or became worse probably because, prior to therapy, Cysticercus larvae had caused tissue damage. The fact that praziquantel did not affect intraventricular cysts suggests a low concentration of the drug in the cerebrospinal fluid. Surgery continues to be an important tool in the treatment of cysticercosis to remove parasites that do not respond to praziquantel therapy as well as for the relief of intracranial hypertension.

Prevention of subdural fluid collections following transcortical intraventricular and/or paraventricular procedures by using fibrin adhesive

2000 ◽  
Vol 92 (3) ◽  
pp. 406-412 ◽  
Author(s):  
Mahmoud Al-Yamany ◽  
Rolando F. Del Maestro
Keyword(s):  
Fluid Collection ◽  
Seizure Disorder ◽  
Neurosurgical Procedures ◽  
Subdural Fluid Collection ◽  
Fibrin Adhesive ◽  
Content Type ◽  
Shunt Placement ◽  
Fluid Collections ◽  
Fine Print

Object. Subdural fluid collections following transcortical intraventricular and/or paraventricular neurosurgical procedures for tumors are common and can be difficult to treat. The authors prospectively studied the efficacy of a fibrin adhesive (Tisseel) in closing cortical and ependymal defects following intraventricular and/or paraventricular lesion resection and in preventing the development of subdural fluid collections.Methods. Twenty-five patients who underwent 29 transcortical approaches for the resection of intraventricular and/or paraventricular lesions were studied. No patient developed a symptomatic subdural fluid collection and no new seizure or progression of a preexisting seizure disorder was encountered during a median follow-up time of 29 months (range 1–57 months). The incidence of preoperative hydrocephalus was 72% and four (22%) of these patients required postoperative shunt placement.Conclusions. The use of a fibrin adhesive to seal cortical and ependymal defects after transcortical procedures appears to prevent the development of subdural fluid collections.

Optimal wound closure after tethered cord correction

1991 ◽  
Vol 74 (4) ◽  
pp. 673-676 ◽  
Author(s):  
Barry M. Zide ◽  
Fred J. Epstein ◽  
Jeffrey Wisoff
Keyword(s):  
Cerebrospinal Fluid ◽  
Wound Closure ◽  
Tethered Cord ◽  
Skin Closure ◽  
Minimal Level ◽  
Content Type ◽  
Hospitalization Time ◽  
Subcutaneous Space ◽  
Fluid Collections ◽  
Fine Print

✓ A technique of wound closure following tethered cord correction is presented that significantly reduces the incidence of cerebrospinal fluid collections in the subcutaneous space. In over 60 cases, the described method of fascia and skin closure has lessened wound problems to a minimal level. Patient hospitalization time has also been greatly diminished.

Ventriculoauriculostomy-associated infection

1971 ◽  
Vol 35 (6) ◽  
pp. 686-694 ◽  
Author(s):  
David B. Shurtleff ◽  
Dennis Christie ◽  
Eldon L. Foltz
Keyword(s):  
Cerebrospinal Fluid ◽  
Infection Rate ◽  
Blood Cultures ◽  
Operative Procedures ◽  
Cerebrospinal Fluid Shunts ◽  
Postoperative Infections ◽  
Content Type ◽  
Delayed Group ◽  
Fine Print

✓ A series of 102 newly referred and uninfected patients on whom 299 operative procedures to insert ventriculoauricular cerebrospinal fluid shunts were performed over a 12-year period were studied for the rate and cause of associated sepsis. It was found that 15.7% of the shunt insertions were followed by infection, and 1.3% of the revisions, for an overall infection rate of 14%. There were two clinical groups, those who developed acute postoperative infections (9%) and those with delayed infections developing 1 month to 6 years after operation (5%). The causes of the infections are discussed. It is suggested that careful follow-up with frequent blood cultures will reveal more infected cases in the delayed group, and that bacteriocidal agents selected for the specific organism should be maintained in cerebrospinal fluid and blood for long periods.

Intraventricular administration of amikacin for complicated Gram-negative meningitis and ventriculitis

1979 ◽  
Vol 50 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Timothy C. Wirt ◽  
Zell A. McGee ◽  
Edward H. Oldfield ◽  
William F. Meacham
Keyword(s):  
Cerebrospinal Fluid ◽  
Persistent Infection ◽  
Intraventricular Administration ◽  
Antimicrobial Drugs ◽  
Gram Negative ◽  
Content Type ◽  
Neurosurgical Patients ◽  
Fine Print

✓ Four pediatric neurosurgical patients with Gram-negative meningitis and ventriculitis were treated with parenteral and intraventricular amikacin, a new aminoglycoside. The organisms infecting these patients were resistant to multiple antimicrobial drugs but were sensitive to amikacin. Treatment was continued for 14 days after cerebrospinal fluid cultures became negative. All four patients were cured and have demonstrated no nephrotoxicity, ototoxicity, or evidence of persistent infection on follow-up examination.

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