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.

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.

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.

Operative repair of lumbosacral myelomeningocele

1983 ◽  
Vol 59 (4) ◽  
pp. 718-722 ◽  
Author(s):  
William R. Cheek ◽  
John P. Laurent ◽  
David A. Cech
Keyword(s):  
Cerebrospinal Fluid ◽  
Wound Dehiscence ◽  
Skin Closure ◽  
Pathological Anatomy ◽  
Junctional Zone ◽  
Content Type ◽  
Operative Repair ◽  
Cerebrospinal Fluid Leaks ◽  
Watertight Closure ◽  
Fine Print

✓ A technique is described for closure of lumbosacral myelomeningoceles. The pathological anatomy of these lesions is examined, and the junction of the skin and dura is identified as the “junctional zone.” This zone permits maximal preservation of the available dura for watertight closure after operative dissection. The junctional zone also serves as an anchor for traction sutures, permitting skin closure without tension. Seventy consecutive repairs have been completed by the authors without significant complications. There have been no instances of cerebrospinal fluid leaks, meningitis, or wound dehiscence. In all cases the repair was carried out rapidly and in a single stage.

Transsphenoidal surgery following unsuccessful prior therapy

1985 ◽  
Vol 63 (6) ◽  
pp. 823-829 ◽  
Author(s):  
Edward R. Laws ◽  
Nicolee C. Fode ◽  
Michael J. Redmond
Keyword(s):  
Transsphenoidal Surgery ◽  
Untreated Patient ◽  
Visual Loss ◽  
Success Rates ◽  
Csf Rhinorrhea ◽  
Content Type ◽  
Prior Therapy ◽  
Transsphenoidal Operation ◽  
Successful Repair ◽  
Fine Print

✓ The authors report the results of a retrospective study conducted in an effort to define the results and risks of transsphenoidal surgery for patients whose prior therapy had failed. In a series of 1210 patients undergoing transsphenoidal surgery during a 10-year period, 158 had received prior therapy: 127 for pituitary adenoma, 20 for craniopharyngioma, and 11 for other lesions. Prior therapy was considered “direct” when it consisted of craniotomy or transsphenoidal surgery (either open or stereotaxic), and “indirect” when it consisted of radiation therapy, adrenalectomy, or bromocriptine therapy. The current transsphenoidal operation was performed for persistent hyperfunctioning endocrinopathy in 63 patients, for visual loss in 72 patients, and for cerebrospinal fluid (CSF) rhinorrhea in 21 patients. Success rates were as follows: normalization of endocrinopathy was achieved in 35% of cases; improvement or stabilization of vision in 59%; and successful repair of CSF rhinorrhea in 74%. The risks associated with repeat transsphenoidal surgery are significantly greater than the same procedure in a previously untreated patient.

Cosmetic mastoidectomy for the combined supra/infratentorial transtemporal approach

1993 ◽  
Vol 79 (3) ◽  
pp. 460-461 ◽  
Author(s):  
William T. Couldwell ◽  
Takanori Fukushima
Keyword(s):  
Cerebrospinal Fluid ◽  
Bone Flap ◽  
Fat Graft ◽  
Mastoid Bone ◽  
Content Type ◽  
Cosmetic Results ◽  
Petroclival Meningiomas ◽  
Cerebrospinal Fluid Leaks ◽  
Fine Print ◽  
Outer Table

✓ The authors describe a cosmetic mastoidectomy technique for use when performing a combined supra/infratentorial craniotomy and transtemporal exposure. The technique involves a single temporal suboccipital bone flap and cosmetic mastoidectomy, removing the outer table of bone for later replacement. Replacement of the outer table of mastoid bone enables tamponade of a fat graft against the dura to reduce the risk of postoperative cerebrospinal fluid leaks. The technique has been performed in eight patients treated for petroclival meningiomas with excellent cosmetic results.

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.

Recurrent intracranial solitary fibrous tumor with cerebrospinal fluid dissemination

2004 ◽  
Vol 101 (6) ◽  
pp. 1045-1048 ◽  
Author(s):  
Katsuyoshi Miyashita ◽  
Yutaka Hayashi ◽  
Hironori Fujisawa ◽  
Mitsuhiro Hasegawa ◽  
Junkoh Yamashita
Keyword(s):  
Cerebrospinal Fluid ◽  
Malignant Transformation ◽  
Solitary Fibrous Tumor ◽  
S100 Protein ◽  
Spinal Tumors ◽  
Content Type ◽  
Csf Dissemination ◽  
Fibrous Tumor ◽  
Fine Print ◽  
Mib 1

✓ Solitary fibrous tumor (SFT) is a benign and rare neoplasm. To date, only 37 patients with intracranial SFTs have been reported. Although a number of the tumors were recurrent and some later underwent malignant transformation, none of these lesions progressed to cerebrospinal fluid (CSF) dissemination. In this paper the authors report a case of SFT in which the lesion recurred several times and ultimately was disseminated by the CSF. The patient was a 63-year-old woman with multiple intracranial and spinal tumors. Fifteen years before this presentation, at the age of 48 she had been hospitalized for resection of a falcotentorial tumor. During the ensuing 15 years she underwent multiple surgeries and sessions of radiation therapy for recurrent lesions. The exclusive location of her tumors in the subarachnoid space at the end of this 15-year period indicate CSF dissemination of the tumor. The tumor that was resected when the patient was 48 years old and the latest resected lesion were analyzed by performing immunohistological CD34, epithelial membrane antigen, vimentin, S100 protein, and reticulin staining, and determining the MIB-1 labeling index (LI). Most of the results were identical, and both tumors were diagnosed as SFT according to a staining pattern that showed a strong and diffuse positive reaction for CD34. Nevertheless, the authors noted that the MIB-1 LI increased from less than 1% in the original tumor to 13% in the latest tumor. The increased proliferation of MIB-1 indicates that the malignant transformation could have occurred during tumor recurrence with CSF dissemination.

Evaluation of endorphin content in the CSF of patients with trigeminal neuralgia before and after Gasserian ganglion thermocoagulation

1981 ◽  
Vol 55 (6) ◽  
pp. 935-937 ◽  
Author(s):  
Giuseppe Salar ◽  
Salvatore Mingrino ◽  
Marco Trabucchi ◽  
Angelo Bosio ◽  
Carlo Semenza
Keyword(s):  
Cerebrospinal Fluid ◽  
Trigeminal Neuralgia ◽  
Control Group ◽  
Gasserian Ganglion ◽  
Content Type ◽  
Group Of Seven ◽  
Idiopathic Trigeminal Neuralgia ◽  
Significant Difference ◽  
Before And After ◽  
Fine Print

✓ The β-endorphin content in cerebrospinal fluid (CSF) was evaluated in 10 patients with idiopathic trigeminal neuralgia during medical treatment (with or without carbamazepine) and after selective thermocoagulation of the Gasserian ganglion. These values were compared with those obtained in a control group of seven patients without pain problems. No statistically significant difference was found between patients suffering from trigeminal neuralgia and those without pain. Furthermore, neither pharmacological treatment nor surgery changed CSF endorphin values. It is concluded that there is no pathogenetic relationship between trigeminal neuralgia and endorphins.

Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases

1998 ◽  
Vol 88 (2) ◽  
pp. 237-242 ◽  
Author(s):  
John L. D. Atkinson ◽  
Brian G. Weinshenker ◽  
Gary M. Miller ◽  
David G. Piepgras ◽  
Bahram Mokri
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Chiari I Malformation ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Content Type ◽  
Intracranial Hypotension Syndrome ◽  
Csf Leakage ◽  
Chiari I ◽  
Fine Print

Object. Spontaneous spinal cerebrospinal fluid (CSF) leakage with development of the intracranial hypotension syndrome and acquired Chiari I malformation due to lumbar spinal CSF diversion procedures have both been well described. However, concomitant presentation of both syndromes has rarely been reported. The object of this paper is to present data in seven cases in which both syndromes were present. Three illustrative cases are reported in detail. Methods. The authors describe seven symptomatic cases of spontaneous spinal CSF leakage with chronic intracranial hypotension syndrome in which magnetic resonance (MR) images depicted dural enhancement, brain sagging, loss of CSF cisterns, and acquired Chiari I malformation. Conclusions. This subtype of intracranial hypotension syndrome probably results from chronic spinal drainage of CSF or high-flow CSF shunting and subsequent loss of brain buoyancy that results in brain settling and herniation of hindbrain structures through the foramen magnum. Of 35 cases of spontaneous spinal CSF leakage identified in the authors' practice over the last decade, MR imaging evidence of acquired Chiari I malformation has been shown in seven. Not to be confused with idiopathic Chiari I malformation, ideal therapy requires recognition of the syndrome and treatment directed to the site of the spinal CSF leak.

Effects of indomethacin and prostacyclin on isolated human pial arteries contracted by CSF from patients with aneurysmal SAH

1981 ◽  
Vol 55 (6) ◽  
pp. 877-883 ◽  
Author(s):  
Lennart Brandt ◽  
Bengt Ljunggren ◽  
Karl-Erik Andersson ◽  
Bengt Hindfelt ◽  
Tore Uski
Keyword(s):  
Cerebrospinal Fluid ◽  
Arachidonic Acid ◽  
Vessel Wall ◽  
Cerebral Arteries ◽  
Pial Arteries ◽  
Content Type ◽  
Cerebral Vasoconstriction ◽  
Arachidonic Acid Metabolites ◽  
Acid Metabolites ◽  
Fine Print

✓ In small human cerebral arteries preincubated with indomethacin, contractions induced by cerebrospinal fluid (CSF), from patients with subarachnoid hemorrhage were markedly increased. Also contractions induced by noradrenaline, but not 5-hydroxytryptamine, were augmented. Prostacyclin and its metabolite 6-keto-prostaglandin (PG)E1 reversed the contractions induced by CSF, as well as by noradrenaline, 5-hydroxytryptamine, and PGF2α. The findings suggest that these substances are able to counteract the influence of vasoconstrictor material in hemorrhagic CSF. If the capacity to synthesize these “protective” arachidonic acid metabolites is reduced, the resulting imbalance between contractile and relaxant forces acting on the vessel wall may lead to sustained cerebral vasoconstriction.

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