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.

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.

The empty sella and some related syndromes

1972 ◽  
Vol 36 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Sixto Obrador
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Space ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Pituitary Glands ◽  
Diaphragma Sellae ◽  
Fine Print ◽  
Syndrome Association

✓ A case of empty sella syndrome due to a benign intrasellar cyst leads the author to a review of variations in this syndrome. Association with intrasellar diverticuli of the subarachnoid space, deficiencies of the diaphragma sellae, and small pituitary glands are identified. Its relationship with certain headaches in women and to unexplained nontraumatic cerebrospinal fluid rhinorrhea are discussed.

Localization of dural fistulas using metrizamide digital subtraction fluoroscopic cisternography

1988 ◽  
Vol 68 (5) ◽  
pp. 721-725 ◽  
Author(s):  
Tatsuo Takahashi ◽  
Naomi Mutsuga ◽  
Toshiki Aoki ◽  
Takashi Handa ◽  
Chiharu Tanoi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Real Time ◽  
Computerized Tomography ◽  
Digital Subtraction ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Minimal Dose ◽  
Real Time Visualization ◽  
Metrizamide Cisternography ◽  
Fine Print

✓ Demonstration of the exact site of dural fistulas in cases of cerebrospinal fluid rhinorrhea is difficult. Previous reports have described the use of metrizamide cisternography combined with either hypocycloidal tomography or computerized tomography; however, direct, dynamic, real-time visualization of the fistula is difficult with instillation of a minimal dose of metrizamide using those methods. A digital video subtraction fluoroscopy system can visualize the actual site of the fistula directly and dynamically using only a small amount of metrizamide.

Neurosurgical Approaches to Cerebrospinal Fluid Rhinorrhea

1992 ◽  
Vol 71 (7) ◽  
pp. 300-305 ◽  
Author(s):  
Bizhan Aarabi ◽  
Lyal G. Leibrock
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Personal Experience ◽  
Surgical Repair ◽  
Resonance Imaging ◽  
Ct Cisternography ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
The Past ◽  
Anterior Fossa ◽  
Metrizamide Ct Cisternography

The evolutionary concepts of pinpointing and treating cerebrospinal fluid (CSF) fistulas over the past few decades are reviewed taking into consideration the dynamic character of CSF circulation. The localization of the site of leakage is greatly facilitated by the judicious use of a variety of radioisotope and radiological techniques. The most recent are Metrizamide CT Cisternography and Magnetic Resonance Imaging. It is asserted that still the most challenging cases are those with intermittent liquorrheas, and those patients in which the site of the fistula is not easily defined. The authors will describe their personal experience with intracranial surgical repair of fistulas located in the anterior fossa.

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.

Cerebrospinal fluid rhinorrhea following surgery for acoustic neurinoma

1986 ◽  
Vol 64 (4) ◽  
pp. 676-678 ◽  
Author(s):  
Derek S. Gordon ◽  
Alan G. Kerr
Keyword(s):  
Cerebrospinal Fluid ◽  
Computerized Tomography ◽  
Posterior Wall ◽  
Acoustic Neurinoma ◽  
Internal Auditory Meatus ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Delayed Onset ◽  
Fine Print

✓ In a series of 48 patients with acoustic neurinoma removed by the suboccipital route, one patient developed cerebrospinal fluid rhinorrhea and another patient had delayed-onset meningitis. Each complication was attributed to opening the posteromedial air-cell tract in the posterior wall of the internal auditory meatus. In operations requiring removal of the posterior meatal wall, it is important to look for the air-cell tract which may not be apparent on computerized tomography. If the tract is opened the cells should be occluded by bone wax.

Intracerebral polyposis

1993 ◽  
Vol 78 (2) ◽  
pp. 294-296 ◽  
Author(s):  
P. Kantha Reddy ◽  
G. Prakash Rao ◽  
Andole Prakasham ◽  
Aila Purnanand ◽  
Chinthalaphani Sulochana ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Lobe ◽  
Nasal Polyps ◽  
Cystic Lesion ◽  
Cribriform Plate ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Bony Lesion ◽  
The Right ◽  
Fine Print

✓ A 25-year-old man presented with nontraumatic cerebrospinal fluid rhinorrhea and meningitis. On investigation, he was found to have a multiloculated intracerebral cystic lesion of the right frontal lobe with a bony lesion inside the cyst, just above the right cribriform plate. Surgery revealed multiple grape-like cystic pedunculated lesions with narrow stalks attached to a bony outgrowth which was adherent to the right cribriform plate. Macroscopically and microscopically, the excised lesions were similar to nasal polyps.

High-resolution metrizamide CT cisternography in sellar and suprasellar abnormalities

1981 ◽  
Vol 54 (2) ◽  
pp. 232-239 ◽  
Author(s):  
Kalyanmay Ghoshhajra
Keyword(s):  
High Resolution ◽  
Carotid Arteries ◽  
Ct Cisternography ◽  
Thin Sections ◽  
Content Type ◽  
High Resolution Technique ◽  
Relationship Of ◽  
The Relationship ◽  
Metrizamide Ct Cisternography ◽  
Fine Print

✓ Metrizamide computerized tomographic cisternography was performed with a small dose and low concentration of intrathecal metrizamide using a newer generation of computerized tomography scanner for the evaluation of sellar and suprasellar abnormalities. The examination was performed with thin sections in axial, direct coronal, and (when feasible) direct sagittal projections in a high-resolution technique. The relationship of the lesions with carotid arteries, optic chiasms, and hypothalamic structures was accurately defined.

Persistent cerebrospinal fluid rhinorrhea treated by lumboperitoneal shunt

1973 ◽  
Vol 38 (4) ◽  
pp. 524-526 ◽  
Author(s):  
Samuel H. Greenblatt ◽  
Donald H. Wilson
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Fracture ◽  
Direct Methods ◽  
The Other ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Lumboperitoneal Shunt ◽  
Methods Of Treatment ◽  
Basilar Skull Fracture ◽  
Fine Print

✓ Two cases of persistent cerebrospinal fluid rhinorrhea were successfully treated by lumboperitoneal shunts. One case was of spontaneous origin, and the other was associated with a basilar skull fracture. The authors emphasize the value of this procedure when the source of the leak cannot be found or when more direct methods of treatment have failed.

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