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.

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.

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.

Transoral transclival removal of a schwannoma anterior to the craniocervical junction

1985 ◽  
Vol 62 (2) ◽  
pp. 293-295 ◽  
Author(s):  
H. Alan Crockard ◽  
Robert Bradford
Keyword(s):  
Cerebrospinal Fluid ◽  
Simple Technique ◽  
Standard Procedure ◽  
Craniocervical Junction ◽  
Fistula Formation ◽  
Content Type ◽  
Csf Fistula ◽  
Watertight Closure ◽  
Csf Diversion ◽  
Fine Print

✓ The transoral route was used to remove a schwannoma situated anteriorly at the craniocervical junction. By a relatively simple technique, a watertight closure of the dura and nasopharynx was obtained combined with continuous cerebrospinal fluid (CSF) diversion, first by lumbar drainage and then via a lumboperitoneal shunt. This modification of the standard procedure provides a useful method to prevent CSF fistula formation following transoral intradural surgery.

A new technique for closure of the dura following transsphenoidal and transclival operations

1990 ◽  
Vol 72 (5) ◽  
pp. 824-828 ◽  
Author(s):  
Afrassiab Guity ◽  
Paul H. Young
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leakage ◽  
Content Type ◽  
Small Opening ◽  
Dural Closure ◽  
Watertight Closure ◽  
A New Technique ◽  
Dural Tears ◽  
Principal Author ◽  
Fine Print

✓ Watertight closure of the dura following transsphenoidal operations for pituitary adenoma or hypophysectomy and following transclival operations for paraclival tumors has been technically very difficult. This is true both immediately after the initial approach and later for the treatment of delayed cerebrospinal fluid leakage. An innovative practical technique and special suture-tying instruments and needle designed by the principal author for this purpose have greatly facilitated this procedure. This technique has been applied to both direct dural closure and dural patching with watertight dural closure. The technique is also widely applicable for closing (or suturing) the dura following any procedure through a small opening, such as the dural tears occasionally encountered during lumbar or cervical discectomy, or tacking the tentorium during a craniotomy. The technique and suture-tying instruments are described in detail.

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.

Traumatic cerebrospinal fluid fistulas in children

1973 ◽  
Vol 38 (1) ◽  
pp. 1-9 ◽  
Author(s):  
W. J. H. Caldicott ◽  
J. B. North ◽  
Donald A. Simpson
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Postnatal Development ◽  
Content Type ◽  
Operative Repair ◽  
Fine Print

✓ The postnatal development of the skull base was studied by dissection and radiography in 15 subjects, and the findings were correlated with the occurrence of traumatic cranionasal and crainioaural cerebrospinal fluid fistulas in seven children. The authors conclude that indications for operative repair of these fistulas are as strong in the child as in the adult, although diagnosis is sometimes more difficult.

Follow-up study of 103 American soldiers who sustained a brain wound in Vietnam

1974 ◽  
Vol 41 (5) ◽  
pp. 542-549 ◽  
Author(s):  
Michael E. Carey ◽  
Harold F. Young ◽  
Berkley L. Rish ◽  
Jacob L. Mathis
Keyword(s):  
Wound Dehiscence ◽  
Pulmonary Emboli ◽  
Content Type ◽  
Follow Up Study ◽  
War Zone ◽  
Bone Fragments ◽  
Brain Abscesses ◽  
Cerebrospinal Fluid Leaks ◽  
Fine Print

✓ The authors report a follow-up study of 103 American soldiers who were treated for brain wounds at one neurosurgical facility in Vietnam. The estimated mortality after evacuation from the war zone was 6% to 8%. Severe brain wounds, meningitis, and pulmonary emboli accounted for the majority of the late deaths. Thirty-four per cent had post-debridement complications such as retained bone fragments (16%), infection (15%), cerebrospinal fluid leaks or wound dehiscence (2%). Removal of retained intracerebral bone was associated with occasional complications but unquestionably prevented several late brain abscesses; only two patients in this series developed a late brain abscess. About half of those who were evacuated from Vietnam with retained intracerebral bone harbored fragments that were contaminated with bacteria.

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.

Cerebrospinal fluid fistulas complicating missile wounds of the brain

1981 ◽  
Vol 54 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Arnold M. Meirowsky ◽  
William F. Caveness ◽  
James D. Dillon ◽  
Berkley L. Rish ◽  
Jay P. Mohr ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Diagnostic Problem ◽  
Wound Site ◽  
Content Type ◽  
Csf Fistula ◽  
Entry Wound ◽  
Watertight Closure ◽  
Base Of The Skull ◽  
The Brain ◽  
Fine Print

✓ The records of 101 casualties of the war in Vietnam have been analyzed, with particular attention to missile wounds of the brain complicated by a cerebrospinal fluid (CSF) fistula. Fifty-four developed CSF drainage at the wound site, 30 presented with rhinorrhea, and 23 with otorrhea. Fifty of the 101 men developed infection, an incidence of 49.5%. The occurrence of a fistula in vertex wounds can usually be traced to failure to close the dura, or to achieve watertight closure of the dura primarily, or by graft. Approximately two-thirds of compound basilar fractures, complicated by rhinorrhea or otorrhea, are due to direct fractures of the anterior, middle, or posterior fossa. The remaining one-third are due to elusive “discrete” fractures of the base of the skull, occurring at a distance from the entry wound, and not in continuity with the fracture of the vault. While direct basilar fractures can readily be recognized, facilitating repair of the dura overlying the basilar fractures, “discontinuous” fractures pose a challenging diagnostic problem. More commonly occurring in vertex wounds crossing the midline, discontinuous fractures producing rhinorrhea or otorrhea may be identified with the aid of tomograms of the base of the skull. Their early diagnosis may well prove to be a significant factor in the reduction of morbidity and mortality of missile wounds of the brain complicated by a CSF fistula.

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