scholarly journals Study on Spontaneous Cerebrospinal Fluid (CSF) Rhinorrhoea: A Birmingham Experience

2013 ◽  
Vol 24 (1) ◽  
pp. 40-43
Author(s):  
Mohammad Saleh Uddin Sayed ◽  
Chris J Dunn ◽  
A Alaani ◽  
Alan Johnson
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Techniques ◽  
Queen Elizabeth Hospital ◽  
Study Group ◽  
Csf Rhinorrhoea ◽  
The Common ◽  
Medicine Today ◽  
Age Range ◽  
Csf Leaks

Spontaneous Cerebrospinal fluid (CSF) rhinorrhoea is not very common. The aim of this study is to identify the common features in the study group of patients with spontaneous CSF rhinorrhoea, to develop a hypothesis to explain the cause of this condition and to investigate the outcome of surgical techniques adopted to repair the leak. In this retrospective study we have reviewed all the cases of spontaneous CSF leaks attending and receiving treatment from the Department of ENT at Queen Elizabeth Hospital, Birmingham, from 1992 to 2002. Among the total number of 34 patients with CSF leaks, 15 were spontaneous in nature and formed our study group, of these 15 patients 14 were female; with age range from 37 to 70 years and a median age of 50 years. All the female patients were obese with a body mass index higher than normal range. We tried to identify common factors in the study group and it was evident that female sex, obesity and age play a key role in this condition. Follow up period ranged from 2 to 98 months and thirteen patients were asymptomatic but two patients remained symptomatic, one of these despite repeated surgical intervention. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.14114 Medicine TODAY Vol.24(1) 2012 pp.40-43

Study on spontaneous cerebrospinal fluid rhinorrhoea: its aetiology and management

2005 ◽  
Vol 119 (1) ◽  
pp. 12-15 ◽  
Author(s):  
C J Dunn ◽  
A Alaani ◽  
A P Johnson
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Intervention ◽  
Surgical Techniques ◽  
Queen Elizabeth Hospital ◽  
Study Group ◽  
Common Features ◽  
Csf Rhinorrhoea ◽  
The Common ◽  
Csf Leaks

The aim of this study was to identify the common features in a study group of patients with spontaneous cerebrospinal fluid (CSF) rhinorrhoea, to develop a hypothesis to explain the cause of this condition and to investigate the outcome of surgical techniques adopted to repair the leak. In this retrospective study the authors have reviewed all the cases of spontaneous CSF leaks attending and receiving treatment from the otolaryngology department of Queen Elizabeth Hospital, Birmingham, from 1992 to 2002.Of 34 patients with CSF leaks, 15 were spontaneous in nature and formed the study group. Of these 15 patients, 14 were female; with ages ranging from 37 to 70 years and a median age of 50 years. All the female patients were overweight with a body mass index (BMI) >24.9 and, of these, nine were considered obese with a BMI >30. It was attempted to identify common factors in the study group and it was evident that female sex, obesity and age played a key role in this condition.The follow-up period ranged from two to 98 months. Thirteen patients were asymptomatic but two patients remained symptomatic, one of these despite repeated surgical intervention.

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.

scholarly journals Comparison of Phacotrabeculectomy and Phacotrabeculectomy with Subconjunctival 5-Fluorouracil

2014 ◽  
Vol 52 (196) ◽  
pp. 1010-1013
Author(s):  
Nanda Kumari Gurung ◽  
Prachand Gautam ◽  
Shanti Gurung ◽  
Binita Bhattarai
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Statistical Difference ◽  
Surgical Techniques ◽  
Significant Statistical Difference ◽  
Keywords Glaucoma ◽  
Group A ◽  
Group B ◽  
Age Range

Introduction: Glaucoma is the second leading cause of blindness worldwide. Phacotrabeculectomyis a technique in which glaucoma and cataract surgery performed. Methods: Prospective study was carried out in the department of glaucoma at Lumbini Eye Institute, Bhairahawa.100 patients who underwent phacotrabeculectomy within a period of two years. Patients were divided into two groups those who received 5FU (n=47) and no antifibrotic agent (n= 53). Results: The age range was from 38 to 80 years; mean age of 62.97±9.14 SD. 55% were male and 45% were female.The postoperative IOP reduction in last follow- up group A was mean=13.08±1.57SD and mean=13.23±1.73SD in group B. This was statically significant with P <0.001. Bleb survival was almost similar in two groups 3.17(78.31%) in group A and 3.20 (78.93%) in group B. 85% visual acuity was improved in both groups. Conclusions: Phacotrabeculectomy and phacotrabeculectomy with inj. 5FU, both were equally effective surgical techniques in terms of visual acuity, IOP control and bleb survival.There was no significant statistical difference vis-à-vis the success of Phacotrabeculectomy using of either these two techniques.  Keywords: glaucoma; 5FU; intraocular pressure; phacotrabeculectomy.

Paediatric hydrocephalus

2019 ◽  
pp. 1023-1036
Author(s):  
Matt Bailey ◽  
Chris Parks ◽  
Conor L. Malucci
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Procedures ◽  
Surgical Techniques ◽  
Disease Process ◽  
Surgical Care ◽  
Csf Shunts ◽  
Classification Management ◽  
Technological Improvements ◽  
Csf Production

Paediatric hydrocephalus is the commonest disorder to be managed by paediatric neurosurgeons. Rather than representing a single disease process, hydrocephalus can result from a variety of different pathological processes or insults that culminate in an imbalance of cerebrospinal fluid (CSF) production and absorption. If left untreated, the majority of cases are fatal, but with appropriate surgical management most patients survive, with some leading normal lives into adulthood. The mainstay of treatment is with CSF shunts, but with technological improvements in imaging and surgical techniques an increasing number are being successfully treated with neuroendoscopic procedures. The disorder can be complex to manage, with many patients requiring multiple surgical procedures and lifelong follow-up. This chapter gives an overview of paediatric hydrocephalus, its causes and classification, management with shunts and endoscopy, description of surgical techniques, and the outcomes of surgical care.

The endoscopic treatment of cerebrospinal fluid rhinorrhoea: the Nottingham experience

1997 ◽  
Vol 111 (2) ◽  
pp. 125-128 ◽  
Author(s):  
R. G. M. Hughes ◽  
N. S. Jones ◽  
I. J. A. Robertson
Keyword(s):  
Cerebrospinal Fluid ◽  
Subsequent Treatment ◽  
Endoscopic Approach ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Closure Rate ◽  
Endoscopic Techniques ◽  
Csf Rhinorrhoea ◽  
Skull Base Defect

AbstractThe conventional neurosurgical management of cerebrospinal fluid (CSF) rhinorrhoea has been by intracranial access. Otorhinolaryngologists have undertaken extracranial approaches where access has been possible, and more recently an endoscopic approach has been advocated. We report 17 patients with confirmed CSF rhinorrhoea treated with endoscopic techniques between 1993 and 1996. Follow-up ranged from four to 32 months and showed an overall closure rate of 16 out of 17 patients with no complications. No patient undergoing primary endoscopic repair developed anosmia. The use of fluorescein helped localize the site of the CSF leak in four patients in whom the computed tomography (CT) scan had not identified the site of the defect.We conclude that the endoscope is a valuable tool in the evaluation and subsequent treatment of CSF rhinorrhoea. Where the skull base defect is accessible to the endoscope, we propose that an endoscopic approach should be considered as the preferred method.

scholarly journals Changing Pattern of Post-infectious Glomerulonephritis: A Study in South-Western Region of Bangladesh

2020 ◽  
Vol 32 (2) ◽  
pp. 130-133
Author(s):  
Muhammed Arshad Ul Azim ◽  
Md Motiur Rahaman ◽  
Kamruzzaman Md Zahir ◽  
Md Obaidul Hauque ◽  
Md Abdul Wadud ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Cross Sectional Study ◽  
Recent History ◽  
Cross Sectional ◽  
Male Predominance ◽  
History Of ◽  
Medicine Today ◽  
Age Range ◽  
Post Infectious

Introduction: In developing countries like Bangladesh, post-infectious glomerulonephritis (PIGN) is the common form ofacute glomerulonephritis having its changing pattern over recent decades. The aim of the study was to analyze the clinicalprofile of PIGN in local scenario. Materials and Methods: This cross-sectional study was conducted at Shaheed Sheikh AbuNaser Specialized Hospital, Khulna during period from 2017 to 2019. A total of 67 cases of PIGN were identified on thebasis of clinical features, laboratory parameters with recent history of infection. The patients’ records were reviewed withrespect to clinical data. Patients with reduced complement level were included. Result: The age range of the patients wasbetween 2 and 55 years with male predominance. The study revealed that 32.8% of patients had a recent history of sorethroat, 31.3 % of patients had a history of skin infection and rest 35% had a history of fever. Moreover, during presentation68% of patients had hypertension and 37 % of patient had renal impairment. In this study, majority of patients (53%)presented with one plus to two plus proteinuria and the rest of the patients (37%) presented with three plus proteinuria ondipstick. After 2 weeks of follow up, the presence of hematuria found in 58 patients out of 67, proteinuria found in 14patients out of 61 and renal impairment found in 5 patients out of 25. Conclusion: PIGN has been changing with respect toage, proteinuria and renal function. To follow-up periodically and reduction in overcrowding of the patients, would be oneof the superior suggestions to reduce the spread of infectious diseases in our country. Medicine Today 2020 Vol.32(2): 130-133

scholarly journals Endoscopic Repair of Spontaneous Cerebrospinal Fluid Leaks in the Lateral Recess of the Sphenoid Sinus

2022 ◽  
pp. 019459982110684
Author(s):  
Zhenxiao Huang ◽  
Qian Huang ◽  
Shunjiu Cui ◽  
E. Qiu ◽  
Junfang Xian ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Sphenoid Sinus ◽  
Surgical Repair ◽  
University Hospital ◽  
Preoperative Imaging ◽  
Imaging Evaluation ◽  
Lateral Recess ◽  
Approach Group ◽  
Csf Leaks

Objective This study aimed to assess the effectiveness of 3 endoscopic endonasal approaches for the management of cerebrospinal fluid (CSF) leaks and meningoencephaloceles in the lateral recess of the sphenoid sinus (LRSS). Study Design Retrospective study. Setting University hospital. Methods This study retrospectively reviewed 49 patients with CSF leaks and meningoencephaloceles in the LRSS. Three endoscopic surgical repair approaches were indicated based on 5 different Rhoton’s types of the LRSS. The postoperative symptoms, complications, and follow-up outcomes were investigated and evaluated. Results The success rate of endoscopic surgical repair was 100% at a median follow-up of 75.06 (12-203.4) months. Endoscopic approaches to the LRSS included the prelacrimal recess (PLR) (18.37%), transsphenoidal (18.37%), and transpterygoid approaches (64.26%). All patients in the PLR approach (PLRA) group and most of the patients in the transpterygoid approach group had a full lateral type LRSS. Hypoesthesia and dry eyes were reported in 5 patients (55.56%) and 1 (11.12%) patient, respectively, from the PLRA group and in 6 (19.35%) and 5 (16.12%) patients, respectively, from the transpterygoid approach group. Conclusions Endoscopic closure is a safe and effective method for the treatment of CSF leaks and meningoencephaloceles in the LRSS. The transpterygoid approach and PLRA offer adequate exposure of the LRSS with extensive lateral pneumatization or a full LRSS. The endoscopic route of the PLRA is more direct than that of the transpterygoid approach. Careful preoperative imaging evaluation is crucial while selecting the optimal surgical approach for the repair of a skull base defect.

Endoscopic repair of frontal sinus cerebrospinal fluid leaks

2005 ◽  
Vol 119 (9) ◽  
pp. 709-713 ◽  
Author(s):  
B A Woodworth ◽  
R J Schlosser ◽  
J N Palmer
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
Outflow Tract ◽  
Endoscopic Approach ◽  
Surgical Trauma ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Frontal Recess ◽  
Csf Leaks

Objective: To describe endoscopic management of frontal sinus cerebrospinal fluid (CSF) leaks.Study design: Retrospective.Methods: We reviewed all frontal sinus CSF leaks treated using an endoscopic approach at ourinstitutions from 1998 to 2003. CSF leaks originated immediately adjacent to or within the frontal recess or frontal sinus proper for inclusion in the study. Data collected included demographics, presenting signs and symptoms, site and size of skull-base defect, surgical approach, repair technique, and clinical follow up.Results: Seven frontal sinus CSF leaks in six patients were repaired endoscopically. Average age of presentation was 45 years (range 25–65 years). Aetiology was idiopathic (three), congenital (one), accidental trauma (one), and surgical trauma (two). All patients presented with CSF rhinorrhea; two patients presented with meningitis. Four defects originated in the frontal recess, while two others involved the posterior table and frontal sinus outflow tract. Four patients had associated encephaloceles. We performed endoscopic repair in all six patients withone patient requiring an adjuvant osteoplastic flap without obliteration. All repairs were successful at the first attempt with a mean follow up of 13 months. All frontal sinuses remained patent on both post-operative endoscopic and radiographic exam.Conclusions: Endoscopic repair of frontal sinus CSF leaks and encephaloceles can be an effective method if meticulous attention is directed toward preservation of the frontal sinus outflow tract, thus avoiding an osteoplastic flap and obliteration. The major limiting factor for an endoscopic approach is extreme extension superiorly or laterally within the posterior table beyond the reach of current instrumentation.

A Shunt Method for the Treatment of Syringomyelia Secondary to Trauma and Tuberculous Meningitis

2021 ◽  
Vol 11 (6) ◽  
pp. 1108-1112
Author(s):  
Hao Li ◽  
Yongli Lou ◽  
Yong Liu
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Subarachnoid Space ◽  
Clinical Symptoms ◽  
Shunt Surgery ◽  
Fluid Circulation ◽  
Cerebrospinal Fluid Circulation ◽  
Magnetic Resonance Imaging Mri ◽  
Age Range

The pathogenesis and surgical treatment of syringomyelia (SM) secondary to trauma and tuberculous meningitis are not clear. We hypothesize that the main cause of SM is impaired cerebrospinal fluid circulation in the subarachnoid space due to spinal arachnoid adhesion induced by trauma or tuberculous meningitis. Using trans-segmental subarachnoid shuntsurgery, we re-established normal cerebrospinal fluid circulation in the subarachnoid space, which resolved the potential cause of SM formation. This study aimed to evaluate the efficacy of trans-segmental subarachnoid shunt surgery in the treatment of SM secondary to trauma or tuberculous meningitis. A total of 143 patients with SM after trauma and tuberculous meningitis were recruited between September 2014 and February 2017. Among these patients, 64 had posttraumatic SM, including 39 males and 25 females with an age range of 21–65 years and an average age of 40.02 years, and 79 patients had SM secondary to tuberculous meningitis, including 49 males and 30 females with an age range of 23–62 years and an average age of 44.95 years. All patients underwent trans-segmental subarachnoid shunt surgery and were subjected to magnetic resonance imaging (MRI) examination between 6 months and 1 year and between 2 and 2.5 years after surgery. Clinical efficacy was assessed by the Tator method. The main symptoms or signs were evaluated by improvement, stabilizationor aggravation of symptoms. Patients were followed-up twice, once at 6 months to 1 year after surgery and once at 2 to 2.5 years after surgery. A total of 143 patients were followed-up for the first time, among whom, the clinical symptoms were improved in 59 patients(41.26%), stable in 51 patients (35.66%) and aggravated in 36 patients (23.08%). MRI exaination showed that the spinal cord cavities completely disappeared in 27 patients (18.88%), shrank significantly in 71 patients (49.65%), did not change or shrink significantly in 32 patients (22.38%) and expanded in 13 patients (9.09%). A total of 122 patients were followed-up for the second time, and the clinical symptoms were improved in 69 patients (56.56%), stable in 25 patients (20.49%) and aggravated in 28 patients (22.95%). Compared to the condition in the first follow-up, 14 patients who were stable were improved, 5 patients who were aggravated were improved, and the symptoms did not change significantly among other patients. The imaging examination did not show any significant change compared to that of the first follow-up. We suggest that trauma or tuberculous meningitis can induce spinal arachnoid adhesion, leading to impaired cerebrospinal fluid circulation in the subarachnoid space, which then causes SM. Trans-segmental subarachnoid shunt surgery is a noninvasive, safe and effective treatment for SM secondary to trauma and tuberculous meningitis.

scholarly journals Optimising outcomes in the management of spontaneous cerebrospinal fluid rhinorrhoea

2013 ◽  
Vol 51 (3) ◽  
pp. 268-274
Author(s):  
J.S Virk ◽  
B. Elmiyeh ◽  
C. Stamatoglou ◽  
H.A. Saleh
Keyword(s):  
Body Mass Index ◽  
Cerebrospinal Fluid ◽  
Body Mass ◽  
Surgical Approach ◽  
Case Series ◽  
Operative Management ◽  
Csf Leak ◽  
Tertiary Referral Centre ◽  
Csf Rhinorrhoea

Background: To describe our experience of the management of spontaneous cerebrospinal fluid (CSF) rhinorrhoea in a large case series focusing on surgical approach, peri-operative management and outcomes; to evaluate the efficacy of endoscopic CSF leak repairs. Methodology: Retrospective chart review was performed for all patients with spontaneous CSF rhinorrhoea managed from 2003 to 2011 at a tertiary referral centre. Data regarding demographics, presentation, site of leak, peri-operative management, surgical approach, body mass index (BMI), follow up and success rates was collated. Results: Thirty-six patients were identified: 9 male and 27 female with a mean age of 50.4 years. Eight patients had previous failed repairs in other units. Success rate after first surgery was 89 % and after second surgery was 100 %. Four patients had recurrences, 3 underwent successful revisions and the fourth had complete cessation of the leak after gastric bypass surgery and weight reduction. All failures were before 2004 prior to instigation of an anatomic three-layered repair with no further failures in the following 7 years. Mean follow up was 21.5 months. Mean body mass index was 34.0 kg/m2. Fifty percent of spontaneous leaks were from the cribriform plate, 22 % sphenoid, 14 % ethmoid and 14 % frontal sinus. Conclusion: Endoscopic CSF fistula closure has become the gold standard of care. In order to optimise the outcome, we recommend a multidisciplinary approach to manage the associated idiopathic intracranial hypertension and an anatomic three-layered closure technique for recalcitrant cases.

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