scholarly journals Cerebrospinal Fluid Leak after Repair of Congenital Spinal Pathologies, Incidence and Management

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
BILAL KHAN ◽  
USMAN HAQQANI ◽  
RIZWAN ULLAH KHATTAK ◽  
SHAFAAT HUSSAIN
Keyword(s):  
Primary Repair ◽  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Spinal Deformities ◽  
Common Complication ◽  
The Mean ◽  
Fluid Leak

Objective:  To know the incidence of CSF leak and role of tincture benzoyl in the management of CSF leak after the repair of congenital spinal deformities like myelomeningocele, meningocele and tethered cord syndrome.Materials and Methods:  All patients who were operated for congenital spinal surgeries in the form of MMC, Meningocele and TCS by a single surgeon were followed for a minimum of 3 months. Patients with already CSF leak/ruptured MMC prior to surgery were not part of the study. The particulars like gender and type of surgery, days since first surgery, associated infection, hydrocephalus and type of management were noted on a proforma.Results:  A total of 73 patients with spinal dysraphism were operated during the study period and of them about 13 patients returned with problems of the CSF leak. The mean duration and duration since the CSF leak was from 6 days to 16 days. Among them, 10 patients had an MMC repair and one patient had TCS release, while 2 patients were having meningocele repair. The patients were stitched and one patient was re-operated two times for repair of CSF leak. Two patients had a CSF leak along with post op signs of HCP that settled by placing a shunt along with primary repair of the wound reinforced with tincture benzoyl in a single setting. Conclusion:  CSF leak is a common complication following repair of spinal dysraphism and most patients can be managed with the application of tincture benzoyl alone or after simple skin reinforcement.

Step Back in Order to Go Forward: Willful Enlargement and Sandwich Closure Technique for Spinal Dura Repair after Several Unsuccessful Closure Attempts

2021 ◽  
Author(s):  
Maximilian Sitz ◽  
Sergej Rot ◽  
Pawel Gutowski ◽  
Lutz Kreißl ◽  
Johannes Lemcke
Keyword(s):  
Cerebrospinal Fluid ◽  
Spine Surgery ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Common Complication ◽  
Closure Technique ◽  
Dural Repair ◽  
Repair Technique ◽  
Fluid Leak

AbstractA CSF leak is a common complication in spine surgery which is usually closed effectivly by suture and/or epidural patches. There is currently no algorithm to treat a recurrent CSF leak that fails to be closed initially. We describe the case of a recurrent cerebrospinal fluid leak that we have successfully treated using an inlay-onlay dural repair technique.

Middle Turbinate Friendly Technique for Cribriform Cerebrospinal Fluid Leak Repair

2019 ◽  
Vol 161 (3) ◽  
pp. 522-528 ◽  
Author(s):  
Lauren J. Luk ◽  
Allison Ikeda ◽  
Sarah K. Wise ◽  
John M. DelGaudio
Keyword(s):  
Cerebrospinal Fluid ◽  
Primary Repair ◽  
Tertiary Care ◽  
Middle Turbinate ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Secondary Outcome ◽  
Free Graft ◽  
Fluid Leak ◽  
Csf Leaks

ObjectiveTo compare surgical outcomes between 2 techniques for cribriform cerebrospinal fluid leak (CSF) repair with middle turbinate preservation (MTP) vs middle turbinate resection (MTR). A secondary outcome is to examine the effectiveness of collagen dura matrix (CDM) as a grafting material for repair of isolated cribriform skull base defects.Study DesignA retrospective chart review was performed of consecutive patients who underwent cribriform CSF repair at Emory University over the past 15 years.SettingTertiary care rhinology practice.SubjectsAdult patients with cribriform defects limited to the cribriform plate that did not extend lateral to the middle turbinate (MT) and were reconstructed with a free graft (mucosal or synthetic).MethodsPatients were stratified into 2 primary groups by surgical technique: MTP vs MTR. A subset of patients underwent repair with CDM alone and was analyzed separately for CSF repair failure rate.ResultsOf 68 patients identified with cribriform defects, 42 underwent repair with MTP and 26 underwent repair with MTR. Average follow-up time was 495 days. Patients with idiopathic intracranial hypertension were also equally distributed ( P = .20). Primary CSF leak repair success was 95.6%, with 100% of leaks ultimately repaired. A subset of 39 patients underwent repair with CDM alone, with a primary repair success rate of 94.9%.ConclusionsWe present an effective method for repair of cribriform CSF leaks while preserving the MT. CDM can be successfully used as a free graft alone for repair of isolated cribriform CSF leaks.

The role of ICP monitoring in patients with persistent cerebrospinal fluid leak following spinal surgery: a case series

2016 ◽  
Vol 158 (9) ◽  
pp. 1813-1819 ◽  
Author(s):  
Claudia Craven ◽  
Ahmed K. Toma ◽  
Akbar A. Khan ◽  
Laurence D. Watkins
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Surgery ◽  
Case Series ◽  
Cerebrospinal Fluid Leak ◽  
Icp Monitoring ◽  
Fluid Leak

Sternberg's Canal and Defect: Is the Lateral Craniopharyngeal Canal a Source of Spontaneous Cerebrospinal Fluid Leak? Anatomic and Radiological Analysis in Pediatric and Adult Populations

2021 ◽  
Author(s):  
Adedamola Adepoju ◽  
Lucas P Carlstrom ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Carlos Diogenes Pinheiro-Neto ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Adult Population ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Superior Orbital Fissure ◽  
Old Patients ◽  
Visual Illustration ◽  
Craniopharyngeal Canal ◽  
High Incidence ◽  
Fluid Leak

Abstract BACKGROUND The lateral craniopharyngeal or Sternberg's canal (SC) originates from superior orbital fissure (SOF) and traverses the sphenoid body into the nasopharynx. A remnant of the canal, Sternberg's defect (SD), has been debated as a source of cerebrospinal fluid (CSF) leak. The canal was described in 1888, and there is limited accurate visual illustration in the literature. OBJECTIVE To provide a detailed anatomic and radiological illustration of the canal in pediatric and adult population including the mechanism undermining the incidence of the canal, and the possibility of the canal as a source of CSF leak. METHODS A total of 195 high-resolution computed tomographies (CT) of patients (50 3-yr-old, 20 5-yr-old, and 125 adults) and 43 dry adult skulls (86 sides) were analyzed for a canal matching the description of the SC. RESULTS A SC was identified in 86% of the 3-yr-old and 40% of 5-yr–old patients. The diameter and length were 2.12 mm and 12 mm, respectively. The incidence of the canal decreased with age as sinus pneumatization extended into the sphenoid sinus. Only 0.8% of the adult skull on CT had the canal. The canal was not present on the dry adult skulls examination, but SD was found in 4.65%. CONCLUSION SC exists with high incidence in the pediatric group. Sinus pneumatization obliterates the canal in the adult population, leaving a defect in 4.65% of cases, which given the location and related anatomic structures, is unlikely to be a source of CSF leak.

Craniopharyngiomas

2018 ◽  
Author(s):  
Daniel M. S. Raper ◽  
John A. Jane
Keyword(s):  
Multidisciplinary Approach ◽  
Preoperative Assessment ◽  
Cerebrospinal Fluid Leak ◽  
Bimodal Distribution ◽  
Visual Evaluation ◽  
Diagnostic Modality ◽  
Cholesterol Crystals ◽  
Fluid Leak ◽  
Radical Surgical Resection

Craniopharyngiomas (CPs) are rare tumors arising from the developmental Rathke’s pouch and present in a bimodal distribution peaking at 5 to 14 and 50 to 74 years. Symptoms at onset include visual loss, headache, and hypopituitarism. Most tumors contain solid and cystic components, and fluid within the cyst usually contains cholesterol crystals. Histopathology is classified into adamantinomatous (most common in children) and papillary (almost exclusively in adults) subtypes. Magnetic resonance imaging is the definitive diagnostic modality for sellar and suprasellar lesions. In addition to imaging, formal visual evaluation and detailed endocrinologic workup are a critical aspect of preoperative assessment. The role of radical surgical resection, versus decompression combined with radiotherapy, remains controversial. The most common complications of surgical and radiotherapeutic treatments include pituitary stalk and hormonal deficiencies, along with cerebrospinal fluid leak. As 5-year overall survival for patients with CP is in the range of 55% to 85%, CP remains a challenging condition to treat and requires a multidisciplinary approach.

Cerebrospinal Fluid-Related Complications With Autologous Duraplasty and Arachnoid Sparing in Type I Chiari Malformation

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS156-ONS161 ◽  
Author(s):  
Caitlin E. Hoffman ◽  
Mark M. Souweidane
Keyword(s):  
Cerebrospinal Fluid ◽  
Retrospective Chart Review ◽  
Cerebrospinal Fluid Leak ◽  
Morbidity Rate ◽  
Type I ◽  
Symptomatic Disease ◽  
Aggressive Surgical Approach ◽  
The Mean ◽  
Postoperative Hydrocephalus ◽  
Fluid Leak

Abstract Objective: Although there is a current consensus that Type I Chiari malformations (CM-I) should be treated only in the setting of symptomatic disease, significant controversy surrounds the most appropriate surgical procedure. Recent enthusiasm for osseous decompression without duraplasty is supported by the purportedly lower morbidity of this approach. Precise rates of morbidity with duraplasty, however, have not been reported. This study is intended to assess the cerebrospinal fluid-related morbidity associated with a patient population treated uniformly with autologous duraplasty for symptomatic CM-I. Methods: A review of one surgeon's practice (MMS) from 1997 to 2007 identified patients treated for symptomatic CM-I with osseous decompression and autologous duraplasty. A retrospective chart review was then performed for these patients with an emphasis on cerebrospinal fluid-related complications. Results: Forty patients were treated for CM-I with decompression and autologous duraplasty. Twenty-four patients presented with a preoperative syrinx. The mean age was 13.3 years, and the median age was 12.9 years (range, 3.3–45.8 yr). The mean follow-up period was 11.4 months (range, 1–101 mo). There was no mortality associated with the procedure. Clinical response was observed in 91.8% of patients, with 70.2% experiencing complete symptomatic resolution and 21.6% experiencing partial improvement. Two patients (5.4%) had persistent symptomatic syringomyelia requiring syringosubarachnoid shunting. There was an overall morbidity rate of 2.5% due to one pseudomeningocele treated with a single percutaneous tap. There were no incidences of cerebrospinal fluid leak, meningitis, or postoperative hydrocephalus. Conclusion: The cerebrospinal fluid-related morbidity associated with autologous duraplasty for CM-I in a uniformly treated population is negligible. These results challenge the current rationale for a less aggressive surgical approach to CM-I.

scholarly journals A Case of Petrous Apex Meningocele: Unusual Presentation of Cerebrospinal Fluid Leak Following Adenoidectomy

2020 ◽  
Vol 27 (2) ◽  
pp. 135-139
Author(s):  
Byung Kil Kim ◽  
Yujin Heo ◽  
Doo-Sik Kong ◽  
Sang Duk Hong
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Petrous Apex ◽  
Diagnostic Process ◽  
Recurrent Meningitis ◽  
Csf Rhinorrhea ◽  
Leakage Site ◽  
Fluid Leak

Cerebrospinal fluid (CSF) leak is possible and can be a cause of recurrent bacterial meningitis. Petrous apex meningocele (PAM) is mostly asymptomatic and is often found during incidental imaging tests. We experienced a case of CSF rhinorrhea with recurrent meningitis in bilateral PAM after adenoidectomy. This report highlights the diagnostic process of CSF leak, identification of leakage site, and surgical approach to petrous apex lesions.

scholarly journals Cerebrospinal Fluid Leak during Stapes Surgery: Gushing Leaks and Oozing Leaks, Two Different Phenomena

2017 ◽  
Vol 96 (8) ◽  
pp. 302-308 ◽  
Author(s):  
Juan Luis Quesada ◽  
Giovanni Cammaroto ◽  
Lilla Bonanno ◽  
Francesco Galletti ◽  
Pedro Quesada
Keyword(s):  
Cerebrospinal Fluid ◽  
Statistical Analysis ◽  
Postoperative Complications ◽  
Multicenter Study ◽  
Cerebrospinal Fluid Leak ◽  
Stapes Surgery ◽  
Csf Leak ◽  
Clinical Evaluations ◽  
Hearing Outcomes ◽  
Fluid Leak

Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients—23 men and 15 women, aged 23 to 71 years (mean: 47)—who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications.

scholarly journals Visualized Ethmoid Roof Cerebrospinal Fluid Leak during Frontal Balloon Sinuplasty

2018 ◽  
Vol 97 (8) ◽  
pp. E34-E38 ◽  
Author(s):  
Navdeep R. Sayal ◽  
Eytan Keidar ◽  
Shant Korkigian
Keyword(s):  
Cerebrospinal Fluid ◽  
Balloon Dilation ◽  
Major Complication ◽  
Cerebrospinal Fluid Leak ◽  
Collagen Matrix ◽  
Sinus Surgery ◽  
Csf Leak ◽  
Safe Alternative ◽  
Revision Sinus Surgery ◽  
Fluid Leak

Balloon sinus dilation (BSD) is generally accepted as a safe alternative to traditional sinus surgery. It is a unique technique designed to potentially minimize complications associated with traditional functional endoscopic sinus surgery (FESS). We present a case in which a 65-year-old man experienced a cerebrospinal fluid (CSF) leak in the ethmoid roof that was visualized instantly after balloon dilation in a revision sinus surgery. In this case report, we discuss the causes of CSF leaks and explain in detail the immediate endoscopic repair with a collagen matrix. Also, literature is reviewed on the safety of BSD versus traditional FESS. Postoperative-ly, the patient has been without CSF leak and remains symptom free. CSF leak is a rare but major complication during both FESS and BSD. As BSD use increases, its complication profile will become clearer when used alone, in conjunction with FESS, and/or during revision surgery. Although BSD is considered a benign procedure, one should be cautious when using it in revision sinus surgery.

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