Surgically repaired posttraumatic CSF rhinorrhea: An institutional experience and review of literature

AbstractPosttraumatic cerebrospinal fluid (CSF) rhinorrhea frequently complicates anterior skull base fracture. Although skull base fracture is present in only about 7% cases of head injury, CSF rhinorrhea develops in 30% of cases with basal fracture.A total of 43 cases admitted in our Institute (SGPGI Lucknow) from January 2000 to June 2011with history of head trauma followed by CSF rhinorrhea. Forty one cases were included in this study as two patients refused surgery.Out of forty one cases, 26 cases (63%) were admitted with history of recurrent meningitis, 21 cases (51%) with loss of smell, 26 cases (63%) with delayed onset CSF rhinorrhea, 3 cases (7%) with early onset rhinorrhea which did not improve after trauma, 12 cases (30%) with early onset rhinorrhea which improved but reappeared after some time. Twenty cases (48.8%) were repaired by extradural approach, 10 cases (24.4%) were repaired by intradural approach and 11 cases (26.8%) were repaired by endoscopic approach. 12 cases (29.0%) required re-surgery for persistent or recurrence of CSF rhinorrhea.Although posttraumatic CSF rhinorrhea usually resolves with conservative management, its persistence makes an individual prone for further complications like meningitis, brain abscess and septicaemia. Timely surgical intervention usually gives promising results. Endoscopic repair was better than transcranial repair.

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Transorbital approach for endoscopic repair of encephalocele

Neurosurgical Focus: Video ◽

10.3171/2020.4.focusvid.19907 ◽

2020 ◽

Vol 2 (2) ◽

pp. V18

Author(s):

Christina E. Sarris ◽

Griffin D. Santarelli ◽

Andrew S. Little

Keyword(s):

Skull Base ◽

Muscle Function ◽

Anterior Skull Base ◽

Endoscopic Repair ◽

Radiographic Evidence ◽

Csf Rhinorrhea ◽

Endoscopic Transorbital ◽

History Of ◽

Skull Base Defect ◽

Minimally Invasive Access

This video demonstrates the transorbital approach for endoscopic repair of an anterior skull base encephalocele. The patient is a 77-year-old man with morbid obesity and a 2-year history of left-sided cerebrospinal fluid (CSF) rhinorrhea and radiographic evidence of an anterior skull base defect with an encephalocele. An endoscopic transorbital approach was chosen for repair because of its minimally invasive access to the anterolateral skull base. The patient had an excellent clinical outcome with resolution of the CSF rhinorrhea and preservation of full vision and extraocular muscle function.The video can be found here: https://youtu.be/oDhZgnaiZ00.

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Preauricular Transzygomatic Approach for Infratemporal Fossa and Surrounding Skull Base Lesion: An Institutional Experience

Annals of Otology and Neurotology ◽

10.1055/s-0038-1636945 ◽

2018 ◽

Vol 01 (02) ◽

pp. 094-099

Author(s):

Rajat Jain ◽

Amit Keshri ◽

Ravi Manogaran ◽

Raj Kumar ◽

Pearly Keeranghat

Keyword(s):

Skull Base ◽

Sphenoid Sinus ◽

Malignant Tumors ◽

Postoperative Radiotherapy ◽

Infratemporal Fossa ◽

Benign Tumors ◽

Critical Areas ◽

Institutional Experience ◽

Base Lesion ◽

Better Than

Abstract Background Preauricular transzygomatic surgical approach (PTZA) can be used to approach and resect tumors of infratemporal fossa (ITF) and surrounding skull base lesion. Various modifications in this approach can be used to approach various critical areas such as cavernous sinus, sphenoid sinus. Materials and Methods Clinical charts were reviewed to determine the association among pathological variables, surgical procedures, and outcomes. Results Three out of seven were malignant tumors and required pterional craniotomy and postoperative radiotherapy. 4 out of 7 were benign tumors and required craniofacial osteotomies. Conclusion PTZA is a versatile approach for tumor of ITF with or without intracranial extradural extension and cosmetically better than other approaches. This approach is better suited for lateral ITF tumors that are difficult to access through endoscopic approaches.

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A retrospective study to analyze treatment of post traumatic cerebro spinal fluid rhinorrhea and role of trans cranial pedicled pericranial repair in present day context

IP Indian Journal of Anatomy and Surgery of Head Neck and Brain ◽

10.18231/j.ijashnb.2021.029 ◽

2022 ◽

Vol 7 (4) ◽

pp. 111-118

Author(s):

Shashivadhanan ◽

Abhishek Mishra

Keyword(s):

Retrospective Study ◽

Skull Base ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Spinal Fluid ◽

Csf Leak ◽

Care Hospital ◽

Endoscopic Repair ◽

Csf Rhinorrhea ◽

Post Traumatic

: Skull base fractures are a major cause of morbidity and mortality in head injury. Anterior cranial Fossa (ACF) skull base fracture, leading to Cerebro Spinal Fluid (CSF) Rhinorrhea is one of the most commonly encountered presentation in ACF base fractures. The key to successful management of such cases lies in early diagnosis and surgical management before it leads to meningitis and avoidable mortality.To evaluate the cases of post traumatic CSF rhinorrhea and analyze the parameters utilized to guide the management strategies. An attempt was made to come up with guidelines for its management in a tertiary care hospital.This was a retrospective study in which all cases of traumatic CSF Rhinorrhea admitted to Tertiary care hospital were included. Patients were divided into three groups. First group was conservatively managed in which the rhinorrhea and serial imaging findings showed favourable response.In thesecond group patients were subjected to endoscopic repair by the ENT surgeon based on anatomical considerations. The third group included patients who were had failed the trial of conservative management and the site of leak did not favor endoscopic repair.The outcomes in all these groups were analyzed and conclusions drawn.A total of 54 patients were included in the study which was conducted between Jan 2014 to 2020. 24 were successfully managed conservatively,10 were managed with endoscopic repair and 20 were managed by bifrontal craniotomy and pedicled pericranial ACF Base repair. There was one case from the first group who developed CSF leak after one month necessitating ACF base repair. There was no recurrence reportedin the cases managed endoscopically, whereas one case subjected to craniotomy had recurrence requiring lumbar drain placement. With each transcranial surgery there was a refinement in the technique further minimizing complications. We have elaborated on the surgical nuances to ensurebetter outcomes. : Pedicledpericranial flap ACF base repair is an elegant approach which requires an understanding of the mechanism of CSF leak from skull base fractures. This procedure can easily be mastered and when performed correctly provides best results for cases where there are multiple ACF defects, those not accessible by endoscope and also in those cases where imaging is not able to localize the exact site of defect leading to CSF rhinorrhea. Anosmia is an in evitable complication of this procedure. However, the trade off between mortality resulting from meningitis versus anosmia makes it a viable and attractive treatment option.

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Endonasal Endoscopic Management of Frontal Sinus Cerebrospinal Fluid Leak

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4478 ◽

2017 ◽

Vol 31 (6) ◽

pp. 406-411 ◽

Cited By ~ 7

Author(s):

Javaneh Jahanshahi ◽

Mehdi Zeinalizadeh ◽

Hasan Reza Mohammadi ◽

Seyed Mousa Sadrehosseini

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Frontal Sinus ◽

Surgical Approaches ◽

Endoscopic Management ◽

Graft Material ◽

Endoscopic Repair ◽

Skull Base Reconstruction ◽

Csf Rhinorrhea

Background A frontal sinus leak is uncommon and is seen in ∼15% of cases of patients with cerebrospinal fluid (CSF) rhinorrhea. Now, endonasal endoscopic techniques have been reported to reconstruct skull base defects in the frontal sinus with a favorable outcome. Objective To review our experience in the repair of frontal sinus CSF leaks through an endonasal endoscopic approach. Methods Twenty-four patients with a frontal sinus leak who underwent endonasal endoscopic repair entered the study. Clinical presentation, location, frontal sinusotomy, graft material, follow-up, and frontal sinus status were evaluated. Results Among >100 cases of surgically repaired CST rhinorrhea, the frontal sinus was the site of the leak in 24 patients (mean age, 28.9 years; mean follow-up, 22 months). The etiology consisted of spontaneous leak and traumatic leak; whereas patients with skull base reconstruction after removal of tumor were excluded. Surgical approaches included Draf IIb, Draf III, Draf IIa in 20, 3, and 1 patients, respectively. Tree autografts as two-layer inlay fat–muscle and onlay fascia lata were used in the majority of patients. A success rate was achieved in 95.83% of the patients. Conclusion Endonasal endoscopic repair of a frontal sinus leak was a successful procedure, with a low failure rate and minimal morbidity.

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Management of malignant tumors of the anterior and anterolateral skull base

Neurosurgical FOCUS ◽

10.3171/foc.2002.12.5.8 ◽

2002 ◽

Vol 12 (5) ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Thomas C. Origitano ◽

Guy J. Petruzzelli ◽

Darl Vandevender ◽

Bahman Emami

Keyword(s):

Skull Base ◽

Malignant Disease ◽

Malignant Tumors ◽

Disease Process ◽

Cranial Base ◽

Medical Oncologists ◽

Institutional Experience ◽

History Of ◽

Technical Considerations ◽

Overall Mortality

Object Malignant tumors of the skull base represent a group of diverse and infrequent lesions. Comprehensive oncological management requires a multidisciplinary team of neurological surgeons, otolaryngologists, radiation oncologists, plastic surgeons, and medical oncologists. The authors describe an institutional experience in performing 54 combined anterior–anterolateral cranial base resections for malignant disease. Methods The technical considerations for preoperative workup, surgical approach, resection, and reconstruction are outlined and illustrated. Considerations for complication management and avoidance are detailed. Conclusions Overall mortality (0%) and morbidity rates (18%) are acceptable. The influence on the natural history of the disease process is an ongoing study.

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Major Cerebral Artery Injury during Skull Base Meningioma Resection: Critical Video Analysis of Institutional Experience and Systematic Review of Literature

10.1055/s-0039-1679694 ◽

2019 ◽

Author(s):

Jai Thakur ◽

Nimer Adeeb ◽

Amey Savardekar ◽

Bharat Guthikonda ◽

Hai Sun

Keyword(s):

Systematic Review ◽

Skull Base ◽

Cerebral Artery ◽

Video Analysis ◽

Review Of Literature ◽

Artery Injury ◽

Skull Base Meningioma ◽

Institutional Experience

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Prognostic and Risk Factors Analysis of 106 Patients Undergoing Ventriculoperitoneal Shunt Combined with Cranioplasty

10.21203/rs.3.rs-78729/v1 ◽

2020 ◽

Author(s):

Hongbo Chang ◽

Ming Gao ◽

Wei-Dong Cao ◽

Hu-Lin Zhao ◽

Gang Cheng ◽

...

Keyword(s):

Risk Factors ◽

Skull Base ◽

Ventriculoperitoneal Shunt ◽

Aneurysm Rupture ◽

Communicating Hydrocephalus ◽

Operation Condition ◽

Csf Rhinorrhea ◽

Course Of Disease ◽

Skull Base Fracture ◽

Gcs Score

Abstract Background: The study is to summarize the therapeutic effect and long-term prognosis of ventriculoperitoneal shunt combined with cranioplasty, analyze the operation-related risk factors and common complications, and summarize the experience, so as to improve the safety of the operation.Methods: Retrospective analysis was performed on 106 patients diagnosed with post-operative skull loss with communicating hydrocephalus who underwent ventriculoperitoneal shunt combined with cranioplasty at our hospital. Age, gender, etiology, course of the disease, imaging manifestations, combined diseases, and prognosis of the patients were analyzed, as well as the risk factors and common complications of the operation.Results: Among the 106 patients, 62 were males, and 44 were females, with an age range from 17~67 years old. There were 72 cases of craniocerebral injury, 23 cases of hypertensive intracerebral hemorrhage, and 11 cases of intracranial aneurysm rupture. There were 84 patients with a course of disease ≤3 months during operation, and 22 patients with a course of disease > 3 months. There were 71 cases with GCS score ≤8, and 35 cases with GCS score > 8. There were 10 patients with skull base fracture and cerebrospinal fluid (CSF) rhinorrhea and 24 patients with severe hydrocephalus. Among the 106 patients, 79 showed improvement after the operation, 24 showed no significant improvement, and 3 underwent the second operation due to aggravated condition. Most of the patients with poor prognosis were patients with GCS score ≤8 points at the time of surgery, patients with previous skull base fracture and CSF rhinorrhea, patients with intraoperative hemorrhage > 800ml, and patients with post-operative body temperature over 39 °C. Conclusions: Our results revealed that ventriculoperitoneal shunt, combined with cranioplasty, is a useful approach. For patients with a high risk of operation, condition assessment, and monitoring should be strengthened. For patients with fever combined with infection or cerebral hemorrhage after the operation, active surgical treatment should be performed. Trial registration: Not applicable

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CSF Rhinorrhea Following Medical Treatment for Prolactinoma: Management and Challenges

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1677686 ◽

2019 ◽

Vol 80 (06) ◽

pp. 620-625

Author(s):

Arivazhagan Arimappamagan ◽

Nishanth Sadashiva ◽

Sandeep Kandregula ◽

Dhaval Shukla ◽

Sampath Somanna

Keyword(s):

Medical Treatment ◽

Skull Base ◽

Rare Complication ◽

Csf Leak ◽

Serum Prolactin ◽

Management Options ◽

Endoscopic Repair ◽

Csf Rhinorrhea ◽

Preoperative Serum ◽

Potential Risk Factors

Objective Cerebrospinal fluid (CSF) rhinorrhea following medical management of prolactinoma is a rare complication. We evaluated the clinical background of this condition, identify potential risk factors, and discuss the management options and challenges involved. Methodology We retrospectively reviewed clinical details of patients who were treated for CSF leaks among patients treated for prolactinoma between 2013 and 2017. Results Seven patients were treated for CSF rhinorrhea in the context of prolactinoma, with the age range between 24 and 56 years. Six patients had CSF leak following initiation of cabergoline, while one patient presented with CSF rhinorrhea. The time of onset of leak following medical treatment ranged from 14 days to 5 years. The mean preoperative serum prolactin level was 12,638 ng/mL (range: 1,000–26,287 ng/mL). All patients underwent repair of skull base defect. (four endoscopic, two microscopic, and one bifrontal craniotomy). The site of defect in the majority of patients was the sellar floor. Two patients who were initially managed with acetazolamide alone, eventually required surgical repair. Three patients were cured of CSF leak with a single procedure. Three patients had to undergo re-exploration and endoscopic repair after their first surgery failed. Two patients required lumboperitoneal (LP) shunt after a failed endoscopic transsphenoidal repair. Conclusion Surgical management for medically-induced CSF rhinorrhea is necessary; however, it can pose significant issues. Endoscopic repair of the defect should be considered at the earliest. Multiple surgical procedures are often required because of skull base erosion. LP shunt can be considered if CSF leak persists following multiple surgeries.

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