scholarly journals Analysis and Clinical Importance of Skull Base Fractures in Adult Patients with Traumatic Brain Injury

2018 ◽  
Vol 09 (03) ◽  
pp. 370-375 ◽  
Author(s):  
Jyothish Sivanandapanicker ◽  
Milesh Nagar ◽  
Raja Kutty ◽  
B. S. Sunilkumar ◽  
Anilkumar Peethambaran ◽  
...  
Keyword(s):  
Road Traffic ◽  
Skull Fracture ◽  
Clinical Signs ◽  
Clinical Importance ◽  
Adult Patients ◽  
Csf Leak ◽  
Adult Males ◽  
High Resolution Computed Tomography ◽  
Csf Rhinorrhea ◽  
Management Protocol

ABSTRACT Aims and Objectives: Basal skull fracture (BSF) is rare in head injury (HI) patients and occasionally goes unnoticed which may lead to cerebrospinal fluid (CSF) fistula. With changing trends in HI, there is a need to reassess incidence and pattern of BSF pattern, CSF leak, meningitis, and management protocol, especially in this part of the world where detailed literature is lacking. Subjects and Methods: We closely followed adult patients admitted with BSF in our institute between January 2013 and December 2014. Associated clinical features were recorded. In case of CSF leak, detailed CSF study was done and patients were managed accordingly. Patients with persistent CSF leak were managed surgically. Results: During the study period, 194 of 5041 HI patients had evidence of BSF (3.85%). BSF was most commonly associated with moderate-to-severe HI (73.19%). About 81.44% patients were male and 29.9% were <30 years. Most common cause was road traffic accident (84.54%). Isolated anterior cranial fossa (ACF) fracture was most common (50%). About 63.92% patients had raccoon eyes. Forty-three patients had CSF leak with CSF rhinorrhea being more common. Culture of only 5 patients suggested bacterial meningitis. CSF leak lasted for more than 10 days in 8 patients, of which 4 patients required surgical repair. Conclusions: BSF is rare in victims of HI. It is more common in young adult males. ACF fractures are most common in our setup. Clinical signs of BSF are supportive but not definitive; high resolution computed tomography head is gold standard to detect BSF. CSF leak is rare and most of the cases can be managed conservatively. Leak persisting more than 7–10 days has high risk of developing meningitis and likely to need surgical intervention.

scholarly journals TRANSCRANIAL DURAL REPAIR;

2017 ◽  
Vol 24 (08) ◽  
pp. 1232-1236
Author(s):  
Sohail Amir ◽  
Maimoona Qadir ◽  
Muhammad Usman
Keyword(s):  
Cerebrospinal Fluid ◽  
Road Traffic ◽  
Csf Leak ◽  
Dural Defect ◽  
Dural Repair ◽  
Csf Rhinorrhea ◽  
Mri Brain ◽  
Fascia Lata Graft ◽  
Minimum Age ◽  
Subfrontal Approach

Objectives: To determine efficacy of transcranial dural repair in managementof early traumatic cerebrospinal fluid (CSF) rhinorrhea by measuring the rate of resolution ofrhinorrhea following repair. Material and Study Design: Descriptive study. Period: 18 monthsfrom March 2014 to September 2015. Setting: Department of Neurosurgery Naseer Teachinghospital Peshawar. Methods: 30 patients, all head injury patients with CSF rhinorrhea of eithergender and any age, reporting to Accident and emergency department were included in thestudy. MRI Brain T2 Weighted in prone position done in all cases to identify the dural rent.Transcranial intradural repair was done through subfrontal approach. Post op complicationswere documented and follow at two months. Results: In this study 30 patients with cerebrospinalfluid (CSF) leak were observed. The minimum age was 8 years and the maximum was 59 years.23 (76.6%) were male and 7 (23.3%) were female. 18 (60%) patients have CSF rhinorrhea dueto road traffic accident, 7 (23.3%) patient with history of fall, while 5 (6.6%) patient were in othercategory. MRI brain T-2 Weighted done in all patient to identify the dural defect. The surgicalapproach was intradural in all of the 30 (100%) patients having fascia lata graft in 28 (93.3%)patients and pericranium in 2 (7%) patients to cover the defect properly. Among the immediatecomplications 3 (10%) patients had recurrent CSF leak, 2(6.6%) had meningitis, 5 (16.6%)had Pneumoencephalus while 3(10%) patients had other complications like subarachnoidhemorrhage, wound infection etc. The overall success rate was 90%. Conclusion: It isconcluded that in post traumatic cerebrospinal fluid (CSF) rhinorrhea, if the defect in dura isdemonstrated it must be repaired as soon as possible in order to prevent fulminant meningitis.

scholarly journals Surgical outcomes of the endonasal endoscopic approach within a standardized management protocol for repair of spontaneous cerebrospinal fluid rhinorrhea

2020 ◽  
pp. 1-7 ◽  
Author(s):  
Daniel C. Kreatsoulas ◽  
Varun S. Shah ◽  
Bradley A. Otto ◽  
Ricardo L. Carrau ◽  
Daniel M. Prevedello ◽  
...  
Keyword(s):  
Significant Risk ◽  
Endoscopic Approach ◽  
Csf Leak ◽  
Fungal Sinusitis ◽  
Opening Pressure ◽  
Surgical Morbidity ◽  
Csf Rhinorrhea ◽  
Management Protocol ◽  
Csf Diversion ◽  
Csf Leaks

OBJECTIVESpontaneous CSF leaks are rare, their diagnosis is often delayed, and they can precipitate meningitis. Craniotomy is the historical “gold standard” repair for these leaks. An endonasal endoscopic approach (EEA) offers potentially less invasiveness and lower surgical morbidity than a traditional craniotomy but must yield the same surgical success. A paucity of data exists studying EEA as the primary management for spontaneous CSF leaks.METHODSThe authors retrospectively reviewed patients undergoing spontaneous CSF rhinorrhea repair at their institution from July 2010 to August 2018. Standardized management includes EEA as first-line treatment, and lumbar puncture (LP) performed 24–48 hours postoperatively. If opening pressure on LP is elevated, CSF diversion or acetazolamide therapy is used as needed. Perioperative lumbar drains are not used.RESULTSOf 46 patients identified, the most common CSF rhinorrhea etiology was encephalocele (28/46, 60.9%), and the most common location was cribriform/ethmoid (26/46, 56.5%). Forty-three patients underwent EEA alone, and 3 underwent a simultaneous EEA/craniotomy. The most common repair strategy was nasoseptal or other pedicled flaps (18/46, 39.1%). Postoperatively, 15 patients (32.6%) received CSF diversion due to elevated ICP, with BMI > 40 kg/m2 being a significant risk factor (odds ratio 4.35, p = 0.033) for postrepair shunt placement. Twelve patients received acetazolamide therapy for treatment of mildly elevated pressures. The average opening pressure of the shunted group was 36 cm H2O and the average for the acetazolamide-only group was 26 cm H2O. Two patients underwent CSF leak repair revision, one because of progressive fungal sinusitis and the other because of recurrent CSF leak. The mean follow-up duration was 15 months.CONCLUSIONSThe paradigm of EEA repair of spontaneous CSF rhinorrhea with postoperative LP to identify undiagnosed idiopathic intracranial hypertension appears to be safe and effective. In the authors’ cohort, morbid obesity was statistically associated with the need for postoperative CSF diversion. This has implications for future surgical treatment as obesity levels continue to rise worldwide.

The Use of Methylene Blue Staining Test in Determining the CSF Leaks Location of the Anterior Skull Base

2018 ◽  
Vol 69 (6) ◽  
pp. 1376-1377
Author(s):  
Razvan Hainarosie ◽  
Teodora Ghindea ◽  
Irina Gabriela Ionita ◽  
Mura Hainarosie ◽  
Cristian Dragos Stefanescu ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Cerebrospinal Fluid ◽  
Intrathecal Injection ◽  
Diagnostic Procedures ◽  
Blue Staining ◽  
Csf Leak ◽  
Glucose Content ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage

Cerebrospinal fluid rhinorrhea represents drainage of cerebrospinal fluid into the nasal cavity. The first steps in diagnosing CSF rhinorrhea are a thorough history and physical examination of the patient. Other diagnostic procedures are the double ring sign, glucose content of the nasal fluid, Beta-trace protein test or beta 2-transferrin. To establish the exact location of the defect imagistic examinations are necessary. However, the gold standard CSF leakage diagnostic method is an intrathecal injection of fluorescein with the endoscopic identification of the defect. In this paper we analyze a staining test, using Methylene Blue solution, to identify the CSF leak�s location.

scholarly journals Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

2021 ◽  
Author(s):  
Sukriti Das ◽  
Bipin Chaurasia ◽  
Dipankar Ghosh ◽  
Asit Chandra Sarker
Keyword(s):  
Head Injury ◽  
Road Traffic ◽  
Head Injuries ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Acute Subdural Hematoma ◽  
Care Hospital ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
The Government

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

scholarly journals Surgical Management of Sporadic Peripheral Nerve Schwannomas in Adults: Indications and Outcome in a Single Center Cohort

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1017
Author(s):  
Julian Zipfel ◽  
Meizer Al-Hariri ◽  
Isabel Gugel ◽  
Alexander Grimm ◽  
Volker Steger ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Clinical Signs ◽  
Complete Resection ◽  
Adult Patients ◽  
Neurological Deficits ◽  
Primary Tumors ◽  
Surgical Interventions ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath

Most sporadic peripheral nerve sheath tumors in adults are schwannomas. These tumors usually present with significant pain but can also cause neurological deficits. Symptomatology is diverse, and successful surgical interventions demand interdisciplinarity. We retrospectively reviewed 414 patients treated between 2006 and 2017 for peripheral nerve sheath tumors. We analyzed clinical signs, symptoms, histology, and neurological function in the cohort of adult patients with schwannomas without a neurocutaneous syndrome. In 144 patients, 147 surgical interventions were performed. Mean follow-up was 3.1 years. The indication for surgery was pain (66.0%), neurological deficits (23.8%), significant tumor growth (8.8%), and suspected malignancy (1.4%). Complete tumor resection was achieved on 136/147 occasions (92.5%). The most common location of the tumors was intraspinal (49.0%), within the cervical neurovascular bundles (19.7%), and lower extremities (10.9%). Pain and neurological deficits improved significantly (p ≤ 0.003) after 131/147 interventions (89.1%). One patient had a persistent decrease in motor function after surgery. Complete resection was possible in 67% of recurrent tumors, compared to 94% of primary tumors. There was a significantly lower chance of complete resection for schwannomas of the cervical neurovascular bundle as compared to other locations. The surgical outcome of sporadic schwannoma surgery within the peripheral nervous system is very favorable in experienced peripheral nerve surgery centers. Surgery is safe and effective and needs a multidisciplinary setting. Early surgical resection in adult patients with peripheral nerve sheath tumors with significant growth, pain, neurological deficit, or suspected malignancy is thus recommended.

Cerebrospinal Fluid Dynamics and Rhinorrhea: The Role of Shunting in Repair

1983 ◽  
Vol 91 (4) ◽  
pp. 399-403 ◽  
Author(s):  
Arnold Komisar ◽  
Stephen Weitz ◽  
Robert J. Ruben
Keyword(s):  
Intracranial Pressure ◽  
Surgical Repair ◽  
Skull Fracture ◽  
Increased Intracranial Pressure ◽  
Csf Rhinorrhea ◽  
Initial Management ◽  
Parasellar Region ◽  
Csf Leakage ◽  
Pathophysiologic Mechanisms

CSF rhinorrhea can have many causes: traumatic, neoplastic, and iatrogenic origins are common. Most traumatic rhinorrhea ceases after a trial of conservative management. While obvious erosion or traumatic destruction of vital structures may be the underlying cause, other pathophysiologic mechanisms may be working in the formation of CSF rhinorrhea, which may require the combined skills of the otolaryngologist and the neurosurgeon. Leakage of CSF is seen in “high-pressure rhinorrhea,” a pathophysiologic state wherein the underlying problem is poor CSF resorption. The result is increased intracranial pressure and eventual rhinorrhea or otorrhea. Areas of CSF leakage correspond to sites of congenital weakness in the cribriform plate region, the parasellar region, or the temporal bone. Weak areas in old base-of-skull fracture sites may leak with increased intracranial pressure. The initial management should stress correction of the deranged pathophysiology, namely shunting. Surgical repair is secondary to controlling the abnormal CSF dynamics.

scholarly journals CT Findings and Histological Evaluation of Red Foxes (Vulpes vulpes) with Chronic Head Trauma Injury: A Retrospective Study

Animals ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 1010
Author(s):  
Luca Lacitignola ◽  
Rossella Samarelli ◽  
Nicola Zizzo ◽  
Elena Circella ◽  
Claudia Acquafredda ◽  
...  
Keyword(s):  
Head Trauma ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Clinical Signs ◽  
Ct Scans ◽  
Histological Evaluation ◽  
Red Foxes ◽  
Large Numbers ◽  
Post Mortem Findings ◽  
Trauma Injury

Large numbers of wild animals are injured every year in road traffic accidents. Scant data are available for rescued wild carnivores, in particular for red foxes. Cases of foxes with head trauma were retrospectively considered for inclusion in this study. Clinical examination, modified Glasgow coma scale (MGCS), computed tomography (CT) examination, therapy, outcome, and post mortem findings of the brain were investigated. In all foxes, cranial vaults lesion occurred in single (67%) or multiple sites (33%). Midline shift and hydrocephalus were observed in this population. The mean survival was 290 (±176) days. In our study, we performed CT scans on average 260 days after fox rescue, and we speculate that persisting clinical signs could be attributed to TBI. In our study, only two foxes were alive at the time of writing. Other foxes were euthanized due to the severity of the clinical signs. CT scans help diagnose chronic lesions and their effect on prognostic judgment for animals released to wildlife environments.

scholarly journals Risks, costs, and outcomes of cerebrospinal fluid leaks after pediatric skull fractures: a MarketScan analysis between 2007 and 2015

2019 ◽  
Vol 47 (5) ◽  
pp. E10
Author(s):  
Kunal Varshneya ◽  
Adrian J. Rodrigues ◽  
Zachary A. Medress ◽  
Martin N. Stienen ◽  
Gerald A. Grant ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Neurological Deficits ◽  
Csf Leak ◽  
Skull Fractures ◽  
Pediatric Head Trauma ◽  
Cerebrospinal Fluid Leaks ◽  
Neurosurgical Intervention ◽  
Csf Leaks

OBJECTIVESkull fractures are common after blunt pediatric head trauma. CSF leaks are a rare but serious complication of skull fractures; however, little evidence exists on the risk of developing a CSF leak following skull fracture in the pediatric population. In this epidemiological study, the authors investigated the risk factors of CSF leaks and their impact on pediatric skull fracture outcomes.METHODSThe authors queried the MarketScan database (2007–2015), identifying pediatric patients (age < 18 years) with a diagnosis of skull fracture and CSF leak. Skull fractures were disaggregated by location (base, vault, facial) and severity (open, closed, multiple, concomitant cerebral or vascular injury). Descriptive statistics and hypothesis testing were used to compare baseline characteristics, complications, quality metrics, and costs.RESULTSThe authors identified 13,861 pediatric patients admitted with a skull fracture, of whom 1.46% (n = 202) developed a CSF leak. Among patients with a skull fracture and a CSF leak, 118 (58.4%) presented with otorrhea and 84 (41.6%) presented with rhinorrhea. Patients who developed CSF leaks were older (10.4 years vs 8.7 years, p < 0.0001) and more commonly had skull base (n = 183) and multiple (n = 22) skull fractures (p < 0.05). These patients also more frequently underwent a neurosurgical intervention (24.8% vs 9.6%, p < 0.0001). Compared with the non–CSF leak population, patients with a CSF leak had longer average hospitalizations (9.6 days vs 3.7 days, p < 0.0001) and higher rates of neurological deficits (5.0% vs 0.7%, p < 0.0001; OR 7.0; 95% CI 3.6–13.6), meningitis (5.5% vs 0.3%, p < 0.0001; OR 22.4; 95% CI 11.2–44.9), nonroutine discharge (6.9% vs 2.5%, p < 0.0001; OR 2.9; 95% CI 1.7–5.0), and readmission (24.7% vs 8.5%, p < 0.0001; OR 3.4; 95% CI 2.5–4.7). Total costs at 90 days for patients with a CSF leak averaged $81,206, compared with $32,831 for patients without a CSF leak (p < 0.0001).CONCLUSIONSThe authors found that CSF leaks occurred in 1.46% of pediatric patients with skull fractures and that skull fractures were associated with significantly increased rates of neurosurgical intervention and risks of meningitis, hospital readmission, and neurological deficits at 90 days. Pediatric patients with skull fractures also experienced longer average hospitalizations and greater healthcare costs at presentation and at 90 days.

scholarly journals Rubella outbreak in Poland in 2013 – an analysis of surveillance data at the national and province level

2015 ◽  
Vol 125 (2) ◽  
pp. 65-71
Author(s):  
Dorota Mrozek-Budzyn ◽  
Renata Majewska ◽  
Agnieszka Kiełtyka ◽  
Małgorzata Augustyniak
Keyword(s):  
Incidence Rate ◽  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
Clinical Signs ◽  
Vaccination Strategy ◽  
Disease Outbreak ◽  
Surveillance Data ◽  
Good Time ◽  
Adult Males ◽  
Laboratory Confirmation

Abstract Introduction. Poland is a member of the WHO European Region where a complete eradication of measles and rubella is planned to be finished by 2015. Poland accounted for 99% of all reported rubella cases in 27 EU/EEA countries in 2013. It is a good time to evaluate whether the established Polish vaccination strategy was sufficient to reach the goal of rubella elimination in the near future. Aim. The aim of this study was to analyze the epidemiology of rubella in Poland when the disease outbreak took place in 2013, to determine the reasons of that situation and to find the solution for future rubella elimination strategies. Material and methods. To analyze the epidemiology of rubella in Poland during the disease outbreak in 2013 the authors used rubella surveillance data collected by the Provincial and National Notifiable Disease Reporting System in 2004-2013. The information at the provincial level derived from one of the 16 provinces (Malopolska). The data on MMR vaccination coverage in 2003-2012 derived from the National Surveillance System. The percentages of rubella cases and vaccine coverage between Poland with Malopolska province were compared. Results. The outbreak started in late 2012 and continued through 2013, when 38548 rubella cases (incidence rate 100.1/ 100 000) were notified. Geographically, rubella cases were reported from the entire country, with the highest incidence rate in Malopolska province (254.9/100 000). Only 5 cases from Malopolska and 120 in whole country were laboratory confirmed, the remaining 99.7% were reported solely on the basis of clinical signs. The vaccination coverage was not sufficient to protect the population against rubella outbreak in Poland, especially among adolescents and young adult males. Conclusions. The strengthening of routine immunization program and implementation of some additional vaccination campaigns in young adults as well as laboratory confirmation of all suspected cases are the challenges that will have to be met to eliminate rubella in Poland

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