Endoscopic Repair of Spontaneous CSF Rhinorrhoea: Results from 21 Cases

Introduction Surgery to close the skull base defect is the treatment of choice in persistent spontaneous cerebrospinal fluid rhinorrhoea with endoscopic endonasal repair being the method of choice. This study analysed the demographics of presentation, optimal diagnostic and localisation strategies and the effectiveness of transnasal endoscopic treatment strategies with post-operative follow-up of CSF rhinorrhoea patients in a tertiary care institution . Materials and Methods A prospective longitudinal study was conducted on 21 CSF rhinorrhoea patients operated on between August 2014 and August 2018 and results documented. Results CSF rhinorrhoea was found most commonly in middle aged female patients in our study. HRCT PNS was capable of identifying a leak site in 66% of the cases. All patients were operated endoscopically with no major intra-operative or post-operative complications. Resolution of CSF leak occurred in 85% of cases. Conclusion CSF rhinorrhoea can be diagnosed and endoscopic repair can be effectively performed in our existing tertiary care set-ups with good results.

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The endoscopic treatment of cerebrospinal fluid rhinorrhoea: the Nottingham experience

The Journal of Laryngology & Otology ◽

10.1017/s0022215100136643 ◽

1997 ◽

Vol 111 (2) ◽

pp. 125-128 ◽

Cited By ~ 48

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.

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Trans-nasal endoscopic repair of cerebrospinal fluid rhinorrhoea: a retrospective analysis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20184354 ◽

2018 ◽

Vol 4 (6) ◽

pp. 1372

Author(s):

Amardeep Singh ◽

Navneet Kumar ◽

Sarvpreet Singh Grewal

Keyword(s):

Surgical Outcomes ◽

Tertiary Care ◽

Middle Turbinate ◽

Csf Leak ◽

Graft Material ◽

Care Hospital ◽

Hospital Data ◽

Endoscopic Repair ◽

Csf Rhinorrhoea ◽

Rate Of Success

Background: The purpose of present study was to assess the management and surgical outcomes of trans-nasal endoscopic repair of CSF rhinorrhoea.Methods: A retrospective study was conducted on the basis of medical records of 8 patients (6 males and 2 females) who had undergone trans-nasal endoscopic reconstructive surgery for CSF leak in a tertiary care hospital. Data so collected was analyzed to determine the demographic and diagnostic factors with surgical outcomes. Rate of success achieved was also assessed. Results: Majority of patients were in the age group of 21-40 years with mean age of 28.50 years. Main cause of leak was trauma (75%) and most common site of defect was found to be the cribriform plate of ethmoid bone (75%). 38% patients suffered from recurrent episodes of meningitis. Repair of dehiscence was done by variety of graft material like fat, fascia, middle turbinate mucosa, septal bone, cartilage or mucosa and fibrin glue. Success rate of 100% was observed. No post-surgical complications were encountered in this series.Conclusions: Trans-nasal endoscopic surgical technique is an effective and atraumatic procedure for repair of CSF rhinorrhoea with minimum morbidity and low post-operative complications.

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Radiological Analysis of Frontal Cells and its Association with Frontal Sinus Mucosal Disease: A Tertiary Care Hospital Based Study

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2019.v27i1.218 ◽

2019 ◽

Vol 27 (1) ◽

pp. 1-7

Author(s):

Bikash Lal Shrestha ◽

Sameer Karmacharya

Keyword(s):

Frontal Sinus ◽

Small Sample Size ◽

Statistical Significance ◽

Tertiary Care ◽

Small Sample ◽

Care Hospital ◽

Prospective Longitudinal Study ◽

Mucosal Disease ◽

Complex Anatomy ◽

Prospective Longitudinal

Introduction The frontal sinus and frontal recess both have complex anatomy causing difficulty during endoscopic sinus surgeries. The term frontal cells is currently used to describe a group of anterior ethmoidal cells classified by Kuhn et al into 4 types. Though there are precise descriptions, the frequency of frontal sinus cells (FSCs) varies widely in the literature. The presence of FSCs is responsible for a narrowing of the frontal sinus outflow tract which subsequently causes a partial obstruction of drainage and aeration of the frontal sinus. Our main aim is to the see the distribution of different frontal cells in Nepali population and relation with frontal sinus mucosal disease. Materials and Methods This prospective, longitudinal study performed in 110 consecutive patients who underwent CT scan of nose and paranasal sinuses. The frontal cells and agger nasi cells were identified and association between the frontal cells and agger nasi cells with frontal sinus mucosal disease was analyzed with chi square test. Results The agger nasi was present in 83.63% CT scans whereas frontal cells were distributed in 61.82% CT (computed tomogram) scans. There was not statistical significance and any association between the frontal cells and agger nasi cells with frontal sinus mucosal disease. Conclusion The frontal cells and agger nasi cells distribution in Nepalese population, even though in small sample size, is similar with other studies in the literature. There is also non association of either frontal cells or agger nasi cells with frontal sinus mucosal disease.

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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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A OBSERVATIONAL STUDY OF ENDOSCOPIC REPAIR OF CSF RHINORRHOEA

10.36106/ijsr/2502752 ◽

2020 ◽

pp. 74-76

Author(s):

Bijoy Krishna Bhadra ◽

Soumen Biswas ◽

Debarshi Jana

Keyword(s):

Success Rate ◽

Middle Turbinate ◽

Csf Leak ◽

Endoscopic Repair ◽

Radiological Investigation ◽

Nasal Endoscope ◽

Primary Surgery ◽

Second Surgery ◽

Csf Rhinorrhoea ◽

Graft Success

Background: Intrathecal fluorescein may be used to visualize CSF fistulas using a nasal endoscope. This allows the examiner to directly visualize the size of the defect, its location, and its rate of flow. The first repair of CSF leak was performed by Dandy in 1926 using a frontal craniotomy. This technique had a 60-80% success rate and was the gold standard for decades. In 1964Vrabec and Hallberg described the endonasal approach of CSF leak repair. AIMS: This study aims to establish the success rate of endoscopic surgical repair of CSF rhinorrhoca. MATERIALS AND METHODS: The study was conducted in Department of ENT IPGMER and SSKM Hospital. During the study period of 18 months, 30 patients have been admitted in our department with CSF leak (most of them were referred from neurosurgery). RESULTS: Fat and fascia lata and temporalis fascia were used to repair CSF leak in 24 patients. Bath plug technique was applied for 3 patients. Repair with vascularised flap such as Hadad flap or middle turbinate graft were used in case of 3 patients. CSF rhinorrhoea repair was successful in 28 out of 30(94%) patients after primary surgery whereas recurrence occurred in 2(6%) cases. Among them 1 patient underwent second surgery which achieved definitive closure of the leak. But one case lost follow up and did not come for second surgery. Interval between surgery and recurrence was varied and so were the causes. CONCLUSION: CSF rhinorrhoea cases can be repaired by an endoscopic approach with a high success rate. Radiological investigation of PNS and brain are equally important for selection of cases for endoscopic repair. Spontaneous leak must be checked cautiously to exclude features of raised ICT. Relapse occurs mainly for failure to delineate actual site or sites of leak and inadequate size or faulty placement of graft. Success depends not only on surgical skill but also on baseline intracranial tension, cause & site of leak and postoperative care.

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Bacteriological profile and antimicrobial susceptibility pattern of endotracheal tube secretion of patients in ICUs of a tertiary care hospital in Punjab

Indian Journal of Microbiology Research ◽

10.18231/j.ijmr.2021.046 ◽

2021 ◽

Vol 8 (3) ◽

pp. 224-229

Author(s):

Kiranjeet Kaur ◽

Shavetika Jindal

Keyword(s):

Antimicrobial Susceptibility ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Multidrug Resistant ◽

Diffusion Method ◽

Care Hospital ◽

Susceptibility Pattern ◽

Prospective Longitudinal Study ◽

Antimicrobial Susceptibility Pattern ◽

Prospective Longitudinal

Healthcare associated pneumonia (HAP)is second most common HCAIs that occur in 27% critically ill patients. Eighty-six percent of HAP are associated with mechanical ventilation and termed as ventilator associated pneumonia (VAP). VAP due to multidrug resistant has also increased in recent past. To isolate and identify the bacterial pathogens in endotracheal tubes aspirates of ICUs patients and study their antimicrobial susceptibility pattern.A prospective longitudinal study was conducted in the Microbiology laboratory of a tertiary care hospital over a period of six months after clearance from institutional Research Committee and Ethical Committee. All the samples of ETT secretions received in Clinical Microbiology lab from ICU patients and fulfilling the criteria for VAP were included in this study. Samples were processed as per standard protocol and organisms were identified on the basis of gram staining, colony characters and biochemical tests. Antibiotic sensitivity was performed by Kirby Bauer disc diffusion method as per CLSI guidelines. : A total of 100 samples of ET secretions were collected and proceeded for culture. Out of 100 samples, 76 (76.0%) were positive for bacterial growth. Among 76 positive cultures, a total 80 bacterial isolates were obtained as some cultures were showing polymicrobial growth. Five (6.26%) isolates were Gram Positive bacteria and 75(93.7%) were Gram negative. The most frequent isolates were 35(43.7%) followed by , isolates were sensitive to colistin while resistant to ampicillin and amoxiclav. isolates were sensitive to colistin and resistant to ampicillin, amoxiclav, ciprofloxacin, cefixime, piperacillin tazobactam. isolates were sensitive to colistin while resistant to ampicillin, amoxiclav, ceftizidime and piperacillin tazobactam. In our study antimicrobial pattern of isolated bacteria shows multidrug resistant pathogens which are associated with VAP and limit therapeutic options.

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Pyomyositis and Infectious Myositis: A Comprehensive, Single-Center Retrospective Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab098 ◽

2021 ◽

Author(s):

Christopher Radcliffe ◽

Savanah Gisriel ◽

Yu Si Niu ◽

David Peaper ◽

Santiago Delgado ◽

...

Keyword(s):

Retrospective Study ◽

Percutaneous Drainage ◽

Treatment Success ◽

Tertiary Care ◽

Treatment Strategies ◽

Altered Mental Status ◽

Gram Positive Bacteria ◽

Tertiary Care Institution ◽

The Mean ◽

Days Open

Abstract Background Pyomyositis is a bacterial infection of skeletal muscle which classically leads to abscess formation. A related, but distinct, entity is infectious myositis. The epidemiology of these infections has changed in recent years. Methods To better characterize both pyomyositis and infectious myositis, we conducted a retrospective study at our tertiary care institution. We identified 43 cases of pyomyositis and 18 cases of infectious myositis treated between January 2012 and May 2020. Results The mean age of patients was 48 years, and 66% were male. Diabetes mellitus affected one-third of patients, and 16% had other immunocompromising comorbidities. Staphylococcal species accounted for 46% of all infections, and common symptoms included muscle pain (95%) and subjective fever (49%). Altered mental status was a presenting symptom in 16% of cases. Roughly half of all patients received >1 class of antibiotic, and the median length of antimicrobial therapy was 18 days. Open and percutaneous drainage procedures figured prominently in the management of these infections, with 28% of patients requiring multiple procedures. Pathology specimens were available for 12 of 61 cases. Overall, the treatment success rate was 84%. Conclusions Gram-positive bacteria accounted for most infections at our institution, and management commonly involved open or percutaneous drainage procedures. Future studies which prospectively evaluate treatment strategies for pyomyositis and infectious myositis are warranted.

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Excavating Meningoencephaloceles: A Newly Recognized Entity

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4413 ◽

2017 ◽

Vol 31 (2) ◽

pp. 127-134 ◽

Cited By ~ 1

Author(s):

Patricia A. Loftus ◽

Sarah K. Wise ◽

Pedram Daraei ◽

Kristen Baugnon ◽

John M. DelGaudio

Keyword(s):

Ct Scan ◽

Skull Base ◽

Operating Room ◽

Tertiary Care ◽

Distinct Type ◽

Csf Leak ◽

Csf Rhinorrhea ◽

Skull Base Defect ◽

Skull Base Defects ◽

Csf Leaks

Background Spontaneous cerebrospinal fluid (CSF) leaks are largely attributed to idiopathic intracranial hypertension and typically present as skull base defects with or without prolapse of intracranial contents. However, in our practice, we have encountered a distinct type of spontaneous CSF leak that presents in a different manner. Objective To discuss a newly-classified, difficult to treat, subset of spontaneous CSF leaks that present as excavation of the bone of the skull base in a tunnel- or canal-like fashion by a meningocele or meningoencephalocele instead of as a localized area of bony dehiscence. Methods A retrospective review was performed at a tertiary care rhinology practice to identify a subset of CSF leak patients with an excavating/canal-like skull base defect visualized radiographically on computed tomography (CT) scan or magnetic resonance imaging and/or endoscopically in the operating room. Results The cohort of patients consisted of 7 females and 1 male with an average age of 53.6 years and a self-reported race of 4:3:1 African-American: Caucasian-Indian. All patients presented with CSF rhinorrhea. The most common leak site was the cribriform and upper septum. Six of the 8 patients had multiple defects and/or progression of their skull base defects, and 5 patients required multiple and/or repeat repairs in the operating room. Seven of the 8 patients underwent a cisternogram because the excavating nature of the leaks made it difficult to identify the specific leak site on high-resolution CT scan alone. Conclusion In spontaneous CSF leaks that are difficult to identify or recur soon after a proper repair, an excavating pattern should be considered. Failure to recognize this type of leak and all of its tributaries, to fully unroof the excavated bone to completely resect the meningocele, and to visualize and close the site of origin will likely result in failure and recurrence of CSF leak.

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Endoscopic cerebrospinal fluid leak repair: how we do it

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192713 ◽

2019 ◽

Vol 5 (4) ◽

pp. 965

Author(s):

Kalpesh Patel ◽

Abhishek Gugliani ◽

Rajesh Vishwakarma

Keyword(s):

Cerebrospinal Fluid ◽

Cerebrospinal Fluid Leak ◽

Subsequent Treatment ◽

Csf Leak ◽

Open Approach ◽

Endoscopic Repair ◽

Civil Hospital ◽

Medical College ◽

Endoscopic Method ◽

Csf Rhinorrhoea

Background: Cerebrospinal fluid (CSF) rhinorrhoea is characterized by a defect in the barriers which separate the subarachnoid space from sinonasal tract resulting in the leakage of watery fluid from the nose. Management of CSF rhinorrhoea is by both conservative and/or surgical approach. Transnasal endoscopic method has become the preferred surgical method for the repair of CSF leak because of less complication as compared to the open approach. To evaluate the results of patients who underwent endoscopic repair of CSF rhinorrhoea over a period of 5 years at BJ Medical College, Civil Hospital, Ahmedabad.Methods: 118 patients were included in this retrospective study who underwent CSF leak repair by nasal endoscopy over a period of 5 years between 2011-2016 in the department of ENT at BJ Medical College, Civil Hospital, Ahmedabad. As per review of the records, these patients were diagnosed with CSF leak on the basis of their history, clinical examination, and radiological investigations. Materials used for the repair were fat, fascia lata, fibrin sealant, and/or vascular flap. Results: Primary surgery was successful in 110 (93%) of cases. In 8 (7%) cases, there was a recurrence of leak which was managed by either conservative management (5 cases, 4%) or by re-exploration (3 cases, 3%).Conclusions: Transnasal endoscope is an important tool for the evaluation and subsequent treatment of CSF rhinorrhoea. Endoscopic repair of CSF rhinorrhoea is safe, effective, has a low complication rate and has almost completely replaced the open technique.

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Low meningitis-incidence in primary spontaneous compared to secondary cerebrospinal fluid rhinorrhoea

Rhinology Journal ◽

10.4193/rhino11.124 ◽

2012 ◽

Vol 50 (1) ◽

pp. 73-79

Author(s):

Sophia C. Poletti-Muringaseril ◽

Kaspar Rufibach ◽

Christian Ruef ◽

David Holzmann ◽

Michael B. Soyka

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Lower Incidence ◽

Tertiary Care ◽

Csf Leak ◽

Clinical Impression ◽

Pathophysiological Mechanism ◽

Elevated Intracranial Pressure ◽

Tertiary Care Medical Center ◽

Csf Rhinorrhoea

Objective: Spontaneous cerebrospinal fluid (CSF) rhinorrhoea is a separate clinical entity with elevated intracranial pressure as its most probable pathophysiological mechanism. Having the clinical impression of distinct courses of diseases in primary spontaneous (PS) compared to secondary CSF rhinorrhoea, our objective was to identify whether the two forms differ in the duration of CSF rhinorrhoea and the incidence of meningitis. Methods: Chart review performed on all patients referred with a CSF leak to our tertiary-care medical center over a 20-year period from 1990 to 2010. Results: In total, 58 cases suffering from CSF rhinorrhoea could be included. The aetiology was primary spontaneous in 23 (40%) and secondary in 35 (60%) patients. The duration of CSF rhinorrhoea was notably longer in patients with PS CSF rhinorrhoea. Moreover, we could show a significantly lower incidence of meningitis with PS CSF rhinorrhoea compared to the secondary group (annual incidence of 0.12 vs. 1.22 episodes). Conclusion: A significantly lower incidence and delayed onset of meningitis in patients suffering from PS CSF rhinorrhoea could be explained by an elevated intracranial pressure that hinders the ascension of bacteria. The closure of a leak in secondary CSF fistula seems more urgent than in PS CSF fistulas.

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