Pneumocephalus and CSF leak secondary to skull base fracture by pyrotechnical object: case report

2021 ◽  
Vol 3 (3) ◽  
Author(s):  
Marcos Vilca ◽  
◽  
Carlos Palacios ◽  
Sofía Rosas ◽  
Ermitaño Bautista ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Skull Base ◽  
Rare Complication ◽  
Cerebrospinal Fluid Leak ◽  
Standing Position ◽  
Csf Leak ◽  
Skull Base Fracture ◽  
Timely Diagnosis ◽  
The Right

Introduction: Pneumocephalus is mainly associated with traumatic injuries, being a rare complication but with high mortality rates; it behaves like a space-occupying lesion and increases intracranial pressure. The symptoms are not specific, but in the event of trauma it is necessary to suspect this entity to carry out a timely diagnosis and treatment, since being the product of the skull base fracture it can cause communication with the outside, and the appearance of cerebrospinal fluid (CSF) leak. Clinical Case: a 38-year-old male patient who suffers trauma from a pyrotechnic explosion near his right ear, when handling a pyrotechnic object (whistle) during the New Year, presenting severe pain, slight bleeding in the right ear, feeling faint and holocranial headache that increased in a standing position; likewise, he presents high-flow aqueous secretion (CSF) from the right ear. Brain and skull base tomography (CT) showed air in the intracranial cavity, fracture of the skull base, and the ossicles of the right middle ear. Conservative management was performed using rest and lumbar drainage, presenting a satisfactory evolution. Conclusion: Pneumocephalus is a frequent and expected complication of trauma with a skull base fracture. Its early and timely diagnosis using skull base CT is essential to define therapeutic measures. Accidents due to the misuse of pyrotechnics continue to be a relevant problem in our country. Knowing and disseminating its consequences can help raise awareness in the population. Keywords: Pneumocephalus, Skull Base, Intracranial Pressure, Cerebrospinal Fluid Leak. (Source: MeSH NLM)

scholarly journals Crayon in the Orbit and Sinuses in a Pediatric Patient

2021 ◽  
pp. 014556132110185
Author(s):  
Michela Borrelli ◽  
Kristen A. Echanique ◽  
Jeffrey Koempel ◽  
Elisabeth H. Ference
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Pediatric Patient ◽  
Cerebrospinal Fluid Leak ◽  
Ethmoid Sinus ◽  
Rare Occurrence ◽  
Lamina Papyracea ◽  
The Right ◽  
Fluid Leak ◽  
Type Of Injury

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.

scholarly journals Cerebrospinal Fluid Leak in Transnasal Transsphenoidal Surgery for Pituitary Adenoma and its Management

2021 ◽  
Vol 29 (1) ◽  
pp. 6-10
Author(s):  
Sanajeet Singh ◽  
Ravi Roy ◽  
Vaibhav A Chandankhede ◽  
Sunil Goyal ◽  
M S Sridhar ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Postoperative Recurrence ◽  
Favourable Outcome ◽  
Csf Leak ◽  
Closure Rate ◽  
Tertiary Centre ◽  
Efficient Management

Introduction Over the past few decades endoscopic transnasal transsphenoidal (ETNTS) approach has been practised for excision of pituitary tumours which has minimised the rate of complications and morbidity. However, cerebrospinal fluid (CSF) leak remains a frequent complication requiring efficient management. Various skull-base repair techniques have been described in the literature all along, but there is no universal protocol for the same. Our study aims to determine an ideal strategy for skull-base repair following ETNTS surgery and suggest a protocol at the tertiary centre for the same. Materials and Methods In this prospective study, patients with pituitary adenoma undergoing ETNTS excision from January 2017 to May 2019 were included. Data were collected based on the intraoperative findings of grade of CSF leak following excision, surgical method for skull-base repair, biomaterials used, and recurrence of CSF leak postoperatively and its management. Results A total of 141 patients between 10 to 74 years of age (mean age 42.6) underwent ETNTS excision of pituitary adenoma. Intraoperative CSF leak was observed in 30.5% patients with 14.1% of grade I, 8.5% of grade II and 7.8% of grade III and repair was done with fat closure, multilayer closure and with naso-septal flap, respectively. Postoperative recurrence of CSF leak was found in 2.83% of total cases and 9.3% of patient with intraoperative leak, which were managed appropriately. Overall closure rate was 100% with no further recurrence of CSF leak. Conclusion Surgical repair of skull-base in CSF leak is challenging and requires management in careful and graded fashion for favourable outcome.

Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps

2016 ◽  
Vol 124 (3) ◽  
pp. 647-656 ◽  
Author(s):  
Jacob B. Archer ◽  
Hai Sun ◽  
Phillip A. Bonney ◽  
Yan Daniel Zhao ◽  
Jared C. Hiebert ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Class Ii ◽  
Anterior Skull Base ◽  
Csf Leak ◽  
Class Iii ◽  
Skull Base Fracture ◽  
Tissue Flaps ◽  
Repair Techniques

OBJECT This article introduces a classification scheme for extensive traumatic anterior skull base fracture to help stratify surgical treatment options. The authors describe their multilayer repair technique for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture using a combination of laterally pediculated temporalis fascial-pericranial, nasoseptal-pericranial, and anterior pericranial flaps. METHODS Retrospective chart review identified patients treated surgically between January 2004 and May 2014 for anterior skull base fractures with CSF fistulas. All patients were treated with bifrontal craniotomy and received pedicled tissue flaps. Cases were classified according to the extent of fracture: Class I (frontal bone/sinus involvement only); Class II (extent of involvement to ethmoid cribriform plate); and Class III (extent of involvement to sphenoid bone/sinus). Surgical repair techniques were tailored to the types of fractures. Patients were assessed for CSF leak at follow-up. The Fisher exact test was applied to investigate whether the repair techniques were associated with persistent postoperative CSF leak. RESULTS Forty-three patients were identified in this series. Thirty-seven (86%) were male. The patients’ mean age was 33 years (range 11–79 years). The mean overall length of follow-up was 14 months (range 5–45 months). Six fractures were classified as Class I, 8 as Class II, and 29 as Class III. The anterior pericranial flap alone was used in 33 patients (77%). Multiple flaps were used in 10 patients (3 salvage) (28%)—1 with Class II and 9 with Class III fractures. Five (17%) of the 30 patients with Class II or III fractures who received only a single anterior pericranial flap had persistent CSF leak (p < 0.31). No CSF leak was found in patients who received multiple flaps. Although postoperative CSF leak occurred only in high-grade fractures with single anterior flap repair, this finding was not significant. CONCLUSIONS Extensive anterior skull base fractures often require aggressive treatment to provide the greatest long-term functional and cosmetic benefits. Several vascularized tissue flaps can be used, either alone or in combination. Vascularized flaps are an ideal substrate for cranial base repair. Dual and triple flap techniques that combine the use of various anterior, lateral, and nasoseptal flaps allow for a comprehensive arsenal in multilayered skull base repair and salvage therapy for extensive and severe fractures.

Chronic cerebrospinal fluid leak into skull base causing intramedullary osteolysis

2000 ◽  
Vol 114 (11) ◽  
pp. 888-890 ◽  
Author(s):  
Sunil Dutt ◽  
Rami Salib ◽  
Richard Irving ◽  
Swarupsinh Chavda
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Imaging Techniques ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Flair Sequence ◽  
Subtotal Petrosectomy ◽  
Fluid Attenuated Inversion Recovery ◽  
Skull Base Lesions ◽  
Fluid Leak

We present the rare case of a 74 – year – old woman with extensive intramedullary osteolysis of the petroclival skull base straddling both sides of the basi – occiput and basi – sphenoid. She presented with clinical features of recurrent spontaneous cerebrospinal fluid (CSF) otorrhoea despite three previous attempts at repair of the CSF leak. Recent advances in imaging techniques enable accurate radiological diagnosis of skull base lesions. We performed T1- and T2-weighted magnetic resonance (MR) images, a fluid attenuated inversion recovery (FLAIR) sequence MR, and a diffusion scan to study the characteristics of the skull base pathology. This revealed extensive osteolysis, with cystic spaces within the clivus and the petrous pyramid extending also to the basi – occiput. The leak was sealed using the technique of subtotal petrosectomy with obliteration of the eustachian tube and blind pit closure of the ear canal. The patient has been followed up for six months with no recurrence of symptoms.

scholarly journals Hadad-Bassagasteguy flap in reconstruction of skull base defects after endonasal skull base surgery

2017 ◽  
Vol 3 (4) ◽  
pp. 1020
Author(s):  
Chandra Veer Singh ◽  
Nishit J. Shah
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Demographic Data ◽  
Cerebrospinal Fluid Leak ◽  
High Flow ◽  
Anterior Skull Base ◽  
Csf Leak ◽  
Female Ratio ◽  
Skull Base Defects ◽  
Fluid Leak

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">To study the clinical outcomes of Hadad-Bassagasteguy flap (HBF) in endonasal reconstruction of anterior skull base defects. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">We prospectively analyzed the demographic data &amp; the outcome results particularly Post-operative CSF leak in 53 patients who underwent HBF in our hospital from February 2013 to June 2014. The early harvested flap was used to reconstruct anterior skull base defects among patients with high-flow on-table CSF leak. Post-operatively the patients were analyzed for CSF leak and bleeding.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Most of the study subjects were between21-50 years of age (73.6%). The mean age of the study subjects was 41.8±13.8 years. Male/female ratio of the study sample was 1.2 with 29 males and 24 females. Of the total 53 patients 46 (86.8%) has macro defects while 7 (13.2%) had micro defects. Non-secretary lesions were present in 60.4% (32/53) patients while secretary were present in 39.6% (21/53) patients. Cerebrospinal fluid leak was present in all the patients undergoing surgery and majority of them were put on lumbar drain, while bleeding was present in 49.1% patients. Of the total 53 patients only 2 had post-operative cerebrospinal fluid leak (2/53; 3.8%). </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Use of HB posterior nasal septal flap for reconstruction of anterior skull base among patients with high-flow intra-operative CSF leak has a remarkable impact in preventing post-operative CSF leak. Its applicability to wide patient-profiles with respect to age, size of defect, diagnosis is making it a versatile choice of reconstruction after endonasal anterior skull base surgeries.</span></p>

scholarly journals A Rare Case of Spontaneous Pneumocephalus Associated with Nontraumatic Cerebrospinal Fluid Leak

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Murad Baba ◽  
Omer Tarar ◽  
Amer Syed
Keyword(s):  
Cerebrospinal Fluid ◽  
Idiopathic Intracranial Hypertension ◽  
Sphenoid Sinus ◽  
Rare Case ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Bony Defect ◽  
History Of ◽  
The Right ◽  
Fluid Leak

Introduction. Spontaneous nontraumatic pneumocephalus (PNC) and cerebrospinal fluid (CSF) leaks are both very uncommon conditions. We report a rare case of spontaneous pneumocephalus associated with CSF leak secondary to right sphenoid sinus bony defect without history of trauma.Case Description. 51-year-old Hispanic female with past medical history of hypertension and idiopathic intracranial hypertension (Pseudotumor Cerebri) presented to the emergency room complaining of headache and clear discharge from the right nostril. Physical examination was significant for right frontal sinus tenderness and clear discharge from right nostril. Computed Tomography (CT) scan of the brain showed moderate amount of extra-axial air within the right cerebral hemisphere indicative of pneumocephalus. CT scan of facial bones showed bony defect along the right sphenoid sinus with abnormal CSF collection. The patient was started on intravenous antibiotics for meningitis prophylaxis and subsequently underwent transsphenoidal repair of cerebrospinal fluid leak with abdominal fat graft. CSF rhinorrhea stopped completely after the surgery with near complete resolution of pneumocephalus before discharge.Conclusions. Early identification of pneumocephalus and surgical intervention can help decrease the morbidity and avoid possible complications. Idiopathic intracranial hypertension, although rare, can lead to CSF leak and pneumocepahlus.

scholarly journals Cerebrospinal fluid rhinorrhoea in young women after 6.5 years of therapy giant prolactinoma with Cabergolin

2018 ◽  
Vol 11 (4) ◽  
pp. 201-208
Author(s):  
Ludmila I. Astafyeva ◽  
Boris A. Kadashev ◽  
Pavel L. Kalinin ◽  
Maxim A. Kutin ◽  
Yuliya G. Sidneva ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Prolactin Level ◽  
Rare Complication ◽  
Csf Leak ◽  
Complete Regression ◽  
Endoscopic Endonasal ◽  
Giant Prolactinoma ◽  
Long Time ◽  
Case Closure

Cerebrospinal fluid (CSF) leak is a rare complication in of the prolactinomas treatment with dopamine agonists. In most cases CSF leak develops within the first three months of treatment starting. The article presents a rare clinical case – later development of CSF leak after pharmacological treatment of giant prolactinoma. Women 29 years with giant endo-supra-infra-laterasellar pituitary adenoma (8,7 cm in diameter), visual impairment, cachexia, secondary amenorrhea and prolactin level more than 2 million 200 thousand mU/l treated with cabergoline. On this background, complete regression of the tumor, recovery of visual function, body mass and normalization of prolactin level was marked. Nevertheless, after 6.5 years after beginning of cabergoline therapy CSF leak occured, which required endoscopic endonasal surgery with the plastic of a CSF fistula. All patients with large and giant prolactinomas which invade into skull base structures, receiving cabergoline even for a long time, should be aware of the possibility of such complications as CSF leak and, if necessary, should urgent appeals to the otolaryngologist and the neurosurgeon. In this case closure of skull base defect is a main tactics of treatment.

Prediction of Postoperative Risk of Raised Intracranial Pressure After Spontaneous Skull Base Cerebrospinal Fluid Leak Repair

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Bryce Buchowicz ◽  
Benson S. Chen ◽  
Samuel Bidot ◽  
Beau B. Bruce ◽  
Nancy J. Newman ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Raised Intracranial Pressure ◽  
Postoperative Risk ◽  
Fluid Leak

scholarly journals Spontaneous Cerebrospinal Fluid Leak Presenting as Unilateral (Left-sided) Middle ear Effusion

2008 ◽  
Vol 87 (2) ◽  
pp. 79-80 ◽  
Author(s):  
Kavadi T. Rajkumar ◽  
Ahmed A. Orabi ◽  
Michael S. Timms
Keyword(s):  
Cerebrospinal Fluid ◽  
Middle Ear ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Middle Ear Effusion ◽  
Presenting Symptoms ◽  
Single Defect ◽  
The Right ◽  
Fluid Leak ◽  
Ear Effusion

Spontaneous leak of cerebrospinal fluid (CSF) into the middle ear occurs rarely and can easily be missed, especially in adults. Although the presenting symptoms can be subtle, early suspicion and confirmatory imaging can establish the diagnosis. Most previously reported cases of spontaneous CSF leak into the middle ear occurred on the right side. We report a case of left-sided single-defect spontaneous leak.

Sign in / Sign up

Export Citation Format

Share Document