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Cerebrospinal fluid leaks by traumatic

Robert E Lieberson, Jan Eckermann, William Meyer, Tung Trang
BACKGROUND: FlowSafe(TM) (BeckerSmith Medical, Irvine, CA, USA) is a novel, robotic, external lumbar drainage (ELD) system, which was designed to control cerebrospinal fluid (CSF) drainage, reduce complications, and decrease treatment costs. METHODS:  Forty-seven consecutive neurosurgical patients requiring ELD were treated using the FlowSafe system. RESULTS: In 39 of 40 patients with traumatic and surgical dural openings, potential CSF leaks were avoided...
February 3, 2017: Curēus
Abubaker Al-Aieb, Ruben Peralta, Mohammad Ellabib, Ayman El-Menyar, Hassan Al-Thani
INTRODUCTION: Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly. CASE PRESENTATION: We presented two cases of post-traumatic tension pneumocephalus. A 30- year old male pedestrian hit by a car presented with right frontal bone fracture extending to right frontal sinuses. He developed pneumocephalus involving all ventricles and subdural space and extending down to foramen magnum with tight basal cistern...
2017: International Journal of Surgery Case Reports
Brian D'Anza, Duc Tien, Janalee K Stokken, Pablo F Recinos, Troy R Woodard, Raj Sindwani
BACKGROUND: Historically, lumbar drains (LD) have played a prominent role in endonasal skull base surgery. Over the past few decades, advancements in techniques have augmented our ability to successfully reconstruct complex skull base defects and often obviates the need for cerebrospinal fluid (CSF) diversion. Clarity on the appropriate use of LDs is needed. OBJECTIVE: To examine the literature for the need for LDs in contemporary skull base reconstruction after resection of skull base tumors...
November 1, 2016: American Journal of Rhinology & Allergy
Austin S Adams, Paul T Russell, James A Duncavage, Rakesh K Chandra, Justin H Turner
OBJECTIVE: Lumbar drains (LD) are commonly used during endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea, either to facilitate graft healing or to monitor CSF fluid dynamics. However, the indications and necessity of LD placement remains controversial. The current study sought to evaluate endoscopic CSF leak repair outcomes in the setting of limited LD use. METHODS: Patients who underwent endoscopic repair of CSF rhinorrhea between 2004 and 2014 were identified by a review of medical records...
November 1, 2016: American Journal of Rhinology & Allergy
Husain Al-Qattan, Joanna E Gernsback, Ajani G Nugent, Kirill A Lyapichev, Ricardo J Komotar, Harvey Chim
BACKGROUND: Craniotomies for trauma are associated with a significant risk of wound complications. We report a case in which a chronic nonhealing draining sinus was caused by an ectopic epidermal lining deep to the craniotomy bone flap, adherent to the underlying dura. CASE DESCRIPTION: A 61-year-old man was examined for a 3-year-old, nonhealing scalp wound resulting after a traumatic brain injury. His initial surgery consisted of an intracranial hematoma evacuation through a temporoparietal craniotomy; this was complicated by wound dehiscence and a chronic sinus draining clear fluid that did not resolve with antimicrobial therapy...
February 2017: World Neurosurgery
Mehmet Akif Eryılmaz, Mitat Arıcıgil, Mehmet Akif Alan
BACKGROUND/AIMS: Since the initial use in 1981 by Wigand, different endoscopic endonasal surgery techniques have been proposed to close ventral skull base defects, all of which include multilayer closure involving vascularized mucoseptal flaps, autologous grafts, and synthetic materials. These methods are used individually or in combination, as required by the operative condition. METHODS: In this study we aimed to describe our endoscopic technique using inlay-outlay fascia lata and autologous fat with fibrin sealant to close spontaneous and traumatic cerebrospinal fluid (CSF) rhinorrhea...
2016: ORL; Journal for Oto-rhino-laryngology and its related Specialties
Rodney C Diaz, Brian Cervenka, Hilary A Brodie
Traumatic injury to the temporal bone can lead to significant morbidity or mortality and knowledge of the pertinent anatomy, pathophysiology of injury, and appropriate management strategies is critical for successful recovery and rehabilitation of such injured patients. Most temporal bone fractures are caused by motor vehicle accidents. Temporal bone fractures are best classified as either otic capsule sparing or otic capsule disrupting-type fractures, as such classification correlates well with risk of concomitant functional complications...
October 2016: Journal of Neurological Surgery. Part B, Skull Base
Richard Salazar
BACKGROUND: Spontaneous intracranial hypotension (SIH) is a clinically variable syndrome caused by low cerebrospinal fluid (CSF) pressure due to a non-traumatic CSF leak. PHENOMENOLOGY SHOWN: This case describes a 68-year-old gentleman who presents with chronic and slightly progressive kinetic tremor of bilateral hands associated with gait ataxia and gait start hesitation. EDUCATIONAL VALUE: This case underscores the importance of having a high index of suspicion for the diagnosis of SIH when encountering a patient presenting with late-onset progressive kinetic tremor and gait ataxia syndrome...
2016: Tremor and Other Hyperkinetic Movements
Sébastien Richard, Lisa Humbertjean, Gioia Mione, Marc Braun, Emmanuelle Schmitt, Sophie Colnat-Coulbois
BACKGROUND: Syringomyelia due to intracranial hypotension is rarely described. As a consequence, intracranial hypotension is less recognized as a potential cause of syringomyelia or mistaken with Chiari type 1 malformation. The pathogeny is poorly understood, and we lack diagnostic and therapeutic strategies for this particular setting. CASE DESCRIPTION: We describe a 45-year-old patient who developed syringomyelia after about 10 years of undiagnosed intracranial hypotension caused by traumatic C6 cerebrospinal fluid (CSF) leak...
July 2016: World Neurosurgery
Ajit Kumar Sinha, Sumit Goyal
STUDY DESIGN: Retrospective descriptive study of an innovative surgical technique. OBJECTIVE: To assess the feasibility and success of repair of transfrontal sinus cerebrospinal fluid (CSF) rhinorrhea through pterional transcranial extradural approach using endoscope. SUMMARY OF BACKGROUND DATA: Repair of CSF rhinorrhea has seen advancement with the evolution of endoscopic transnasal techniques. However, leaks from defect in the posterior wall of frontal sinus still remain a challenge for the skull base surgeons and requires conventional craniotomy more often...
April 2016: Journal of Neurosciences in Rural Practice
Sarita Kumari Mishra, George Ani Mathew, Roshna Rose Paul, Syed Kamran Asif, Mary John, Ajoy Mathew Varghese, Mary Kurien
INTRODUCTION: Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. The aim of our study was to analyze the etiopathogenesis of CSF rhinorrhea, the outcome of treatment and the causes of failure in a developing-country setting. MATERIALS AND METHODS: A retrospective review of patients treated with endoscopic repair for CSF rhinorrhea at a tertiary care hospital in southern India from January 2002 to December 2009 identified 36 patients, the majority of them being women...
January 2016: Iranian Journal of Otorhinolaryngology
C Rory Goodwin, Christine E Boone, James Pendleton, Benjamin D Elder, Zhikui Wei, Wesley Hsu, Daniel M Sciubba, Timothy F Witham
Pneumocephalus is a collection of air within in the intracranial cavity, most commonly seen following traumatic injury or cranial surgeries. Esophageal injury and cerebrospinal fluid (CSF) leak are rare complications that may occur following anterior cervical discectomy and fusion (ACDF). We present a novel case of pneumocephalus arising from unrestricted leakage of CSF via coincident esophageal injury and durotomy in a patient who underwent an ACDF after trauma. A 21-year-old man presented to an outside hospital with C5/C6 subluxation, complete spinal cord injury, and quadriplegia from a motor vehicle accident...
April 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
S D Sharma, G Kumar, J Bal, A Eweiss
GOAL: The purpose of this review was to look at the success rate of transnasal endoscopic repair of CSF rhinorrhoea and the impact of patient factors, repair techniques and adjuvant treatment. MATERIAL AND METHODS: A literature search was performed on PubMed, Medline and Cochrane Central databases, independently by two of the authors, of all studies reporting the outcomes of CSF rhinorrhoea repair, published until the 1st June 2014, using keywords Cerebrospinal fluid leak, CSF leak, CSF fistula, CSF leak or fistula repair, endoscopic sinus surgery or ESS complications...
June 2016: European Annals of Otorhinolaryngology, Head and Neck Diseases
Rohan Ramakrishna, Louis J Kim, Randall A Bly, Kris Moe, Manuel Ferreira
Transorbital neuroendoscopic surgery (TONES) is a relatively new technique that not only allows access to the contents of the orbit but also the intracranial compartment, including the anterior cranial fossa, middle fossa and lateral cavernous sinus. In this study, we aimed to retrospectively review the largest experience to our knowledge with regards to surgical outcomes of skull base pathologies treated with a TONES procedure. Forty patients (aged 3-89 years) underwent 45 TONES procedures between the years of 2006-2013...
February 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Tatsuya Ohtonari, Shinzo Ota, Yoshinobu Sekihara, Nobuharu Nishihara, Taisei Ota, Michiyoshi Sato, Akio Tanaka
Cerebrospinal fluid (CSF) leak, which usually occurs idiopathically or traumatically as a rare situation, is a rare disease that causes orthostatic headache or idiopathic chronic subdural hematoma (CSDH). We report our therapeutic experience of consecutive 20 cases for this disease, and review the current status and problems. Consecutive 20 patients (11 women; age 44.7±12.1 years) between April, 2006 and March, 2014, who were diagnosed by MRI and/or CT myelography (CTM), were evaluated retrospectively about clinical features...
September 1, 2015: Journal of UOEH
M Májovský, D Netuka, V Masopust, V Beneš
INTRODUCTION: Clivus is a central structure of the skull base located in the vicinity of the brainstem and vital brain vessels. Clival fractures are usually caused by a high-energy trauma. Cerebrospinal fluid leak is one of the most common complications. CASE REPORT: A middle-aged male sustained a mild head trauma, followed by a nasal cerebrospinal fluid leak. CT scan revealed the massive pneumocephalus and the fracture of the clivus in the posterior wall of the sphenoidal sinus...
July 2015: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Ibrahim Alhelali, Tanya Charyk Stewart, Jennifer Foster, Ibrahim M Alharfi, Adrianna Ranger, Hani Daoud, Douglas D Fraser
BACKGROUND: Basal skull fractures (BSFs) are caused by blunt force trauma, occurring in the temporal, occipital, sphenoid, and/or ethmoid bones. In pediatric severe traumatic brain injury (sTBI), there is a paucity of data on BSFs. Our goal was to investigate the BSF prevalence, anatomy, and association with short-term outcomes in pediatric sTBI. METHODS: We retrospectively reviewed all severely injured (Injury Severity Score ≥12) pediatric patients (aged <18 years) admitted to our hospital after experiencing an sTBI (Glasgow Coma Scale score ≤8 and head Abbreviated Injury Scale score ≥4)...
June 2015: Journal of Trauma and Acute Care Surgery
Dariush Hasheminia, Mahmood Reza Kalantar Motamedi, Hadi Hashemzehi, Rahman Nazeri, Bijan Movahedian
BACKGROUND: A number of patients with facial fractures have cerebrospinal fluid (CSF) leak that may result in meningitis and other central nervous system complications. Commonly, CSF leak occurs following trauma, but the etiology and pattern of this disorder are different from region to region. This study aims to evaluate the distribution of CSF leak in patients with maxillofacial fractures in Isfahan province, Iran. PATIENTS AND METHODS: In this retrospective cross-sectional study, 1,287 medical files of patients admitted to a medical center with head and face injuries were evaluated during a 7-year period (2004-2010)...
June 2015: Journal of Maxillofacial and Oral Surgery
Jaskaran S Gosal, Tenzin Gurmey, Gopi K Kursa, Pravin Salunke, Sunil K Gupta
BACKGROUND: Traumatic cerebrospinal fluid (CSF) rhinorrhea is a serious and potentially fatal condition as it may lead to meningitis. As acetazolamide decreases CSF production and hence CSF pressure, it has been proposed that the medication may help in curing CSF rhinorrhea. There is no definitive evidence, however, that acetazolamide is actually beneficial in treating traumatic CSF rhinorrhea. The aim of this study was to determine if the administration of acetazolamide in patients of head trauma with CSF rhinorrhea was beneficial in decreasing the duration of CSF rhinorrhea...
March 2015: Neurology India
Peter Bernhard Sporns, Sebastian Zimmer, Uta Hanning, Tarek Zoubi, Johannes Wölfer, Mirco Herbort, Wolfram Schwindt, Thomas Niederstadt
BACKGROUND CONTEXT: Cases of cerebral hypotension and tonsillar herniation after accidental lumbar cerebrospinal fluid (CSF) drainage or chest tube drainage with intrathoracic CSF leaks have been reported. To the authors' knowledge, this case presents the first report of severe intracranial hypotension because of suction of CSF by a Vacuum-Assisted Closure (VAC) device. PURPOSE: The purpose of this study was to report a life-threatening intracranial hypotension in a polytraumatized patient after VAC therapy...
July 1, 2015: Spine Journal: Official Journal of the North American Spine Society
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