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Cerebrospinal fluid leak

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https://www.readbyqxmd.com/read/29777885/posttraumatic-cerebrospinal-fluid-leak-associated-with-an-upper-cervical-meningeal-diverticulum
#1
Noriya Enomoto, Hideo Mure, Toshiyuki Okazaki, Mai Azumi, Shinya Okita, Shinji Nagahiro, Yasushi Takagi
Spontaneous intracranial hypotension (SIH) has been increasingly recognized as a phenomenon caused by cerebrospinal fluid (CSF) leaks; however, its pathogenesis is still unclear. Here, we report two cases of SIH as a result of CSF leak from a meningeal diverticulum at the C2 nerve root sleeve. The first case is that of a 46-year-old man who had suffered from orthostatic headache after a bicycle accident at age 45. Computed tomography (CT) myelography revealed CSF leaks at the C1/2 level. He underwent epidural blood patch (EBP) therapy, but it was unsuccessful...
May 16, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29775983/classification-and-microvascular-flap-selection-for-anterior-cranial-fossa-reconstruction
#2
James D Vargo, Wojciech Przylecki, Paul J Camarata, Brian T Andrews
BACKGROUND:  Microvascular reconstruction of the anterior cranial fossa (ACF) creates difficult challenges. Reconstructive goals and flap selection vary based on the defect location within the ACF. This study evaluates the feasibility and reliability of free tissue transfer for salvage reconstruction of low, middle, and high ACF defects. METHODS:  A retrospective review was performed. Reconstructions were anatomically classified as low (anterior skull base), middle (frontal bar/sinus), and high (frontal bone/soft tissue)...
May 18, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29770252/utility-of-magnetic-resonance-cisternography-with-intrathecal-gadolinium-in-detection-of-cerebrospinal-fluid-fistula-associated-with-mondini-dysplasia-in-a-patient-with-recurrent-meningitis-case-report-and-literature-review
#3
Enrique Caro-Osorio, Alba Espino-Ojeda, Lino Guevara-Maldonado, José C Herrea-Castro
Background: The intrathecal contrast-enhanced magnetic resonance cisternography (MRC) is a diagnostic method that has been proven effective in selected patients with various disorders of the cerebrospinal system, including the detection of cerebrospinal fluid (CSF) leaks. The Mondini dysplasia is a malformation of the inner ear characterized by an incomplete cochlear development. The cerebrospinal fistula associated with Mondini dysplasia usually occurs in the first 5-10 years. Case Description: The case of a 34-year-old woman with CSF rhinorrhea and recurrent meningitis associated with CSF fistula into the right inner ear, which was detected by MRC with intrathecal gadolinium, is presented...
2018: Surgical Neurology International
https://www.readbyqxmd.com/read/29767319/endoscopic-vs-microscopic-transsphenoidal-surgery-for-cushing-s-disease-a-systematic-review-and-meta-analysis
#4
Leonie H A Broersen, Nienke R Biermasz, Wouter R van Furth, Friso de Vries, Marco J T Verstegen, Olaf M Dekkers, Alberto M Pereira
PURPOSE: Systematic review and meta-analysis comparing endoscopic and microscopic transsphenoidal surgery for Cushing's disease regarding surgical outcomes (remission, recurrence, and mortality) and complication rates. To stratify the results by tumor size. METHODS: Nine electronic databases were searched in February 2017 to identify potentially relevant articles. Cohort studies assessing surgical outcomes or complication rates after endoscopic or microscopic transsphenoidal surgery for Cushing's disease were eligible...
May 16, 2018: Pituitary
https://www.readbyqxmd.com/read/29765818/targeted-epidural-blood-patch-treatment-for-refractory-spontaneous-intracranial-hypotension-in-china
#5
Fei-Fang He, Li Li, Min-Jun Liu, Tai-Di Zhong, Qiao-Wei Zhang, Xiang-Ming Fang
Objective  An epidural blood patch (EBP) is the mainstay of treatment for refractory spontaneous intracranial hypotension (SIH). We evaluated the treatment efficacy of targeted EBP in refractory SIH. Methods  All patients underwent brain magnetic resonance imaging (MRI) with contrast and heavily T2-weighted spine MRI. Whole spine computed tomography (CT) myelography with non-ionic contrast was performed in 46 patients, and whole spine MR myelography with intrathecal gadolinium was performed in 119 patients...
June 2018: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/29764819/penetrating-trauma-causing-cerebrospinal-fluid-leak-without-nerve-root-damage
#6
Holly Carpenter, Katherine-Helen Hurndall, Ajay K Asokan, Roland Fernandes
A 19-year-old man with a stab injury to the lower back presented with no focal neurology or haemodynamic instability. He complained of a headache that was improved by lying flat and underwent imaging to look for damage to local structures. He was found to have air in his intraspinal space. Initially this case was managed conservatively; however, 2 weeks after discharge, he presented with cerebrospinal fluid leak from his wound. This was managed with neurosurgical intervention and watertight closure of fascia...
May 14, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29761066/anterior-skull-base-reconstruction-does-fat-preparation-matter
#7
Joshua Wood, Jaron Densky, John Boughter, Merry Sebelik, Courtney Shires
Objectives  This article aims (1) to determine whether there is any difference in cerebrospinal fluid (CSF) leak rate after anterior skull base autologous fat reconstruction based on how the fat is prepared, and (2) to measure impact on surgical times by reconstruction type. Design  Translational animal model surgical technique 3-arm trial, comparing two different methods of autologous fat skull base reconstruction versus a nonreconstructed control group. Setting  Animal study. Subjects  Adult Sprague-Dawley rats...
April 2018: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/29754975/endoscopic-endonasal-double-flap-technique-for-reconstruction-of-large-anterior-skull-base-defects-technical-note
#8
Ricardo Landini Lutaif Dolci, Alexandre Bossi Todeschini, Américo Rubens Leite Dos Santos, Paulo Roberto Lazarini
INTRODUCTION: One of the main concerns in endoscopic endonasal approaches to the skull base has been the high incidence and morbidity associated with cerebrospinal fluid leaks. The introduction and routine use of vascularized flaps allowed a marked decrease in this complication followed by a great expansion in the indications and techniques used in endoscopic endonasal approaches, extending to defects from huge tumours and previously inaccessible areas of the skull base. OBJECTIVE: Describe the technique of performing endoscopic double flap multi-layered reconstruction of the anterior skull base without craniotomy...
April 19, 2018: Brazilian Journal of Otorhinolaryngology
https://www.readbyqxmd.com/read/29753644/extradural-anterior-clinoidectomy-in-the-management-of-parasellar-meningiomas-analysis-of-13-years-of-experience-and-literature-review
#9
Laura Salgado López, Fernando Muñoz Hernández, Carlos Asencio Cortés, Pere Tresserras Ribó, María Jesús Álvarez Holzapfel, Joan Molet Teixidó
BACKGROUND AND AIM: The extradural anterior clinoidectomy (EAC) is a key microsurgical technique that facilitates the resection of tumors located in the parasellar region. There is currently no consensus regarding the execution of the procedure via extradural or intradural nor scientific evidence that supports its routine use. The purpose of this article is to expose our experience in performing EAC as part of the management of the parasellar meningiomas. MATERIALS AND METHODS: A retrospective analysis of the EAC for parasellar meningioma resection performed in our center between 2003 and 2015 was done...
May 9, 2018: Neurocirugía
https://www.readbyqxmd.com/read/29750727/adipofascial-flaps-with-acellular-dermal-matrix-compared-with-myocutaneous-flap-reconstruction-in-lumbar-myelomeningocele-defects
#10
Navid Pourtaheri, Derek Wang, Daniel Calva, Karan Chopra, Anand R Kumar
BACKGROUND: Adipofascial flaps (AFF) with acellular dermal matrix (ADM) have the potential to reconstruct neural tube defects without sacrificing muscle that may be critical for long-term function. Comparative studies between myocutaneous flap (MF) reconstruction, the accepted standard reconstructive technique, and AFF/ADM remain under-reported. The aim of this study was to evaluate the safety and efficacy of myelomeningocele reconstruction using muscle sparing AFF/ADM versus MF. METHODS: A retrospective comparison was conducted on consecutive myelomeningocele patients reconstructed with MF or AFF/ADM over an 84-month period...
May 10, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29740678/-complications-of-anterior-skull-base-surgery
#11
REVIEW
M Wagenmann, K Scheckenbach, B Kraus, I Stenin
Anterior skull base operations are complex surgical procedures that are performed to treat serious and complicated diseases. Despite significant advances in surgical techniques, complications are relatively frequent and can be serious. Endoscopic skull base surgery seems to be associated with less complications than open techniques. Different classifications aimed at categorizing these complications have been suggested, the use of which can be recommended when reporting complication rates. The most relevant and frequent complications of anterior skull base surgery are hemorrhage, cerebrospinal fluid (CSF) leak, meningitis, and cranial nerve injury...
May 8, 2018: HNO
https://www.readbyqxmd.com/read/29738390/incidence-and-risk-factors-for-sigmoid-venous-thrombosis-following-cpa-tumor-resection
#12
Matthew Shew, Hannah Kavookjian, Kelly Dahlstrom, Thomas Muelleman, James Lin, Paul Camarata, Luke N Ledbetter, Hinrich Staecker
OBJECTIVE: Our primary aim was to determine the incidence of sigmoid venous thrombosis (SVT) and determine risks factors and sequelae of SVT following cerebellopontine angle tumor resection. STUDY DESIGN: Retrospective cohort study. SETTING: Academic tertiary care hospital. PATIENTS: Patients over 18 years of age who underwent resection of cerebellopontine angle meningioma or vestibular schwannoma from January 2005 to April 2016 who had postoperative magnetic resonance imaging...
June 2018: Otology & Neurotology
https://www.readbyqxmd.com/read/29737744/-clinical-analysis-of-adult-spontaneous-cerebrospinal-fluid-rhinorrhea
#13
Zheng Jie Zhu, Lan Cheng, Jun Yang, Qi Huang, Guo Zhen Meng, Rong Ping Cao
OBJECTIVES: To discuss the clinical characteristics, diagnosis and treatment of adult spontaneous cerebrospinal fluid rhinorrhea (CSFR). METHODS: A retrospective study was conducted on 18 patients of CSFR. Nasal secretion was collected for biochemical analysis. Imaging examination was done for identification of the bony defect in skull base. RESULTS: In all cases, the glucose concentration of nasal secretion were more than 1.7 mmol/L, and the β-2 transferrin detected by immunoelectrophoresis technique were positive...
March 2018: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
https://www.readbyqxmd.com/read/29732935/use-of-autologous-fat-grafts-for-the-endoscopic-reconstruction-of-skull-base-defects-indications-outcomes-and-complications
#14
Kent Lam, Amber U Luong, William C Yao, Martin J Citardi
Background The use of abdominal free fat is a traditional surgical method for the repair and reconstruction of the anterior skull base. Our objective is to assess the outcomes associated with the autologous fat graft to endoscopically repair anterior skull base defects at a single tertiary care center. Methods All patients, who underwent endoscopic skull base repair utilizing abdominal free fat from September 2009 to June 2016, were included for retrospective chart review. Evaluated outcome measurements included (1) the successful closure of preoperative and intraoperative cerebrospinal fluid (CSF) leaks and (2) complications at both donor and recipient graft sites during the postoperative periods...
January 1, 2018: American Journal of Rhinology & Allergy
https://www.readbyqxmd.com/read/29732314/modified-two-flap-palatoplasty-in-asymptomatic-transsphenoidal-encephalocele-a-case-report
#15
Sunil Richardson, Rakshit Vijay Khandeparker, Ajit Kumar Raghuvaram, Ram Mohan
About one-third of patients with transsphenoidal basal encephaloceles have associated congenital anomalies, including cleft palate. Moreover, they are often plagued by symptomatic exacerbations in the form of upper respiratory obstructions, cerebrospinal fluid leaks, meningitis, etc., with few patients being asymptomatic. We herein present a rare asymptomatic case of transsphenoidal basal encephalocele in an 18-month-old child with cleft palate and highlight a modified version of two-flap palatoplasty.
April 2018: Journal of the Korean Association of Oral and Maxillofacial Surgeons
https://www.readbyqxmd.com/read/29730270/management-of-iatrogenic-spinal-cerebrospinal-fluid-leaks-a-cohort-of-124-patients
#16
Royce W Woodroffe, Kirill V Nourski, Logan C Helland, Brian Walsh, Jennifer Noeller, Panagiotis Kerezoudis, Patrick W Hitchon
OBJECTIVES: Cerebrospinal fluid leaks are a frequent complication of spinal surgery, with reported rates between 2 and 20%. Management is highly variable and dependent on comorbidities, complexity of the index procedure, and surgeons' experience. Treatment options include primary or delayed repair, with or without spinal drainage. Using a retrospective cohort, the authors aim to identify the appropriate management of iatrogenic spinal cerebrospinal fluid (CSF) leaks. PATIENTS AND METHODS: We queried our institutional database for postoperative spinal CSF leaks between 1/1/2007 and 3/14/2017 using Current Procedural Terminology (CPT) and International Classification of Disease (ICD) codes...
April 22, 2018: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/29697584/clinical-implications-of-the-association-between-temporal-bone-tegmen-defects-and-superior-semicircular-canal-dehiscence
#17
Ophir Handzel, Adi Brenner-Ullman, Oren Cavel, Yahav Oron, Oshri Wasserzug, Dan M Fliss, Omer J Ungar
OBJECTIVE: To discuss the clinical implications of the association between temporal bone tegmen dehiscence (TD) necessitating surgical correction and the adjacent dehiscent superior semicircular canal (SSCD). STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. PATIENTS: Sixteen patients with idiopathic TD, with or without SSCD, requiring surgical correction. INTERVENTIONS: Corrective surgery for TD...
April 24, 2018: Otology & Neurotology
https://www.readbyqxmd.com/read/29688821/risk-of-postoperative-complications-in-patients-with-obstructive-sleep-apnea-following-skull-base-surgery
#18
Phillip Huyett, Ryan J Soose, Amy E Schell, Juan C Fernandez-Miranda, Paul A Gardner, Carl H Snyderman, Eric W Wang
Objectives Obstructive sleep apnea (OSA) presents several challenges in skull base surgery, including increased intracranial pressure, worsened OSA with nasal packing, and avoidance of positive airway pressure (PAP) therapy postoperatively. The objective of this study was to examine the risk of postoperative complications in a skull base population with OSA in which PAP therapy is withheld. Study Design Retrospective cohort study. Setting Tertiary care hospital. Subjects and Methods Medical records of 414 adult patients undergoing anterior skull base procedures between January 1, 2014, and January 7, 2017, were retrospectively reviewed...
April 1, 2018: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29688445/extrapolating-the-limits-of-the-nasoseptal-flap-with-pedicle-dissection-to-the-internal-maxillary-artery
#19
Carlos D Pinheiro-Neto, Maria Peris-Celda, Tyler Kenning
BACKGROUND: The nasoseptal flap is the main pedicled flap used for endoscopic cranial base reconstruction. For large anterior cranial base defects, the anterior edge is a concern for the nasoseptal flap reach. OBJECTIVE: To present a surgical technique that completely releases the vascular pedicle of the nasoseptal flap from the sphenopalatine artery (SPA) foramen improving considerably the reach of the flap. METHODS: A patient with left anterior cranial base fracture involving the posterior table of the frontal sinus, who presented with cerebrospinal fluid leak and contused brain herniation to the ethmoid and frontal sinuses...
April 24, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29686958/temporal-lobe-cystic-collection-and-associated-oedema-a-rare-complication-of-translabyrinthine-resection-of-vestibular-schwannoma
#20
Abdurrahman Raeiq
Vestibular schwannomas (VS) are benign tumours arising from the vestibulocochlear nerve. Among the management options available, surgical resection is often considered, especially if lesions are enlarging or symptomatic. Translabyrinthine (TL) resection of a vestibular schwannoma is one of three basic approaches available to the surgeon. Complications generally associated with this approach can include cerebrospinal fluid (CSF) leak, hearing and balance issues, infection, and facial nerve palsies. We present the case of a patient with a previously unreported type of complication: that of cystic CSF collection within the temporal lobe and associated oedema...
February 21, 2018: Curēus
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