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Csf leaks

Jens Fichtner, Christian T Ulrich, Christian Fung, Debora Cipriani, Jan Gralla, Eike Immo Piechowiak, Felix Schlachetzki, Werner J Z'Graggen, Andreas Raabe, Jürgen Beck
Objective Spontaneous intracranial hypotension is caused by spinal cerebrospinal fluid leakage. Patients with orthostatic headaches and cerebrospinal fluid leakage show a decrease in optic nerve sheath diameter upon movement from supine to upright position. We hypothesized that the decrease in optic nerve sheath diameter upon gravitational challenge would cease after closure of the leak. Methods We included 29 patients with spontaneous intracranial hypotension and refractory symptoms admitted from 2013 to 2016...
August 12, 2018: Cephalalgia: An International Journal of Headache
Smriti Panda, Manoj Phalak, Alok Thakar, Sundara Krishnan
BACKGROUND: Non-steroidal androgen receptor blocker like flutamide has been described as an adjuvant treatment for preoperative shrinkage of extensive juvenile nasopharyngeal angiofibroma (JNA).We present a case of CSF (cerebrospinal fluid) leak due to flutamide induced tumour shrinkage. CASE REPORT: A 15- year- old male with a prior diagnosis of JNA stage IIIB on preoperative flutamide for 3.5 weeks presented with altered sensorium, meningeal signs and clear watery nasal discharge consistent with CSF leak...
August 9, 2018: World Neurosurgery
Jia Wei, Hufei Qian, Yu Liu, Jiangang Liu, Rui Zhao, Xiao Yang, Xiangdong Zhu, Ruoping Chen, Xingdong Zhang
This work aimed at investigating the possibility and effectiveness of osteoinductive calcium phosphate (CaP) ceramics to close the drilled skull holes and prevent the postoperative cerebrospinal fluid (CSF) leaking in children's endoscopic neurosurgery. Five children patients (four boys and one girl, 3- to 8-years old) underwent the surgery, in which the endoscopic third ventriculostomy (ETV) was operated in four cases of hydrocephalus, and biopsy and ETV were both performed in one case of pineal tumor. The drilled skull holes were filled with the commercial osteoinductive CaP ceramics...
August 2018: Regenerative Biomaterials
Shoko Yoshimoto, Keisuke Takai, Koichi Takahashi, Toshio Yasui, Makoto Taniguchi
Gorham-Stout disease (GSD) is an intractable disease characterized by massive osteolysis caused by abnormal lymphangiogenesis in bone. In rare cases of GSD, CSF abnormalities develop. The authors present the case of a 19-year-old woman with GSD presenting with orthostatic headache due to intracranial hypotension (5 cm H2 O). The clinical course of this case was very unusual. Orthostatic headache was associated with a CSF leak from the thigh after pathological fractures of the femur and pelvis. The chronic CSF leak led to acquired Chiari malformation (CM) with syringomyelia...
August 3, 2018: Journal of Neurosurgery. Pediatrics
James L West, Madison Arnel, Atilio E Palma, John Frino, Alexander K Powers, Daniel E Couture
OBJECTIVE Spine surgery is less common in children than adults. These surgeries, like all others, are subject to complications such as bleeding, infection, and CSF leak. The rate of incidental durotomy in the pediatric population, and its associated complications, has scarcely been reported in the literature. METHODS This is a retrospective chart review of all pediatric patients operated on at Wake Forest Baptist Health from 2012 to 2017 who underwent spine surgeries. The authors excluded any procedures with intended durotomy, such as tethered cord release or spinal cord tumor resection...
August 3, 2018: Journal of Neurosurgery. Pediatrics
Rifat Karli, Ugur Yildirim
Cerebrospinal fluid (CSF) rhinorrhea is that the fluid in subarachnoid space leaks into the nasal passage in any way as a transparent discharge. Cerebrospinal fluid fistulas generally develop as secondary to trauma. Only 3% of CSF fistulas develop spontaneously. Spontaneous CSF fistulas are mostly originated from ethmoid roof and cribriform plate; however, the development of spontaneous CSF fistula due to defect in clivus is very rare. To our knowledge, till date only 13 patients with spontaneous CSF fistulae due to Clivus defect have been reported in English literature...
July 31, 2018: Journal of Craniofacial Surgery
S Peraio, F H Ebner, M Tatagiba
BACKGROUND: To evaluate the significance for outcome of meningioma invasion into the internal auditory canal (IAC) in posterior fossa meningiomas. METHODS: From April 2005 to September 2015, 174 posterior fossa meningiomas have been surgically treated in our Institution. Careful analysis of preoperative MRI depicted in 63 cases (36%) meningioma invasion into the IAC. A retrospective analysis was done of clinical and radiological presentation, surgical findings, outcome, and relevant prognostic factors in order to stratify the risk of complication and evaluate the surgical outcome...
July 29, 2018: Acta Neurochirurgica
Keisuke Takai, Makoto Taniguchi
BACKGROUND: Difficulties are associated with the diagnosis and management of patients with coma due to intracranial hypotension. CASE DESCRIPTION: The authors describe the case of a 70-year-old male with coma (Glasgow Coma Scale of 6) with fixed dilated pupils due to severe intracranial hypotension. After unsuccessful epidural blood patch (EBP), the patient underwent microsurgical dural repair and drainage of hematoma with intracranial pressure (ICP) monitoring...
July 25, 2018: World Neurosurgery
Jürgen Beck, Andreas Raabe, Wouter I Schievink, Christian Fung, Jan Gralla, Eike Piechowiak, Kathleen Seidel, Christian T Ulrich
BACKGROUND: Spinal cerebrospinal fluid (CSF) leaks are the cause of spontaneous intracranial hypotension (SIH). OBJECTIVE: To propose a surgical strategy, stratified according to anatomic location of the leak, for sealing all CSF leaks around the 360° circumference of the dura through a single tailored posterior approach. METHODS: All consecutive SIH patients undergoing spinal surgery were included. The anatomic site of the leak was exactly localized...
July 25, 2018: Neurosurgery
Ahmed Youssef, Shahzad Ahmed, Ahmed Aly Ibrahim, Mulvihill Daniel, Hisham M Abdelfattah, Haitham Morsi
Septoplasty/septorhinoplasty is a common ear, nose and throat procedure offered for those patients with deviated septum who are suffering from nasal obstruction and functional or cosmetic problems. Although it is a basic and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks. We describe two different cases of traumatic CSF leaks following septoplasty/septorhinoplasty at two different sites. The first patient suffered a CSF leak following septoplasty and presented to Alexandria University Hospital...
July 2018: Archives of Plastic Surgery
Nicholas Erickson, Alan Siu, Jonathan H Sherman, Cristian Gragnaniello, Ameet Singh, Zachary Litvack
OBJECTIVE: Brainstem cavernous malformations (BSCM) represent around 8-22% of all intracranial CMs but exhibit a higher annual incidence of hemorrhage (2-3%) compared to other cavernous angiomas and tend to be more symptomatic given their proximity to critical nuclei and fiber tracts. Recently, endoscopic endonasal techniques have been employed for the removal of ventral skull base lesions, with significant improvement in operative morbidity and mortality compared to open approaches. Here we demonstrate the utility and feasibility of the endoscopic transclival approach for ventrally located pontine cavernomas in carefully selected patients...
July 18, 2018: World Neurosurgery
Issam Saliba, Marc-Henri Asmar
BACKGROUND: Endolymphatic sac decompression has shown limited success for the treatment of Ménière's disease (MD). We have published a novel technique with very promising results for the treatment of refractory MD: the Endolymphatic Duct Blockage (EDB) with two titanium clips. One of the challenges of this technique was an increased incidence of intraoperative Cerebrospinal Fluid (CSF) Leak. OBJECTIVE: To assess the effect of intraoperative CSF Leak on short-term surgical outcomes...
July 17, 2018: Acta Oto-laryngologica
Danielle Houlden, Dmitriy Khodorskiy, Sandra Miller-Portman, Maria Li
Introduction  Unlike low-pressure hydrocephalus, very low pressure hydrocephalus (VLPH) is a rarely reported clinical entity previously described to be associated with poor outcomes and to be possibly refractory to treatment with continued cerebrospinal fluid (CSF) drainage at subatmospheric pressures. 1, 2 We present four cases of VLPH following resection of suprasellar lesions and hypothesize that untreatable patients can be identified early, thereby avoiding futile prolonged external ventricular drainage in ICU...
August 2018: Journal of Neurological Surgery. Part B, Skull Base
Garrett T Venable, Mallory L Roberts, Ryan P Lee, L Madison Michael
Object  Primary closure of posterior fossa dura can be challenging, and postoperative cerebrospinal fluid (CSF) leaks continue to represent a common complication of the retrosigmoid approach. We describe a simple technique to allow for primary closure of the dura following retrosigmoid approaches. The incidence of CSF leaks using this method is reported. Methods  A retrospective chart review was conducted on all cases of retrosigmoid craniotomies performed by the senior surgeon from February 2009 to February 2015...
August 2018: Journal of Neurological Surgery. Part B, Skull Base
Daniel G Eichberg, Sheikh C Ali, Simon S Buttrick, Ricardo J Komotar
BACKGROUND: In cranial neurosurgery, primary watertight dural closure is the standard method of post-craniotomy dural repair. However, cerebrospinal fluid (CSF) leaks, pseudomeningoceles, postoperative infections, and dural scarring are possible complications, even when a meticulous technique is implemented. For this reason, materials that enhance the dura's ability to create a watertight seal, inhibit the inflammatory response, and prevent disease transmission are sought. Dehydrated amniotic membrane (DAM) allograft appears to facilitate these properties, as studies have shown that it improves wound healing, prevents scar tissue formation, promotes epithelialization, and inhibits bacterial growth...
May 7, 2018: Curēus
Christian Brogna, José Pedro Lavrador, Sabina Patel, Francesco Vergani, Sanjeev Bassi, Gordan Grahovac, Ranjeev Bhangoo, Keyoumars Ashkan
Background: Intradural disc herniations (IDH) are rare, particularly in the cervical spine, where they account for less than 5% of all discs. Adhesions between the ossified/calcified posterior longitudinal ligament (OPLL), dura, and ossified/calcified disc herniations increase the complexity of resecting these cervical lesions. Case Description: A 42-year-old male presented with a rapidly progressive cervical myelopathy over a 2-month period. This was attributed to an ossified/calcified intradural cervical disc herniation in conjunction with OPLL...
2018: Surgical Neurology International
Justin Seltzer, Michelle A Wedemeyer, Phillip A Bonney, John D Carmichael, Martin Weiss, Gabriel Zada
OBJECTIVE Incidental pituitary adenomas (IPAs) are commonly discovered during cranial imaging evaluations obtained for unrelated indications. The optimal management of IPA remains controversial. The authors investigated the outcomes and safety of the surgical treatment of IPAs at their institution. METHODS Clinical outcome data for 1692 patients surgically treated for pituitary adenomas at the Keck Medical Center of USC/USC Pituitary Center over a 17-year period (1999-2016) were reviewed to identify all cases with surgically managed IPAs...
June 1, 2018: Journal of Neurosurgery
Daniel G Eichberg, Sheikh C Ali, Simon S Buttrick, Ricardo J Komotar
BACKGROUND: Primary watertight dural closure is the preferred method of postcraniotomy dural repair. However, even when ideal technique is implemented, postoperative infection, cerebrospinal fluid (CSF) leaks, pseudomeningoceles, and dural scarring are possible complications. For this reason, materials that augment the dura's ability to create a watertight seal, prevent disease transmission, and inhibit inflammatory response are sought. Dehydrated amniotic membrane (DAM) allograft appears to fulfil these requirements as it has several beneficial properties that aid wound healing, including promotion of epithelialization, scar tissue prevention, and inhibition of bacterial growth...
July 10, 2018: British Journal of Neurosurgery
Yasser W Khafagy, Ahmed M Abd Elfattah, Waleed Moneir, Eman H Salem
BACKGROUND: Spontaneous CSF leak is a challenging condition, with frequent recurrences following attempted surgical closure. The selection of graft materials depends on the experience of the operating surgeon. Leukocyte- and platelet-rich fibrin (L-PRF) is a second-generation platelet concentrate that has currently invaded every surgical specialty. To our knowledge, no previous reports about the use of L-PRF in repair of CSF leak were published. The study was conducted to assess the potential role of L-PRF in spontaneous CSF leaks repair...
July 7, 2018: European Archives of Oto-rhino-laryngology
M Fevzi Ozkaynak, Andrew L Gilman, Wendy B London, Arlene Naranjo, Mitchell B Diccianni, Sheena C Tenney, Malcolm Smith, Karen S Messer, Robert Seeger, C Patrick Reynolds, L Mary Smith, Barry L Shulkin, Marguerite Parisi, John M Maris, Julie R Park, Paul M Sondel, Alice L Yu
Purpose: A phase 3 randomized study (COG ANBL0032) demonstrated significantly improved outcome by adding immunotherapy with ch14.18 antibody to isotretinoin as post-consolidation therapy for high-risk neuroblastoma (NB). This study, ANBL0931, was designed to collect FDA-required safety/toxicity data to support FDA registration of ch14.18. Experimental design: Newly diagnosed high-risk NB patients who achieved at least a partial response to induction therapy and received myeloablative consolidation with stem cell rescue were enrolled to receive six courses of isotretinoin with five concomitant cycles of ch14...
2018: Frontiers in Immunology
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