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Csf leaks

Panagiotis Kerezoudis, Amy E Glasgow, Mohammed Ali Alvi, Robert J Spinner, Fredric B Meyer, Mohamad Bydon, Elizabeth B Habermann
BACKGROUND: Return to the operating room (ROR) has been put forth by the National Quality Forum and the American College of Surgeons as a surgical quality indicator. However, current quality metrics fail to consider the nature and etiology of the ROR. OBJECTIVE: To provide a comprehensive description of all reoperations after neurosurgical procedures and assess the validity of ROR as a quality measure in neurosurgery. METHODS: We retrospectively analyzed all neurosurgical procedures performed in a high-volume, tertiary care academic medical center between June 1, 2014 and December 31, 2016...
October 8, 2018: Neurosurgery
Keisuke Takai, Manabu Niimura, Hiroki Hongo, Motoyuki Umekawa, Akio Teranishi, Tomomichi Kayahara, Makoto Taniguchi
OBJECTIVE: The diagnosis and treatment of intracranial hypotension associated with a spinal cerebrospinal fluid (CSF) leak, especially in comatose patients, have yet to be established. METHODS: Clinical manifestations, neuroimaging findings, and treatment outcomes in 11 patients (Glasgow Coma Scale 10±4) were described and compared with 36 patients with normal consciousness. RESULTS: Patients with disturbed consciousness were diagnosed at a significantly older age (55±11 years; p<0...
October 4, 2018: World Neurosurgery
Stephanie H Chen, Annelise Sprau, Leon Chieng, Simon Buttrick, Elie S Alam, Ali Sheikh, Karthik Madhavan, Zoukaa B Sargi, Ricardo Komotar
INTRODUCTION: With a rapidly expanding elderly population in the United States, the incidence of pituitary adenomas in elderly will continue to rise. In this study, we aim to evaluate the safety and efficacy of transsphenoidal endoscopic endonasal resection for pituitary adenomas in the elderly population. METHODS: A retrospective review was performed of 131 consecutive patients who underwent transsphenoidal endoscopic endonasal resection for pituitary adenomas at the University of Miami Hospital between 2012 and 2016...
October 4, 2018: World Neurosurgery
Rabi Narayan Sahu, Jayesh Sardhara, Amit Kumar Singh, Sandeep Sahu, Puja Chovatiya, Arun Kumar Srivastava, Awadhesh Kumar Jaiswal, Anant Mehrotra, Kuntal Kanti Das, Kamlesh Singh Bhaisora, Sanjay Behari
Background: Postoperative pain and cerebrospinal fluid (CSF) leak are common known complications of spinal surgery, both having a synergistic effect on each other. Thus, both need to be dealt simultaneously. Double drug impregnated autologous coagulum patch (DDIAC) is a novel method which reduced both incidences of postoperative CSF leaks as well as pain. Methodology: Twenty-seven patients undergoing lumbar disc surgery without instrumentation were included and randomized into DDIAC and single drug impregnated autologous coagulum patch (SDIAC) group...
July 2018: Asian Journal of Neurosurgery
Erik C Brown, Brandon Lucke-Wold, Justin S Cetas, Aclan Dogan, Sachin Gupta, Timothy E Hullar, Timothy L Smith, Jeremy N Ciporen
BACKGROUND: Cerebrospinal fluid (CSF) rhinorrhea from a lateral skull base defect refractory to spontaneous healing and/or conservative management is most commonly managed via open surgery. The approach for repair is dictated by location of the defect, which may require surgical exploration. The final common pathway, however, is the Eustachian tube (ET). Endoscopic ET obliteration (EETO) via endonasal and lateral approaches are under development. OBJECTIVE: While the anatomy of the ET has been studied, surgical landmarks have not been previously described or quantified...
September 25, 2018: World Neurosurgery
Rajesh Kasimahanti, Sai Kandraju Satish, Mridu Anand
Background: Community-acquired gram-negative bacillary meningitis is rare to occur without preexisting conditions like trauma, organ dysfunction, and immunocompromised state, and very few case reports with Escherichia coli have been described in literature till now. Presence of ventriculitis along with meningitis makes the incidence further sparse. Case presentation: A review of literature identified a total of only 45 community-acquired E. coli meningitis from 1945 till to date...
2018: Journal of Intensive Care
A N Shkarubo, K V Koval, I V Chernov, D N Andreev, A A Panteleyev
INTRODUCTION: With the introduction into the neurosurgical practice of minimally invasive methods utilizing endoscopic techniques, it became possible to effectively remove hard-to-reach tumors, including central tumors of the anterior region of the posterior cranial fossa. OBJECTIVE: To analyze the results of surgical treatment of patients with various centrally located tumors of the base of the skull that extend into the anterior region of the posterior cranial fossa using the endoscopic endonasal transclival approach...
September 24, 2018: World Neurosurgery
Saksham Gupta, Abdul-Kareem Ahmed, Wenya Linda Bi, Hassan Y Dawood, Bryan Iorgulescu, C Eduardo Corrales, Ian F Dunn, Timothy R Smith
OBJECTIVE: Readmission and reoperation are unfortunate risks in the resection of benign cranial nerve tumors (BCNTs). This report analyzes the impact of patient-level and surgical factors on these adverse outcomes. METHODS: A retrospective cohort review of patients diagnosed with a BCNT enrolled in the American College of Surgeons-National Surgical Quality Improvement Program registry from 2011-2015 was performed. Multivariable logistic regression was utilized to determine the impact of select medical and operative factors on the primary outcomes, readmission and reoperation within 30 days, adjusted for relevant co-variates...
September 24, 2018: World Neurosurgery
Michelle A Wedemeyer, Michelle Lin, Vance L Fredrickson, Anush Arakelyan, Daniel Bradley, Daniel A Donoho, Kyle M Hurth, Martin H Weiss, John D Carmichael, Gabriel Zada
Background: Limited data exist pertaining to outcomes following surgery for recurrent Rathke's cleft cysts (RCC). Objective: To determine treatment outcomes in patients undergoing reoperation for recurrent or residual RCCs. Methods: A retrospective analysis of 112 consecutive RCC operations in 109 patients between 1995 and 2017 was conducted. Results: Eighteen patients underwent 21 RCC reoperations with a mean follow-up of 58 mo...
September 22, 2018: Operative Neurosurgery (Hagerstown, Md.)
Amrit K Chiluwal, Alyssa Rothman, Maja Svrakic, Amir R Dehdashti
BACKGROUND: Currently, there is no consensus in the initial management of small vestibular schwannomas (VSs). They are routinely watched and/or referred for radiosurgical treatment, although surgical removal is also an option. We hereby evaluate clinical outcomes of patients who have undergone surgical removal of smaller symptomatic VSs. METHODS: Patients with vestibular schwannomas (grade T1-T3b according to Hannover classification) were reviewed. Patients with symptomatic tumors who underwent surgery were evaluated...
September 18, 2018: Acta Neurochirurgica
Tomas Dobrocky, Pascal J Mosimann, Felix Zibold, Pasquale Mordasini, Andreas Raabe, Christian T Ulrich, Jan Gralla, Jürgen Beck, Eike I Piechowiak
Purpose To propose a modified dynamic CT myelographic technique to locate cerebrospinal fluid (CSF) leaks, also known as cryptogenic leaks, in patients with spontaneous intracranial hypotension (SIH) in whom previous imaging did not show the dural breach. Materials and Methods This retrospective analysis included 74 consecutive patients with SIH and a myelographically proven CSF leak who were evaluated between February 2013 and October 2017. In 14 patients, dynamic CT myelography in the prone or lateral position showed the exact leakage point after unsuccessful previous imaging...
September 18, 2018: Radiology
Carlos Eduardo da Silva, Paulo Eduardo Peixoto de Freitas
OBJECTIVES: Meningiomas are tumors that frequently occur in elderly patients, surgical treatment of which is hazardous due to multiple comorbidities. The authors report on a series of elderly patients who were treated with surgical removal and compare them with a group of younger patients with similar tumors. METHODS: A retrospective study, including a group of elderly patients with symptomatic skull base meningiomas and a matched control group of younger patients was carried out...
September 12, 2018: World Neurosurgery
M Stavrakas, P D Karkos, S Triaridis, J Constantinidis
INTRODUCTION: Congenital meningoencephaloceles represent a rare clinical entity, with its frequency being around 1 out of 4000-5000 live births. They usually present as a midline mass and the differential diagnosis includes dermoids, encephaloceles, and gliomas. Although the standard coronal approach with frontal craniotomy and pericranial flap has been considered the preferred method for several years, it is associated with risks and prolonged hospitalization. The endoscopic procedure is gaining ground and we are aiming to present our experience from five cases that were treated endoscopically...
September 14, 2018: European Archives of Oto-rhino-laryngology
Nikita G Alexiades, Edward S Ahn, Jeffrey P Blount, Douglas L Brockmeyer, Samuel R Browd, Gerald A Grant, Gregory G Heuer, Todd C Hankinson, Bermans J Iskandar, Andrew Jea, Mark D Krieger, Jeffrey R Leonard, David D Limbrick, Cormac O Maher, Mark R Proctor, David I Sandberg, John C Wellons, Belinda Shao, Neil A Feldstein, Richard C E Anderson
OBJECTIVE Complications after complex tethered spinal cord (cTSC) surgery include infections and cerebrospinal fluid (CSF) leaks. With little empirical evidence to guide management, there is variability in the interventions undertaken to limit complications. Expert-based best practices may improve the care of patients undergoing cTSC surgery. Here, authors conducted a study to identify consensus-driven best practices. METHODS The Delphi method was employed to identify consensual best practices. A literature review regarding cTSC surgery together with a survey of current practices was distributed to 17 board-certified pediatric neurosurgeons...
September 14, 2018: Journal of Neurosurgery. Pediatrics
Doo-Sik Kong, Stephanie Ming Young, Chang-Ki Hong, Yoon-Duck Kim, Sang Duk Hong, Jung Won Choi, Ho Jun Seol, Jung-Il Lee, Hyung Jin Shin, Do-Hyun Nam, Kyung In Woo
OBJECTIVE Cranioorbital tumors are complex lesions that involve the deep orbit, floor of the frontal bone, and lesser and greater wing of the sphenoid bone. The purpose of this study was to describe the clinical and ophthalmological outcomes with an endoscopic transorbital approach (TOA) in the management of cranioorbital tumors involving the deep orbit and intracranial compartment. METHODS The authors performed endoscopic TOAs via the superior eyelid crease incision in 18 patients (16 TOA alone and 2 TOA combined with a simultaneous endonasal endoscopic resection) with cranioorbital tumors from September 2016 to November 2017...
September 14, 2018: Journal of Neurosurgery
V Sasindran, N Mathew, A K Shabna, B Harikrishan
Cribriform plate is the commonest site of spontaneous CSF leak, the fragility of the plate and juxtaposition of arachnoid's investment to the bone, where the olfactory nerve pierces the skull made this area, a vulnerable site for CSF leak. Transnasal endoscopic approach has gained popularity for CSF leak repair over the years. To describe the 5 year experience of spontaneous medial cribriform CSF leak repair with free mucosal graft in a tertiary medical centre. All patients who underwent transnasal endoscopic repair with free mucosal graft for spontaneous medial cribriform CSF leak in our institution between 2011 and 2016 were reviewed...
September 2018: Indian Journal of Otolaryngology and Head and Neck Surgery
Matteo Zoli, Federica Guaraldi, Ernesto Pasquini, Giorgio Frank, Diego Mazzatenta
Introduction  The endoscopic endonasal approach (EEA) might seem an "unnatural" route for intradural lesions such as meningiomas. The aim of this study is to critically revise our management of anterior skull base meningiomas to consider, in what cases it may be advantageous. Material and Methods  Each consecutive case of anterior skull base meningioma operated on through an EEA or combined endoscopic-transcranial approach at our institution, between 2003 and 2017, have been included. Tumors were classified on the basis of their location and intra or extracranial extension...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Neil S Patel, Matthew L Carlson
Objectives  To describe transnasal Eustachian tube (ET) occlusion with a liquid embolic solution for lateral skull base cerebrospinal fluid (CSF) leaks. Design  A lateral skull base CSF fistula model was developed by the authors using fresh cadaveric heads. Using a transtympanic needle, regulated pressurized pigmented saline was continuously instilled into the middle ear space and visualized endoscopically in the nasopharynx. An angioembolization catheter was then placed through the cartilaginous ET orifice just medial to the bony ET...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Enrique Perez, Daniel Carlton, Matthew Alfarano, Eric Smouha
Objective  Determine the efficacy of using a purely transmastoid approach for the repair of spontaneous cerebrospinal fluid (CSF) leaks and further elucidate the relationship of elevated body mass index (BMI) and skull base thickness in our patient population. Method  We conducted a retrospective chart review of patients treated for spontaneous temporal bone CSF leaks at our tertiary care institution from the years 2006 to 2015. Cases were categorized as primary or secondary. We analyzed success rates, length of stay, use of lumbar drains, BMIs, and rates of meningitis...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Jonathon Cavaleri, Jennifer L Perez, Alp Ozpinar, Nima Alan, Edward Monaco
Background: Cerebrospinal fluid (CSF) leakage into the epidural space following lumbar puncture (LP) has been documented in pediatric patients, but there have been no reported cases in adults. Case Description: We report an epidural CSF leak in an adult who presented with back pain, positional headache, urinary retention, and constipation following an LP performed as a part of a research study. The patient's magnetic resonance (MR) scan showed an extensive epidural CSF collection...
2018: Surgical Neurology International
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