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leak csf mri

Leigh A Rettenmaier, Brian J Park, Marshall T Holland, Youssef J Hamade, Shuchita Garg, Rahul Rastogi, Chandan G Reddy
Spontaneous intracranial hypotension (SIH) is a more common than previously noted condition (1-2.5 per 50,000) typically caused by cerebrospinal fluid (CSF) leakage. Initial treatment involves conservative therapies, but the mainstay of treatment for patients who fail conservative management is the epidural blood patch (EBP). Subdural hematoma (SDH) is a common complication occurring with SIH, but its management remains controversial. In this report, we discuss a 62-year-old female who presented with a 5-week history of orthostatic headaches associated with nausea, emesis, and neck pain...
September 27, 2016: World Neurosurgery
Christopher S Graffeo, Avital Perry, Eelco F M Wijdicks
BACKGROUND: Intracranial subarachnoid hemorrhage (SAH) and spinal subdural hematoma (SDH) are rare complications of spine surgery, thought to be precipitated by cerebrospinal fluid (CSF) hypotension in the setting of an intraoperative durotomy or postoperative CSF leak. Considerable clinical variability has been reported, requiring a high level of clinical suspicion in patients with a new, unexplained neurologic deficit after spine surgery. METHODS: Case report...
September 22, 2016: Neurocritical Care
Atsushi Arai, Hirohito Miyamoto, Ryoji Shiomi, Shotaro Tatsumi, Eiji Kohmura
Spontaneous cerebrospinal fluid leak and intracranial hypotension associated with cervical spondylosis have rarely been observed, and only a few cases are reported. A 69-year-old woman, previously treated for rectal and thyroid cancer, complained of a non-postural persistent headache. The patient regularly practiced aerobic exercise, but a month earlier she had started experiencing headache and neck pain while exercising. Computed tomography(CT)showed bilateral chronic subdural hematomas, and magnetic resonance imaging(MRI)revealed diffuse dural enhancement and tonsillar herniation...
September 2016: No Shinkei Geka. Neurological Surgery
Samuel J C Fishpool, Anthony Amato-Watkins, Caroline Hayhurst
The objective is to assess whether free middle turbinate (FMT) graft reconstruction, after endoscopic endonasal pituitary surgery, combines an acceptably low post-operative cerebrospinal fluid (CSF) leak rate with acceptable rhinological morbidity. This study identified 50 patients who underwent endoscopic endonasal pituitary surgery by the senior author in our teaching hospital between May 2011 and June 2012. FMT graft reconstruction was used in 32 cases. 18 patients were judged pre-operatively as not suitable for FMT reconstruction according to a novel skull base reconstructive algorithm...
September 1, 2016: European Archives of Oto-rhino-laryngology
Jürgen Beck, Christian T Ulrich, Christian Fung, Jens Fichtner, Kathleen Seidel, Michael Fiechter, Kety Hsieh, Michael Murek, David Bervini, Niklaus Meier, Marie-Luise Mono, Pasquale Mordasini, Ekkehard Hewer, Werner J Z'Graggen, Jan Gralla, Andreas Raabe
OBJECTIVE: To visualize and treat spinal dural CSF leaks in all patients with intractable spontaneous intracranial hypotension (SIH) who underwent spinal microsurgical exploration. METHODS: Patients presenting between February 2013 and July 2015 were included in this consecutive case series. The workup included spinal MRI without and with intrathecal contrast, dynamic myelography, postmyelography CT, and microsurgical exploration. RESULTS: Of 69 consecutive patients, 15 had intractable symptoms...
September 20, 2016: Neurology
Peter G Kranz, Timothy J Amrhein, Kingshuk Roy Choudhury, Teerath Peter Tanpitukpongse, Linda Gray
OBJECTIVE: The objective of our study was to determine whether the presence of individual imaging signs of spontaneous intracranial hypotension (SIH) is correlated with increasing duration of headache symptoms. Of particular interest is the relationship of symptom duration to dural enhancement because it is the most commonly identified imaging sign in patients with SIH. MATERIALS AND METHODS: Eighty-nine patients with SIH who underwent pretreatment brain MRI and total-spine CT myelography and whose medical record included data on the duration of clinical symptoms were included in this cross-sectional retrospective study...
August 24, 2016: AJR. American Journal of Roentgenology
Sun Qizhi, Li Peijia, Sun Lei, Chen Junsheng, Li Jianmin
BACKGROUND: Noncontiguous cervical spondylotic myelopathy (CSM) is a special degenerative disease because of the intermediate normal level or levels between supra and infraabnormal levels. Some controversy exists over the optimal procedure for two noncontiguous levels of CSM. The study was to evaluate the outcomes of the anterior cervical discectomy and fusion (ACDF) with zero-profile devices for two noncontiguous levels of CSM. MATERIALS AND METHODS: 17 consecutive patients with two noncontiguous levels of CSM operated between December 2009 and August 2012 were included in the study...
July 2016: Indian Journal of Orthopaedics
Stuart R Pomerantz
Myelography describes the instillation of intrathecal contrast media for the imaging evaluation of spinal canal pathology. The technique has evolved with the use of progressively less toxic contrast agents over its 90-year history and the inclusion of advanced image acquisition technology, including both computed tomography (CT) and magnetic resonance imaging (MRI), in addition to plain radiographic projections. The use of myelography for routine evaluation of spinal disease has diminished greatly due to the advent of MRI which has superior soft-tissue contrast and is relatively non-invasive...
2016: Handbook of Clinical Neurology
Han-Song Sheng, Nu Zhang, Jian Lin, Fen-Chun Lin, Bo Yin, Mao-de Wang
OBJECTIVES: Surgical management of cranial burst fracture (CBF) usually involves craniotomy to remove the devitalized brain tissues, followed by watertight repair of dural tears. However, there were times when the dural tear was so extensive that a substantially large bone flap would have to be removed in order to expose the retracted dural margins before it could be repaired. In such cases, strict dural repair would incur a significantly higher risk of damages to the surrounding neural tissues and severe bleeding, especially when the fracture was in the vicinity of eloquent cortical areas and sinus...
September 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Babak Alijani, Hamid Reza Bagheri, Shahrokh Yousefzadeh Chabok, Hamid Behzadnia, Siavash Dehghani
INTRODUCTION: Temporal bone meningoencephalic herniation may occur in head trauma. It is a rare condition with potentially dangerous complications. Several different routes for temporal bone meningoencephalocele have been proposed. CLINICAL REPORT: An11-year-old boy with history of head trauma initially presented with a 9-months history of progressive right-sided hearing loss and facial weakness. The other complaint was formation of a cystic mass in the right external auditory canal...
July 2016: Journal of Craniofacial Surgery
Archil Eristavi, Ian Sabin
We describe an unusual and rarely documented site of SIH supported by clear radiological evidence: a case of spontaneous cerebrospinal fluid (CSF) fistulae involving the C7 and C8 nerve root sheaths, presenting with sudden onset headache and requiring surgical intervention to seal the leaks. Investigations confirmed the leaks and the typical MRI findings of meningeal enhancement, which were resolved after surgery.
June 24, 2016: British Journal of Neurosurgery
Woori Park, Sang Duk Hong, Do-Hyun Nam, Doo-Sik Kong, Gwanghui Ryu, Hyo Yeol Kim, Seung-Kyu Chung, Hun-Jong Dhong
OBJECTIVE: The nasoseptal flap (NSF) has been shown to be a mainstay in the reconstruction of skull base defects. We evaluated the efficacy and complications of NSF in patients with a history of septal surgery who had the potential risk of tearing and poor vascularity. METHODS: We performed a retrospective chart and video review of patients who underwent NSF for skull base reconstruction between February 2012 and May 2015. Comparison was made between 18 patients (revision group) who had a history of septoplasty and/or transseptal transsphenoidal approach and 88 patients (primary group) without a history of septal surgery...
September 2016: World Neurosurgery
Nicholas L Deep, Joseph M Hoxworth, Christopher J Stevens, Michael J Link, Colin L W Driscoll, Christopher P Wood
OBJECTIVE: The radiologic appearance of arachnoid granulations (AGs) in typical locations is well established and they are rarely mistaken for other pathologies. However, when large and seen in atypical locations, such as along the posterior petrous bone, AGs can be a source of diagnostic and therapeutic confusion. We present two cases of giant posterior temporal bone AGs and review their clinical presentation, potential complications, and an imaging-based differential diagnosis. PATIENTS: Two patients with surgically or pathologically proven giant symptomatic AGs in the posterior petrous bone...
August 2016: Otology & Neurotology
Ha Son Nguyen, Andrew Foy, Peter Havens
BACKGROUND: Surgery is routinely recommended for lumbar lipomyelomeningocele, especially in the setting of tethered cord syndrome. The most common complications are wound infections and cerebrospinal fluid (CSF) leak, which remain confined to the surgical site. To the best of our knowledge, there have been no prior reports relating an intracranial subdural empyema following detethering surgery. Prompt diagnosis is essential since subdural empyema is a neurosurgical emergency. CASE DESCRIPTION: The patient was an 11-month-old male who underwent detethering surgery for a lumbar lipomyelomeningocele...
2016: Surgical Neurology International
Vilaas S Shetty, Martin N Reis, Joseph M Aulino, Kevin L Berger, Joshua Broder, Asim F Choudhri, A Tuba Kendi, Marcus M Kessler, Claudia F Kirsch, Michael D Luttrull, Laszlo L Mechtler, J Adair Prall, Patricia B Raksin, Christopher J Roth, Aseem Sharma, O Clark West, Max Wintermark, Rebecca S Cornelius, Julie Bykowski
Neuroimaging plays an important role in the management of head trauma. Several guidelines have been published for identifying which patients can avoid neuroimaging. Noncontrast head CT is the most appropriate initial examination in patients with minor or mild acute closed head injury who require neuroimaging as well as patients with moderate to severe acute closed head injury. In short-term follow-up neuroimaging of acute traumatic brain injury, CT and MRI may have complementary roles. In subacute to chronic traumatic brain injury, MRI is the most appropriate initial examination, though CT may have a complementary role in select circumstances...
June 2016: Journal of the American College of Radiology: JACR
Lisa B E Shields, John R Johnson, Christopher B Shields
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by headaches, altered mental status, seizures, and visual disturbances. Classic MRI findings include white matter changes of the parieto-occipital regions. This syndrome has been encountered in myriad medical illnesses, including hypertension, preeclampsia/eclampsia, and immunosuppressive conditions. While the pathogenesis of the disorder is unclear, vasoconstriction and hypoperfusion leading to brain ischemia and vasogenic edema have been implicated as potential mechanisms...
June 3, 2016: Journal of Neurosurgery. Spine
Justin Seltzer, Arash Babadjouni, Bozena B Wrobel, Gabriel Zada
Spontaneous cerebrospinal fluid (CSF) rhinorrhea due to a skull base defect requires prompt diagnosis and treatment. Multiple surgical options are available for repairing the fistula, including the two-layer "fascial apposition" method and use of a pedicled nasal-septal flap. A 44-year-old obese woman presented with 4 months of progressive cough, exertional dyspnea, hoarseness, and intermittent fluid drainage from the right nostril. Chest computed tomography (CT) imaging and bronchoscopy showed chronic pneumonitis, which was confirmed by pulmonary wedge resection...
June 2016: Journal of Neurological Surgery Reports
Hakeem J Shakir, Paul McBride, Renée M Reynolds
BACKGROUND: The authors present the unique case of a dural-based, infantile hemangioma located in the posterior fossa of a 15-day-old infant. CASE DESCRIPTION: The patient presented with hydrocephalus. The lesion was identified by magnetic resonance imaging and was subsequently resected. Diagnosis of the lesion was confirmed with immunohistochemistry staining. The patient's hospital course was complicated by transverse sinus thrombosis and a cerebrospinal fluid leak that were treated with anticoagulation therapy and ventriculoperitoneal shunt placement, respectively...
2016: Surgical Neurology International
Semra Işik, Baran Yilmaz, Murat Şakir Ekşi, Emel Ece Özcan-Ekşi, Akin Akakin, Zafer Orkun Toktaş, Mustafa Kemal Demir, Deniz Konya
In this case-based review, the authors analyzed relevant literature with an illustrative patient of theirs about subdural hematoma secondary to dural tear at spinal surgery. Intracranial hypotension is a condition of decreased cerebrospinal fluid volume and pressure. Even though intracranial hypotension is temporary and can be managed conservatively, it may progress and result in subdural fluid collections, hematoma formations, "brain sagging or slumping" states, syringohydromyelia, encephalopathy, coma, and even death...
June 2016: Journal of Craniofacial Surgery
Aikaterini Patrona, Kunal S Patel, Evan D Bander, Alpesh Mehta, Apostolos John Tsiouris, Vijay K Anand, Theodore H Schwartz
OBJECTIVE Surgery within the cavernous sinus (CS) remains a controversial topic because of the delicate and complex anatomy. The risk also varies with tumor consistency. Softer tumors such as pituitary adenomas are more likely to be surgically treated, while firm tumors such as meningiomas are often treated with radiosurgery. However, a wide range of pathologies that can involve the CS are amenable to surgery. The authors describe and analyze their results using endonasal endoscopic "medial-to-lateral" approaches for nonadenomatous, nonmeningeal tumors, in relation to the degree of invasion within the CS...
April 29, 2016: Journal of Neurosurgery
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