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Csf leaks

Tomas Dobrocky, Lorenz Grunder, Philipe S Breiding, Mattia Branca, Andreas Limacher, Pascal J Mosimann, Pasquale Mordasini, Felix Zibold, Levin Haeni, Christopher M Jesse, Christian Fung, Andreas Raabe, Christian T Ulrich, Jan Gralla, Jürgen Beck, Eike I Piechowiak
Importance: Various signs may be observed on brain magnetic resonance imaging (MRI) in patients with spontaneous intracranial hypotension (SIH). However, the lack of a classification system integrating these findings limits decision making in clinical practice. Objective: To develop a probability score based on the most relevant brain MRI findings to assess the likelihood of an underlying spinal cerebrospinal fluid (CSF) leak in patients with SIH. Design, Setting, and Participants: This case-control study in consecutive patients investigated for SIH was conducted at a single hospital department from February 2013 to October 2017...
February 18, 2019: JAMA Neurology
Samuel Bidot, Joshua M Levy, Amit M Saindane, Nelson M Oyesiku, Nancy J Newman, Valérie Biousse
BACKGROUND: The association between cerebrospinal fluid (CSF) leaks at the skull base and raised intracranial pressure (ICP) has been reported since the 1960s. It has been suggested that spontaneous CSF leaks might represent a variant of idiopathic intracranial hypertension (IIH). We review the evidence regarding the association between spontaneous CSF leaks and IIH, and the role of ICP in the pathophysiology of nontraumatic skull base defects. We also discuss the management of ICP in the setting of CSF leaks and IIH...
February 8, 2019: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Ju Hyung Moon, Eui Hyun Kim, Sun Ho Kim
OBJECTIVEEndonasal surgery of the skull base requires watertight reconstruction of the skull base that can seal the dural defect to prevent postoperative CSF rhinorrhea and consequent intracranial complications. Although the incidence of CSF leakage has decreased significantly since the introduction in 2006 of the vascularized nasoseptal flap (the Hadad-Bassagasteguy flap), reconstruction of extensive skull base dural defects remains challenging. The authors describe a new, modified vascularized nasoseptal flap for reconstruction of extensive skull base dural defects...
February 8, 2019: Journal of Neurosurgery
J De Vlieger, J Dejaegher, F Van Calenbergh
OBJECTIVE: Determining clinical and radiological characteristics, complication rates and outcome for patients undergoing posterior fossa decompression (PFD) and duraplasty for Chiari malformation type I (CM-I). METHODS AND MATERIALS: Retrospective, single-university hospital study of all PFDs for CM-I between January 1995 and December 2016. RESULTS: PFD was performed in 105 patients with CM-I (n = 105), of whom 62 suffered from associated syringomyelia and 37 were pediatric cases...
February 8, 2019: Acta Neurologica Belgica
Theodore H Schwartz, Peter F Morgenstern, Vijay K Anand
OBJECTIVEEndoscopic skull base surgery (ESBS) is a relatively recent addition to the neurosurgical armamentarium. As with many new approaches, there has been significant controversy regarding its value compared with more traditional approaches to ventral skull base pathology. Although early enthusiasm for new approaches that appear less invasive is usually high, these new techniques require rigorous study to ensure that widespread implementation is in the best interest of patients.METHODSThe authors compared surgical results for ESBS with transcranial surgery (TCS) for several different pathologies over two different time periods (prior to 2012 and 2012-2017) to see how results have evolved over time...
February 1, 2019: Journal of Neurosurgery
Sandeep Muram, Daniel Yavin, Stephan DuPlessis
BACKGROUND: Spontaneous intracranial hypotension is a rare condition for which no optimal treatment guidelines have been determined. The most common presentation is orthostatic headaches, but patients can present with a variety of symptoms. CASE DESCRIPTION: We present a case of a 34 year old male who developed progressive orthostatic headaches and bilateral subdural collections. His symptoms along with imaging of his brain and spine were consistent with SIH. Unfortunately, his symptoms continued to progress, and his level of consciousness became affected...
February 1, 2019: World Neurosurgery
Timothy J Amrhein, Peter G Kranz
This article reviews the role of imaging in the diagnosis, management, and treatment of spontaneous intracranial hypotension (SIH). SIH is a debilitating and often misdiagnosed condition caused by either a spinal cerebrospinal fluid (CSF) leak or a CSF to venous fistula. This pathologic condition is identified and localized via spinal imaging, including computed tomographic (CT) myelography, dynamic myelography, dynamic (ultrafast) CT myelography, MR imaging, or MR myelography with intrathecal gadolinium. Treatment of SIH involves conservative measures, surgery, or imaging-guided epidural blood patching...
March 2019: Radiologic Clinics of North America
Lukas Faltings, Kay O Kulason, Victor Du, Julia R Schneider, Shamik Chakraborty, Kevin Kwan, Bidyut Pramanik, John Boockvar
Management of cerebrospinal fluid (CSF) leak during minimally invasive lumbar tubular microdiscectomy poses challenges unique to the surgical approach. Primary repair can be limited via tubular retractor systems, and onlay graft and dural sealant are often the treatment of choice intraoperatively. Postoperative persistent CSF leak may lead to intracranial hypotension (IH) and positional headaches. Early epidural blood patch (EBP) efficacy in the treatment of spinal CSF leaks of both spontaneous and iatrogenic origin is well-established in numerous studies...
November 26, 2018: Curēus
Bing Wang, Wen-Jia Dai, Xiao-Ting Cheng, Wen-Yi Liuyang, Ya-Sheng Yuan, Chun-Fu Dai, Yi-Lai Shu, Bing Chen
OBJECTIVE: To describe the characteristics of the clinical presentation, diagnosis, surgical methods, and outcomes of patients with otogenic cerebrospinal fluid (CSF) leakage secondary to congenital inner ear dysplasia. METHODS: A retrospective review was performed of 18 patients with otogenic CSF leakage secondary to inner ear dysplasia who underwent surgery in our group from 2007 to 2017 and had a follow-up of at least 4 months. The average length of follow-up was three years...
2019: Journal of Zhejiang University. Science. B
Khetam Hussein, Galit Rabino, Omri Feder, Haneen Eghbaryeh, Hiba Zayyad, Gil Sviri, Rima Benenson, Mical Paul
BACKGROUND: Cerebrospinal fluid (CSF) drainage or intracranial pressure (ICP) monitoring devices are life-saving devices. We examined the risk factors for infections related to them and assessed the effect of an infection control (IC) intervention. METHODS: A prospective observational study was conducted in the Neurosurgical Department of our hospital between 2014 and 2017. We included all consecutive patients undergoing CSF catheter insertions, including external ventricular drainage (EVD), lumbar drainage (LD), and ICP catheters...
January 22, 2019: Acta Neurochirurgica
Javan Nation, Alexander J Schupper, Adam Deconde, Michael Levy
INTRODUCTION: The endoscopic expanded endonasal approach (EEA) has been shown to be a safe and effective surgical technique in the resection of pediatric skull base lesions. Cerebrospinal fluid (CSF) leaks are among the most common complications of this approach. Here we review skull base resections using EEA in pediatric patients at our single institution, to identify potential risk factors for this surgical complication. METHODS: A retrospective chart review was conducted on pediatric patients at our single institution for patients 19 years-old and under, who underwent an EEA for resection of a skull base tumor...
January 11, 2019: International Journal of Pediatric Otorhinolaryngology
Sandro M Krieg, Lukas Bobinski, Lucia Albers, Bernhard Meyer
OBJECTIVELateral lumbar interbody fusion (LLIF) is frequently used for anterior column stabilization. Many authors have reported that intraoperative neuromonitoring (IONM) of the lumbar plexus nerves is mandatory for this approach. However, even with IONM, the reported motor and sensory deficits are still considerably high. Thus, the authors' approach was to focus on the indication, trajectory, and technique instead of relying on IONM findings per se. The objective of this study therefore was to analyze the outcome of our large cohort of patients who underwent LLIF without IONM...
January 18, 2019: Journal of Neurosurgery. Spine
Samuel Mt Jeffery, Balázs Markia, Ian K Pople, Kristian Aquilina, Jenny Smith, Amr Z Mohamed, Alison Burchell, Lyn Jenkins, Peter Walsh, Natasha Clark, Jenny Sacree, Mary Cramp, Mohamed O E Babiker, William Guy Atherton, Anna Clarke, Richard J Edwards
OBJECTIVES: Selective dorsal rhizotomy (SDR) is used to improve spasticity, gait and pain in children with spastic diplegia. There is growing evidence supporting its long-term benefits in terms of functional outcomes, independence and quality of life. There is, however, little contemporary work describing the surgical morbidity of this irreversible procedure. The purpose of this study is to evaluate the surgical outcomes and complications of SDR at a single UK centre. METHODS: Demographics, surgical, postoperative and follow-up data for all patients undergoing SDR between 2011 and 2016 were collected from medical records...
January 16, 2019: World Neurosurgery
K A Kinsman, J T Verdoorn, P H Luetmer, M S Clark, F E Diehn
BACKGROUND AND PURPOSE: The significance of renal contrast on CT myelography is uncertain. This project examined different patient populations undergoing CT myelography for the presence of renal contrast to determine whether this finding is of diagnostic value in spontaneous intracranial hypotension. MATERIALS AND METHODS: Four groups of patients were analyzed for renal contrast on CT myelography. The control group underwent CT myelography for reasons other than spontaneous intracranial hypotension ( n = 47)...
January 17, 2019: AJNR. American Journal of Neuroradiology
Katherine De Rome, Elinor Warner, Kostas Barkas, Nick Thomas, Sinan Barazi, Pavol Surda
Hemopatch (HE) advanced hemostatic pad composed of collagen and a synthetic, protein-reactive monomer which polymerises on contact with protein containing body fluids such as blood and CSF to seal tissues. HE is readily available which shortens the operating time, and may be manipulated intra-nasally to reconstruct defects of the anterior skull base. Reconstruction using HE reduces the morbidity compared with traditional facia lata graft harvesting techniques. Length of stay and operative times might be decreased due to lower morbidity from donor site complications...
January 15, 2019: Clinical Otolaryngology
Ayham Al Afif, Robert Farmer, Manohar Bance
OBJECTIVE: Superior semicircular canal dehiscence is a well-described syndrome with potentially debilitating symptoms. We report on the audiologic and long-term symptom outcomes of 10 patients (12 ears) undergoing a cartilage overlay transmastoid resurfacing technique. METHODS: Retrospective chart review and cross-sectional outcomes recall survey were used. A mailed questionnaire quantifying the effect of surgery on symptom severity and patient satisfaction were used...
January 10, 2019: Laryngoscope
William Rieley, Ayda Askari, Ryojo Akagami, Peter A Gooderham, Petrus A Swart, Alana M Flexman
BACKGROUND: Patients who undergo transsphenoidal pituitary resection have an elevated risk of obstructive sleep apnea (OSA) yet their outcomes and the safety of continuous positive airway pressure (CPAP) remains unclear. Our study objective was to determine the incidence of complications related to the use of early positive airway pressure following pituitary resection. METHODS: We retrospectively identified all patients who underwent endoscopic transsphenoidal pituitary tumor resection between January 1, 2005 and March 24, 2016 at our institution, including those with diagnosed or suspected OSA...
January 8, 2019: Journal of Neurosurgical Anesthesiology
Alvaro Campero, Juan F Villalonga, Armando Basso
BACKGROUND: Cerebrospinal fluid (CSF) fistulae are among the most clinically-important and frequent complications of transsphenoidal surgery for pituitary adenomas. Between the adenoma and the CSF, a "barrier" exists that consists of up to three elements which, from cephalad to caudad, are: the arachnoid, dura mater (sellar diaphragm), and pituitary glandular tissue. The objective of this study was to determine if the presence or absence of any of these three anatomical elements is associated with the development of an intraoperative CSF fistula...
January 4, 2019: World Neurosurgery
Chi-Wei Chen, Shih-Chia Yang, Kuan-Ting Liu, Yen-Hung Wu
RATIONALE: Spinal cord injuries could be catastrophic because they may result in severe neurovascular complications. Here, we present a case of thoracic spine-penetrating injury by a nail-gun. PATIENT CONCERNS: A 60-year-old male presented to our emergency department with complaints of progressive right chest pain for 1 week that was preceded by back pain. He had a medical history of hypertension and denied any trauma history. He had alert consciousness and stable vital signs...
December 2018: Medicine (Baltimore)
Mohsen Benam, Mansour Parvaresh, Alfonso Fasano, Mohammad Rohani
No abstract text is available yet for this article.
December 22, 2018: Postgraduate Medical Journal
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