1/237. Spontaneous cerebrospinal fluid (CSF) rhinorrhoea in spongiform dysplasia of the cranium: an unusual presentation of neurofibromatosis.A 20-year-old woman with neurofibromatosis presented with CSF rhinorrhoea. Spongiform dysplasia of the cranium was found. The dysplastic bone contained CSF. The exact site of the CSF fistula into the calvarium and into the paranasal sinuses could not be detected on investigation but nasal packing of the ethmoid and sphenoid sinuses controlled the rhinorrhoea. The unique features of this case are presented along with a brief review of the literature.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/237. Transnasal endoscopic repair of congenital defects of the skull base in children.OBJECTIVE: To examine imaging findings and methods of endoscopic treatment of congenital skull base defects in children. DESIGN: Retrospective study and case series. SETTING: Academic tertiary care center. patients: Four patients (aged 12 and 14 months and 8 and 13 years) were included from 1995 to 1997. Three presented with a nasal glioma, which was recurrent in 1 case. The fourth patient presented with bacterial meningitis due to a spontaneous cerebrospinal fluid leak. Computed tomography and magnetic resonance imaging were used to locate the defect of the skull base. INTERVENTION: Transnasal endoscopic resection of the glioma or the meningocele, with immediate repair of the skull base defects using free mucosal flaps and/or pediculized mucosal flaps and/or conchal cartilage together with fibrin glue and nasal packing during a 3-week period. RESULTS: None of the 4 patients has experienced recurrent cerebrospinal fluid leaks or postoperative meningitis. CONCLUSIONS: The transnasal endoscopic repair of congenital meningoceles is a reliable technique in select pediatric patients. Computed tomography and magnetic resonance imaging provide information that can be used to help the surgical procedure.- - - - - - - - - - ranking = 0.5keywords = spinal (Clic here for more details about this article) |
3/237. Spontaneous cerebrospinal fluid leakage detected by magnetic resonance cisternography--case report.A 49-year-old male with no history of head trauma suffered cerebrospinal fluid (CSF) discharge from the left nostril for one month. Coronal computed tomography (CT) showed lateral extension of the sphenoid sinus on both sides and CSF collection on the left side. CT cisternography could not identify the site of CSF leakage. Heavily T2-weighted magnetic resonance (MR) imaging (MR cisternography) in the coronal plane clearly delineated a fistulous tract through the sphenoid bone into the sphenoid sinus. Patch graft with muscle fragment completely relieved the CSF rhinorrhea. Postoperative three-dimensional CT showed the two bone defects identified during surgery. Small bony dehiscences in the sphenoid bone and lateral extension of the sphenoid sinus predisposed the present patient to CSF fistula formation. MR cisternography in the coronal and sagittal planes is superior to CT scanning or CT cisternography for detection of the site of active CSF leakage.- - - - - - - - - - ranking = 1.25keywords = spinal (Clic here for more details about this article) |
4/237. Intrasphenoid cephalocele: MRI in two cases.The intrasphenoid form of basal cephalocele is uncommon. We describe the clinical, CT and MRI findings in two cases presenting in middle age with persistent cerebrospinal fluid rhinorrhoea. Emphasis is placed upon the imaging findings which aid in discrimination of intrasphenoidal cephalocele from more common causes of a sphenoid sinus mass.- - - - - - - - - - ranking = 0.25keywords = spinal (Clic here for more details about this article) |
5/237. Intracranial mucocele as a complication of endoscopic repair of cerebrospinal fluid rhinorrhea: case report.OBJECTIVE AND IMPORTANCE: Endoscopic repair of an anterior cranial fossa cerebrospinal fluid (CSF) fistula has gained widespread acceptance. We report a case of mucocele development at the site of an endoscopic CSF leak repair. CLINICAL PRESENTATION: A 46-year-old woman underwent functional endoscopic sinus surgery for nasal obstructive symptoms. The surgery was complicated by an intraoperative CSF leak from the posterior cribriform plate/anterior sphenoid, which was repaired immediately using bone and mucosa grafts. Two years postoperatively, a 13-mm anterior cranial base mass was found incidentally. This mass increased to 20 mm over the next year. INTERVENTION: The anterior cranial base mass was excised via a right frontal craniotomy and confirmed histologically to be a mucocele. CONCLUSION: Endoscopic repair of an anterior cranial base CSF fistula with mucosal grafts may lead to formation of a mucocele.- - - - - - - - - - ranking = 1.25keywords = spinal (Clic here for more details about this article) |
6/237. skull base reconstruction utilizing titanium mesh in chronic CSF leakage repair.OBJECTIVE AND IMPORTANCE: Chronic cerebrospinal fluid leakage is a perplexing management problem in skull base surgery, as well as craniofacial and certain otolaryngologic procedures. When all less invasive techniques have been tried and have failed, craniotomy for direct repair is often done. CLINICAL PRESENTATION: This case represents one such case in which the pathology found required an unusual application of a common surgical adjunct for correction. The patient in question had experienced CSF rhinorrhea intermittently for 10 years prior to presentation. Several intracranial procedures had failed to curtail the rhinorrhea, after failure of lumbar drainage and other less invasive procedures had also failed. The patient was taken to surgery again for an attempt to directly correct the CSF leak, after demonstration of the location of the leak was accomplished with the assistance of contrasted coronal CT images of the anterior fossa. TECHNIQUE: At the time of surgery, comminuted fractures of the floor of the anterior fossa were noted. These fractures were associated with multiple sites of dural impingement. Following meticulous repair of all dural injuries, reconstruction of the floor of the anterior fossa was accomplished with the use of titanium micro mesh. The mesh placement isolated the dura from further contact with the fracture surfaces, preventing recurrent dural injury. CONCLUSION: The use of titanium mesh in skull base surgery has previously been reported in craniofacial and cranial vault procedures. Its use in skull base applications may prove useful in certain situations. This patient remains asymptomatic nearly 2 years after its use, longer than with any previous procedures to correct his chronic CSF leakage.- - - - - - - - - - ranking = 0.25keywords = spinal (Clic here for more details about this article) |
7/237. Otogenic cerebrospinal fluid rhinorrhea: a new technique for closure of cerebrospinal fluid leak.OBJECTIVE: To describe a new technique for control of cerebrospinal fluid (CSF) rhinorrhea and to review alternative approaches. STUDY DESIGN: Five cases and literature review. SETTING: Tertiary referral center. patients: Five case study patients. INTERVENTION: Surgical. MAIN OUTCOME MEASURE: Control of CSF rhinorrhea. RESULTS: CSF rhinorrhea can be controlled through eustachian tube ligation in the nasopharynx, distal to all known pathways through which CSF leaks may occur from the temporal bone into the eustachian tube. CONCLUSION: Transoral eustachian tube ligation appears to be a safe and effective alternative to other techniques for controlling CSF rhinorrhea and should be included in the otologist's repertoire.- - - - - - - - - - ranking = 2.25keywords = spinal (Clic here for more details about this article) |
8/237. Bilateral cerebrospinal fluid rhinorrhoea.Cerebrospinal fluid (CSF) rhinorrhoea is leakage of fluid from the subarachnoid space to the frontal, sphenoidal or ethmoidal sinuses, and may occur spontaneously. The authors present the first reported case of bilateral spontaneous CSF rhinorrhoea. Bony defects on both sides of the cribriform plate were identified using endoscopic and radiological techniques, and the CSF fistula was closed endoscopically. The aetiology, diagnosis and contemporary surgical treatment of spontaneous CSF leaks is discussed. Endoscopic repair was successful in this case, and in view of the high success and low reported complication rates this surgical approach should be considered for treatment of spontaneous CSF rhinorrhoea.- - - - - - - - - - ranking = 1.25keywords = spinal (Clic here for more details about this article) |
9/237. Identification of intranasal cerebrospinal fluid leaks by topical application with fluorescein dye.The purpose of this paper is to describe a safe new technique for intraoperative identification of the site of cerebrospinal fluid rhinorrhea. Cerebrospinal fluid (CSF) rhinorrhea after intracranial or intranasal surgery is a known potential complication with significant morbidity and mortality. It is currently accepted that endoscopic intranasal management of CSF rhinorrhea is the preferred method of surgical repair, with higher success rates and less morbidity than intracranial surgical repair in selected cases. Accurate identification of the site of CSF leakage is necessary for a successful endoscopic surgical repair. Computer tomography (CT) with or without intrathecal contrast and preoperative nasal endoscopy are frequently used to preoperatively localize the site of the leak. Intrathecal fluorescein administered immediately before surgery has aided in the intraoperative identification of the site of CSF leak in 25-64% of patients undergoing endoscopic repair of CSF rhinorrhea in whom preoperative CT scanning and nasal endoscopy had not identified the site of CSF leak. Intrathecal fluorescein, however, has been associated with severe complications, such as lower extremity weakness, numbness, generalized seizures, opisthotonus, and cranial nerve deficits. We present three cases of CSF rhinorrhea in which fluorescein was applied intranasally during the endoscopic surgical repair. Ten percent fluorescein was applied to the nose with a cotton swab. Under endoscopic visualization the fluorescein changed its fluorescent color from amber/yellow to a dark green and was found streaming from high in the nasal cavity, which led to accurate identification of the site of the CSF leak.- - - - - - - - - - ranking = 1.5keywords = spinal (Clic here for more details about this article) |
10/237. Delayed cerebrospinal fluid rhinorrhea seven months after transsphenoidal surgery for pituitary adenoma--case report.A 51-year-old female had undergone transsphenoidal surgery for pituitary adenoma producing growth hormone. Cerebrospinal fluid (CSF) leakage occurred during surgery. The sella turcica and sphenoid sinus were packed with abdominal fat and fibrin glue, buttressing the closure with a fragment of sphenoid bone. No CSF rhinorrhea occurred postoperatively. Severe meningitis developed 7 months later. CSF rhinorrhea occurred 10 days after readmission. Exploration through the transsphenoidal approach identified a small hole at the floor of the sella and CSF leaking into the sphenoid sinus through the hole. The CSF leakage stopped after the second surgery. Delayed CSF rhinorrhea without bromocriptine administration is very rare. The cause of delayed CSF rhinorrhea remains unclear. CSF rhinorrhea should be suspected if meningitis develops even months after transsphenoidal surgery.- - - - - - - - - - ranking = 1.25keywords = spinal (Clic here for more details about this article) |
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