241/303. Vascular malformation of the cerebellopontine angle associated with "SUNCT" syndrome. A 70-year-old man complained of two distinct types of unilateral headache during the past fifteen years. When the illness began, the pain was intermittent and short-lasting. In successive years, the crises appeared in clusters and lasted weeks to months. At present, the pain occurs daily, and is located on the right side, from the forehead supraorbitally to the temporal region. Some attacks last 30 sec and are accompanied by tearing, conjunctival injection, rhinorrhea and a subjective need to micturate. Other headaches last 1/2-1 h and are occasionally accompanied by local ipsilateral dysautonomic symptoms. Attacks of pain are provoked by movements of the trunk and neck. A vascular malformation in the right cerebellopontine angle was demonstrated on cranial CT and MRI, and by angiography. ( info) |
| Four patients undergoing treatment for benign intracranial hypertension presented with spontaneous CSF rhinorrhoea. The four patients, all women, were aged between 33 and 44 years. They had been receiving treatment for benign intracranial hypertension for a period ranging from eight months to 11 years, before developing the CSF leak. There was no history of previous head injury and there were no congenital anomalies of the floor of the anterior fossa. The site of the CSF fistula was localised to the cribriform plate in all four cases. The pathophysiology of the CSF rhinorrhoea and the surgical management of this group of patients are discussed. The authors propose that benign intracranial hypertension should be included in the classification of high pressure CSF leaks. ( info) |
243/303. bromocriptine-induced cerebrospinal fluid fistula in patients with macroprolactinomas: report of three cases and a review of the literature. bromocriptine therapy for macroprolactinoma induced cerebrospinal fluid (CSF) rhinorrhea in three patients. The tumor had extended well beyond the sella turcica and caused bony erosion in all the cases. All three patients responded to bromocriptine therapy rapidly. CSF fistula occurred concomitantly with the reduction of tumor size and caused meningitis in two of the patients. Withdrawal of bromocriptine resulted in cessation of the leakage. One of the patients underwent transsphenoidal repair. Two patients refused surgery. This potentially lethal complication encountered in these three cases demonstrates the need for close supervision of macroprolactinoma patients with skull base erosion placed under bromocriptine therapy. ( info) |
244/303. "SUNCT" syndrome. A case of transformation from trigeminal neuralgia? A patient with typical trigeminal neuralgia involving the first branch of the nerve developed short-lasting unilateral attacks in the same area which were associated with severe vasomotor phenomena consistent with the recently described sunct syndrome. This evolution suggests that SUNCT might correspond, at least in this case, to a "transformed" trigeminal neuralgia and emphasizes the close relationship between these unilateral facial pain syndromes. ( info) |
245/303. Endoscopic repair of anterior skull base cerebrospinal fluid fistulas: an emphasis on postoperative nasal function maximization. Endoscopic repair of cerebrospinal fluid (CSF) fistulas has been proposed as an alternative to the traditional intracranial and extracranial approaches. This study reports on four consecutive adult cases of anterior skull base CSF fistulas. The technique used for endoscopic repair, which was designed to maximize postoperative nasal function, is described in detail. The results and complications recorded, using this technique, are reported. Endoscopic repair appears to be a safe and successful approach in the surgical treatment of CSF fistulas while preserving nasal function. ( info) |
246/303. A case of bacterial meningitis complicated by post-traumatic cerebrospinal fluid rhinorrhea. This paper reports an 11 year old boy with bacterial meningitis accompanied by post-traumatic cerebrospinal fluid (CSF) rhinorrhea. streptococcus pneumoniae was cultured from CSF. The clinical course was very rapid before admission and his age relatively high for usual bacterial meningitis. Consequently, we examined the cause in detail. Immunological findings were within normal limits. Although routine graphic examinations, such as cranial X-ray photography, horizontal cranial computed tomography (CT) and magnetic resonance imaging, could not demonstrate a bone defect, both coronal thin-section cranial CT scanning and radioactive isotope counting by means of cotton packed into the nasal cavity were useful for detecting CSF rhinorrhea. In a case of atypical meningitis, the past history should be examined with caution and coronal thin-section CT should be performed. ( info) |
247/303. Cerebrospinal fluid rhinorrhoea: unusual presentation of acoustic neurinoma. A 40-year-old male presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhoea was found to have raised intracranial pressure due to an acoustic tumour. This report adds to the scant literature on an intracranial tumour causing markedly raised intracranial pressure leading to a non-traumatic CSF rhinorrhoea. After a ventricular shunt and resection of the tumour the CSF leak stopped. ( info) |
248/303. Cerebrospinal fluid rhinorrhoea and Haemophilus influenzae meningitis 37 years after a head injury. Bacterial meningitis secondary to CSF rhinorrhoea is well recognised. We present a case of meningitis due to haemophilus influenzae type b associated with a CSF fistula. The patient was 40 years of age at presentation, having sustained a head injury when 3-years-old. He had suffered intermittent rhinorrhoea for 18 months before admission. Delays between head injury and meningitis are well recognised, but our case may represent the longest recorded interval. H. influenzae meningitis in adults is discussed. ( info) |
249/303. Closure of clival cerebrospinal fluid fistula with biocompatible osteoconductive polymer. Cerebrospinal fluid fistula into the upper airway often results in meningitis. Closure of fistulas is usually effective using conventional surgical techniques to reconstruct the defect. We report a case of cerebrospinal fluid fistula into the sphenoid sinus and nasopharynx secondary to resection of a clivus chordoma that resisted conventional attempts at closure, including a rectus abdominus free flap. Closure of the fistula was accomplished with the use of a novel alloplast, biocompatible osteoconductive polymer. Follow-up for more than 1 year shows no evidence of rejection, infection, or recurrent cerebrospinal fluid rhinorrhea. ( info) |
250/303. Major complications of sinus surgery: a review of 1192 procedures. Based on this review of 1192 intranasal sinus procedures under endoscopic control with video assistance, the risk of major complications was estimated to be about 1.3 per cent. Ethmoidectomy was the most hazardous procedure. Operation by a right-handed surgeon standing on the right side of the patient was an added risk factor. We stress ways of achieving prevention, peroperative recognition of cerebrospinal fluid leaks and proper management of complications. ( info) |