11/15. Successful treatment of a patient with a 13-year history of post-traumatic rhinorrhea due to malabsorption of cerebrospinal fluid. Chronic cerebrospinal fluid (CSF) leaks associated with skull base fractures are rare but intractable and patients may be subjected to numerous operations. We present a 30-year-old man with a 13-year history of chronic CSF rhinorrhea following a cranial trauma. Computed tomography (CT) showed a bone defect in the planum sphenoidale. CT cisternography revealed a leak from the defect and CSF malabsorption. The absence of symptoms of CSF malabsorption may be attributable to external leakage of excess CSF. After closing the leak via the extended transsphenoidal approach we placed a ventriculoperitoneal shunt for occult hydrocephalus. We discuss the clinical symptoms of chronic CSF leakage and present therapeutic strategies dictated by the mechanisms underlying the leak. ( info) |
| Carotid-cavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Fractures or the shearing forces of severe head trauma may cause the internal carotid artery to be torn from its points of dural attachment and rupture, with resultant direct flow into the cavernous sinus. Current treatment options for carotid-cavernous sinus fistulae are surgery and coil embolization, with embolization being the most common. Clinicians and nurses treating patients with these injuries should have an understanding of this vascular entity, because prompt intervention helps to prevent permanent disability and improve patient outcomes. This case study reports the diagnosis and treatment of a carotid-cavernous sinus fistula that developed several months after a traumatic head injury. ( info) |
13/15. Posttraumatic active bleeding of mediastinal mixed vascular malformation: a case report. A case of an actively bleeding mediastinal mass in a 4-year-old boy who sustained multitrauma is described. A computed tomography (CT) scan of the chest upon admission demonstrated a mediastinal mass, which enlarged significantly as seen by repeat CT scan at 3 days with a concomitant drop in serum hemoglobin levels. The lesion was excised, and pathological examination established the diagnosis of a lymphatic-venous malformation containing bloody fluid. Lymphatic-venous malformations are rare vascular malformations and are usually found in the head and neck and less commonly at other sites. Spontaneous bleeding is a known complication, and there are few reports describing posttraumatic hemorrhage. Our case is the first description in the English medical literature of a posttraumatic bleeding mediastinal mixed vascular malformation and includes sequential CT scans illustrating the dynamic nature of hemorrhage. ( info) |
14/15. diagnosis and management of posttraumatic oculorrhea. Posttraumatic cranio-orbital cerebrospinal fluid (CSF) fistula is very rare. diagnosis of these fistulas may be difficult, and it is possible that this complication of craniofacial injury is underdiagnosed. Early recognition and adequate treatment is of paramount importance to prevent hazardous complications. The authors report the case of a 20-year-old woman in whom a CSF leak developed through the medial canthus area of her eye after she sustained a mild sports-related injury. Clinical examination and chemical analysis of the fluid led to the correct diagnosis, and the leak was stopped with conservative treatment. It is proposed that a CSF leak through the eye be termed "oculorrhea" as compared with otorrhea and rhinorrhea. The mechanism of the fistula in this patient is discussed, as is the pertinent radiologically demonstrated anatomy and the mechanism of injury. Management and controversies are also discussed. ( info) |
15/15. Endoscopic removal of ethmoido-sphenoidal foreign body with intracranial extension. We describe the case of a foreign body lodged into ethmoidal labyrinth and sphenoidal sinus with fracture of the clivus and consequent rhinoliquorrhea removed by an endoscopic technique. We performed a skull base plasty to close the rhino-liquoral fistula with resolution of the rhinoliquorrhea. There were no postoperative complications and there was a good therapeutic result at long-term follow-up. ( info) |