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Cerebrospinal Fluid Leak (cerebrospinal + fluid_leak)
Selected AbstractsCerebrospinal Fluid Leak After Anterior Cervical Disc Fusion: An Unusual Cause of Dysphagia and Neck Mass,THE LARYNGOSCOPE, Issue 11 2007Madeleine R. Schaberg MD Abstract Objective: Dysphagia after anterior cervical disc fusion (ACDF) is a common complaint. We present two cases of dysphagia caused by a rare complication after ACDF: cerebrospinal fluid (CSF) leak into the neck. Study Design: A case series of two patients. Methods: Both patients underwent a chart review, comprehensive history, physical examination, flexible nasolaryngoscopy, and radiographic imaging. A literature review of the MEDLINE database (1966,2006), using key words "dysphagia" and "anterior discectomy," was performed. Results: We present two patients with persistent dysphagia after ACDF surgery caused by CSF leak into the neck. Their clinical presentation, physical and radiographic examination findings, and hospital course will be discussed. Conclusions: CSF collection presenting as dysphagia and neck mass after ACDF must be included in the differential diagnosis because incision and drainage is contraindicated, and fine needle aspiration (FNA) must be performed under sterile conditions. Treatment including lumbar drain or re-exploration is appropriate. [source] The Management of Cerebrospinal Fluid Leaks in Patients at Risk for High-Pressure Hydrocephalus,THE LARYNGOSCOPE, Issue 2 2005Ricardo L. Carrau MD Abstract Objectives/Hypothesis: The transnasal endoscopic approach has become the preferred technique for the surgical management of patients with cerebrospinal fluid (CSF) leaks of the anterior, sellar, and parasellar skull base. The literature has reported an 85% to 100% success rate for the endoscopic repair of CSF leaks, which compares favorably with that reported after transcranial repair. Despite an adequate repair, a subpopulation of patients remain at high risk for recurrence of the CSF leak attributable to undiagnosed high-pressure hydrocephalus. Patients at high risk for high-pressure hydrocephalus include those who have had a subarachnoid hemorrhage as a result of trauma (accidental or surgical) or stroke and those with spontaneous CSF leaks. Study Design: With the goal of reducing the risk of recurrence, the authors developed a protocol for the identification and management of patients with CSF leaks who are at risk for high-pressure hydrocephalus. Methods: The protocol includes endoscopic repair, temporary CSF diversion, measurement of CSF pressure after the repair, and immediate ventriculoperitoneal shunting if necessary. Results: During the period of September 1999 to April 2002, the authors repaired 25 CSF leaks through an endonasal endoscopic approach. Nineteen patients were considered at high risk for high-pressure hydrocephalus. Using the protocol described, the authors identified six patients (31%) with CSF leaks that could be associated with undiagnosed high-pressure hydrocephalus. All CSF leaks were successfully repaired using a transnasal endoscopic repair. Six patients with high-pressure hydrocephalus underwent ventriculoperitoneal shunting after repair of the CSF Leak. No recurrence has been observed at a follow-up ranging from 24 to 84 months (median period, 30 mo). Conclusion: Patients with high-pressure hydrocephalus may be identified in a prospective fashion to prevent recurrence or persistence of the CSF leaks. The presence or absence of high-pressure CSF may be established by means of direct CSF pressure measurement through lumbar puncture postoperatively. This allows early intervention and prevention of recurrence. [source] Spontaneous Intracranial Hypotension Successfully Treated by Epidural Patching With Fibrin GlueHEADACHE, Issue 10 2000Masaki Kamada MD We report a case of spontaneous intracranial hypotension due to a cerebrospinal fluid leak at the C2 level, which was successfully treated by epidural fibrin glue patching. Epidural blood patching was performed twice, first with 6 mL of autologous blood and then with 10 mL, but the intracranial hypotension was unresponsive. Although successful treatment of postdural puncture headache and persistent leak after intrathecal catheterization by epidural patching with fibrin glue has been reported, fibrin glue has not been previously applied in spontaneous intracranial hypotension. Our observation suggests that epidural patching with fibrin glue should be considered in patients with spontaneous intracranial hypotension, if epidural blood patching fails to resolve the symptoms. [source] Outcomes following temporal bone resection,,THE LARYNGOSCOPE, Issue 8 2010Nichole R. Dean DO Abstract Objectives/Hypothesis: To evaluate survival outcomes in patients undergoing temporal bone resection. Study Design: Retrospective review. Methods: From 2002 to 2009 a total of 65 patients underwent temporal bone resection for epithelial (n = 47) and salivary (n = 18) skull base malignancies. Tumor characteristics, defect reconstruction, and postoperative course were assessed. Outcomes measured included disease-free survival and cancer recurrence. Results: The majority of patients presented with recurrent (65%), advanced stage (94%), cutaneous (72%), and squamous cell carcinoma (57%). Thirty-nine patients had perineural invasion (60%) and required facial nerve resection; 16 (25%) had intracranial extension. Local (n = 6), regional (n = 2), or free flap (n = 46) reconstruction was required in 80% of patients. Free flap donor sites included the anterolateral thigh (31%), radial forearm free flap (19%), rectus (35%), and latissimus (4%). The average hospital stay was 4.9 days (range, 1,28 days). The overall complication rate was 15% and included stroke (n = 4), cerebrospinal fluid leak (n = 2), hematoma formation (n = 1), infection (n = 1), flap loss (n = 1), and postoperative myocardial infarction (n = 1). A total of 22 patients (34%) developed cancer recurrence during the follow-up period (median, 10 months), 17 (77%) of whom presented with recurrent disease at the time of temporal bone resection. Two-year disease-free survival was 68%, and 5-year disease-free survival was 50%. Conclusions: Aggressive surgical resection and reconstruction is recommended for primary and recurrent skull base malignancies with acceptable morbidity and improved disease-free survival. Laryngoscope, 2010 [source] Safety of Minimally Invasive Pituitary Surgery (MIPS) Compared with a Traditional ApproachTHE LARYNGOSCOPE, Issue 11 2004David R. White MD Introduction: Transsphenoidal hypophysectomy is becoming progressively less invasive. Recent endoscopic techniques avoid nasal or intraoral incisions, use of nasal speculums, and nasal packing. Several case series of endoscopic endonasal pituitary surgery have been reported, but relatively little data exists comparing complication rates to more traditional approaches. We compare the complications of our first 50 cases of endoscopic, minimally invasive pituitary surgery (MIPS) to our last 50 sublabial transseptal (SLTS) procedures. Study Design: Retrospective case control study. Methods: Fifty consecutive MIPS procedures and 50 consecutive SLTS procedures were reviewed retrospectively. Complication rates were analyzed and compared. Results: Total complications per patient (P = .005), postoperative epistaxis (P = .031), lip anesthesia (P = .013), and deviated septum (P = .028) occurred more often in the SLTS group. No significant difference was seen in cerebrospinal fluid leak, meningitis, ophthalmoplegia, visual acuity loss, diabetes insipidus, intracranial hemorrhage, or death. In the MIPS group, length of stay (P < .001), use of lumbar drainage (P = .007), and nasal packing (P < .001) were also significantly reduced. Conclusions: Endoscopic endonasal pituitary surgery provides improved complication rates when compared with SLTS approaches. In addition, we note advantages of the MIPS approach, including reduced length of hospital stay and decreased use of lumbar drainage and nasal packing. [source] Informed Consent in Functional Endoscopic Sinus Surgery,THE LARYNGOSCOPE, Issue 5 2002Jeffrey S. Wolf MD Abstract Objectives Functional endoscopic sinus surgery (FESS) is one of the more common procedures performed by otolaryngologists. Before performing FESS, surgeons are obligated to discuss the procedure and its risks through the process of informed patient consent. The study identifies current practices in informed consent for FESS and formulates guidelines for informed consent for FESS. Study Design Survey. Methods Surveys were sent to 1000 American Academy of Otolaryngology,Head and Neck Surgery members in the United States. Surveys inquired about current informed consent practices related to FESS. Results Three hundred forty-six surveys were returned. Nearly 60% of respondents thought that 1% incidence of a complication warrants a discussion with patients. The percentage of respondents who discuss specific risks were as follows: bleeding, 96.7%; infection, 84.8%; cerebrospinal fluid leak, 99.1%; orbital injury, 96.7%; smell changes, 40.2%; cerebrovascular accident, 17.9%; myocardial infarction, 8%; and death, 28.0%. Conclusions The study suggests that there is variability in specific informed consent practices for FESS among otolaryngologists. It also suggests that the incidence or severity of a complication does not necessarily correlate with whether or not it is mentioned during the informed consent process. The authors think that practicing otolaryngologists may be able to use this information to improve their consent practices. [source] Endoscopic Transnasal Craniotomy and the Resection of Craniopharyngioma,THE LARYNGOSCOPE, Issue 7 2008Aldo C. Stamm MD Abstract Objectives/Hypothesis: To describe the utility of a large transnasal craniotomy and its reconstruction in the surgical management of patients with craniopharyngioma. Study Design: Observational retrospective cohort study. Methods: Retrospective review of patients treated in an academic neurosurgery/rhinology practice between 2000 and 2007. Patient characteristics (age, sex, follow-up), tumor factors (size, position extension, previous surgery), type of repair (pedicled mucosal flaps, free mucosal grafts), and outcomes (visual, endocrine, and surgical morbidity) were defined and sought in patients who had an entirely endoscopic resection of extensive craniopharyngioma (defined as requiring removal of the planum sphenoidale in addition to sella exposure in the approach). Results: Seven patients had an entirely endoscopic resection of extensive craniopharyngioma during the study period. Mean age was 23.4 years (standard deviation ± 16.3). Mean tumor size was 3.2 cm (standard deviation ± 2.0). The majority of these pathologies had extensive suprasellar disease, and two (28.6%) had ventricular disease. Cerebrospinal fluid leak rate was 29% (2 of 7). These leaks occurred only in reconstructions with free mucosal grafts. There were no cerebrospinal fluid leaks in patients who had vascularized pedicled septal flap repairs. Conclusions: The endoscopic management of large craniopharyngioma emphasizes recent advancements in endoscopic skull base surgery. The ability to provide exposure through a large (4 cm+) transnasal craniotomy, near-field assessment of neurovascular structures, and the successful reconstruction of a large skull defect have significantly advanced the field in the past decade. The use of a two-surgeon approach and bilateral pedicled septal mucosal flaps have greatly enhanced the reliability of this approach. [source] | ||||||||||