Conservative and Operative Management for Cerebrospinal-Fluid Leakage After Closed Head Injury

Leech, Peter; Paterson, Andrew D.

doi:10.1016/s0140-6736(73)90662-4

Cited by 126 publications

(39 citation statements)

References 15 publications

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“…Cerebrospinal flUiid otorrhea occurs most frequently as the result of cranillocerebral tra'llm:a and much less commonly as a complication of surgicaJ procedures irn and abowt the ear (Lang and Bucy, 1962). The majority of cases of cerebrospin~a.W fluid otorrhea are of traumatic origin and frequently heal sponta:neousQy (Leech and Paterson, 1973;Frable et al, 1964). However, rif ; such Clllosures occur spontaneously, one can not be sure that these w1illl remain closed permanerutily and that recanaldtzation is not possibJe (Frable et ral., 1962).…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Otorrhea after Head Injury

Hassan

Ongkie

Hendardji

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Otorrhea after Head Injury

Hassan

Ongkie

Hendardji

et al. 2017

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“…13,16,18,24,26,29,30,37,41 According to the authors of these studies, all acute patients underwent surgery for persistent CSF leaks, large comminuted fractures with a suspected dural tear, or perforating injuries.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of complex traumatic frontobasal lesions: personal experience in 74 patients

Piek¹

2000

FOC

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Object The author's personal series included 148 patients who sustained traumatic frontobasal injuries and were treated between 1986 and 1999. Included in this study are 74 of 148 patients with acute injuries and complex fronto-basal lesions involving the frontal sinus, the cribriform/ethmoid roof complex, one or both orbital roofs, and the planum sphenoidale. Methods Surgery was delayed for up to 4 weeks postinjury in most patients (67 cases), whereas 17 with space-occupying hematomas and perforating injuries required early surgery. In 30 patients additional surgery was required to treat maxillofacial fractures, which was performed as a one-stage procedure together with the neurosurgical operation. The author performed a standard bifrontal craniotomy in which an intradural or combined intradural–extradural approach was used in all cases. Four patients developed ascending meningitis in the preoperative period. As a result of surgical treatment one patient died, another two patients suffered from permanent defects, and three suffered from transitory neurological worsening. In two patients recurrence of a cerebrospinal fluid fistula occurred within a 3-month period posttreatment but was successfully obliterated during reoperation. In the author's experience the intradural approach is comparable in terms of the morbidity, mortality, and success rates with extracranial approaches; additionally the intradural approach provides full visualization of the intracranial lesion. Useful olfactory nerve function can only be preserved if both olfactory nerves are left intact and not crushed during initial injury; this occurred in only five patients in this series. Conclusions If possible, surgical treatment of more complex lesions should be delayed until the 2nd or 3rd week following traumatic injury. With antibiotic prophylaxis the risk that ascending meningitis will occur prior to surgery is low. If the patient is systemically stable and brain swelling has resolved, even extensive one-stage neurosurgical/ maxillofacial procedures are well tolerated.

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“…9 Secondly and more importantly, it has been noted that if the period of conservative management exceeds one week, there is a eight to ten fold increase in the risk of meningitis over the first week. 10,11 Therefore, present recommendation is for a trial of conservative management for not more than 7 days.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Anterior CSF Leaks : Our Experience

Chatterji¹,

Ranjan²

2015

jemds

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CSF leaks through the nose (CSF rhinorrhea) may occur due to defects in the anterior, middle or posterior cranial fossa. Among them, anterior CSF leaks are most commonly encountered in clinical practice and may be traumatic or spontaneous in origin. A prompt diagnosis is essential as the main risk of a persistent leak is the chance of developing life threatening meningitis. Radiological imaging by non-contrast high-resolution CT scan is the initial investigation of choice and shows the site of leak in most cases. In case of recent onset leaks, a period of conservative management is indicated. If conservative management fails, then the traditional neurosurgical procedures like craniotomy and other open approaches were the most preferred line of management of such leaks till a few years back. But now endoscopic repair of these leaks has provided a better alternative because of reduced surgical morbidity, hospital stay and costs. We present our initial experience with seven cases of anterior CSF rhinorrhea which were encountered in a two year period in our institute. Two out of three cases with recent onset leaks healed spontaneously with medical management while five cases required endoscopic repair with two surgical failures.

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Conservative and Operative Management for Cerebrospinal-Fluid Leakage After Closed Head Injury

Cited by 126 publications

References 15 publications

Cerebrospinal Fluid Otorrhea after Head Injury

Cerebrospinal Fluid Otorrhea after Head Injury

Surgical treatment of complex traumatic frontobasal lesions: personal experience in 74 patients

Diagnosis and Management of Anterior CSF Leaks : Our Experience

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