Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: Learning from Our Failures

Castelnuovo, Paolo; Mauri, Sílvia; Locatelli, Davide; Emanuelli, Enzo; Delù, Giovanni; Giulio, Giuseppe Di

doi:10.1177/194589240101500509

Cited by 86 publications

(62 citation statements)

References 13 publications

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“…3,[5][6][7]18) In this manner, even limited incisions to the abdomen or leg to harvest fascia lata or fat tissue can be avoided, as previous reconstructions have generally been performed using abdominal fat or fascia lata. 1,5,6,9,18) Nevertheless, no consensus has yet been established regarding the material or combination of materials and methods that can be considered the optimal remedy for repairing osteodural defects, with each option providing a similar number of pros and cons. The choice of adequate technique and materials to be used should therefore be addressed in each case based on the experience of the surgeon and the features of the osteodural defect.…”

Section: Discussionmentioning

confidence: 99%

“…18,20,22) The widespread application of endoscopic endonasal techniques extending beyond the sellar region 2,4,11) has recently led neurosurgeons and otorhinolaryngological surgeons to advocate this technique as a possible treatment option for CSF leaks. 5,6,15,18,22) We report a case of traumatic ethmoidal leak that was successfully treated using a purely endoscopic endonasal method.…”

Section: Introductionmentioning

confidence: 99%

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Purely Endoscopic Repair of Traumatic Cerebrospinal Fluid Rhinorrhea From the Anterior Skull Base -Case Report-

Komatsu

Cavallo

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 38-year-old woman presented with a case of post-traumatic ethmoidal cerebrospinal fluid (CSF) leak that was repaired using a purely endoscopic endonasal approach. Six weeks after a mild domestic maxillofacial trauma, she started complaining of clear, watery discharge from the left nostril and headache. Neuroimaging investigations disclosed a linear fracture of the left anterior ethmoidal roof without evidence of large bony breaches or any brain tissue damage. After conservative medical treatment with carbonic anhydrase inhibitors failed, she was referred to our hospital for surgical repair of the osteodural defect. An endoscopic endonasal transethmoidal approach was successfully performed, and an overlay technique was used to reconstruct the defect. The patient was discharged without clinical evidence of CSF rhinorrhea and no leaks were apparent at the 3-month follow-up clinical and radiological examinations. Post-traumatic CSF rhinorrhea occurs in cases of dural tears associated with small bone breaks, most frequently involving the anterior skull base. Recovery is often spontaneous following only bed rest, or with medical treatments such as inhibitors of carbonic anhydrase diuretics, steroids, or eventually stool softeners to help reduce CSF pressure. Surgical repair is required when first-line conservative treatment proves ineffective. The present case shows that the endoscopic endonasal technique for the management of CSF leaks provides a less invasive surgical route to achieve valid dural repair.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Purely Endoscopic Repair of Traumatic Cerebrospinal Fluid Rhinorrhea From the Anterior Skull Base -Case Report-

Komatsu

Cavallo

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…72,80 Various authors have successfully used different types of autologous and nonautologous grafts, such as a mucoperiosteal flap from the middle turbinate or septum or mucoperichondrial, osseous, cartilaginous, fat, muscular fascia, middle turbinate, or septum pedunculated graft, or any combination of these grafts. 1,3,11,13,15,22,[24][25][26]28,35,47,51,55,56,64,65,67,77,79,90,101,108 Another widely discussed issue in endoscopic transnasal repair is whether the grafts used for repair should be placed above (inlay) or beneath (onlay) the skull base defects. In a meta-analysis, Hegazy et al 53 found that both techniques yielded similar results.…”

Section: Surgical Managementmentioning

confidence: 99%

Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures

Ziu¹,

Savage²,

Jimenez³

2012

FOC

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Cerebrospinal fluid rhinorrhea is a serious and potentially fatal condition because of an increased risk of meningitis and brain abscess. Approximately 80% of all cases occur in patients with head injuries and craniofacial fractures. Despite technical advances in the diagnosis and management of CSF rhinorrhea caused by craniofacial injury through the introduction of MRI and endoscopic extracranial surgical approaches, difficulties remain. The authors review here the pathophysiology, diagnosis, and management of CSF rhinorrhea relevant exclusively to traumatic anterior skull base injuries and attempt to identify areas in which further work is needed.

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“…Several Graft materials can be used; cartilage, bone, mucoperichondrium, septal mucosa, turbinate, fascia, abdominal fat, conchal cartilage, free tissue, pedicle tissue or composite grafts. The uses of the various types of graft materials do not seem to alter the outcome [4, 45,46,47]. Different ways of applying the graft; Bathplug see ( Figure 3) where a fat plug with a specifically secured vicryl suture into the intradural space [48], Composite mucochondrial flap, for larger defects [49], Middle turbinate, composite bone/mucosa, for moderate and large defects [42], Inferior turbinate graft for defects > 2 cm [50].…”

Section: Preparationsmentioning

confidence: 99%

mentioning

confidence: 99%

Journal of ISSN: 2379-6359 JOENTR Otolaryngology-ENT Research Case Report Volume 7 Issue 1 - 2017 Current Approach to Cerebrospinal Fluid Rhinorrhea Diagnosis and Management

Sumaily¹

2017

JOENTR

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Laboratory a) CSF analysis of the fluid. b) Glucose concentration is >30 mg/dl. Neither sensitive nor specific [10,11].c) Beta-2 transfer in is the gold standard (sensitivity of 94% to 100%, and specificity of 98% to 100%), unfortunately not available in many centers, needs 5-7 days [10]. ImagingThis can be classified into primary and secondary:Primary (helpful in the detection of most of the leaks) [12]:i. MRI cisternography: heavily T2-weighted, fast spin-echo, fatsaturated sequences. Better in prone position with Valsalva maneuver. FLAIR sequence is very useful in differentiating CSF (change to dark) from sinus secretions (persist whitish) without the need for contrast [13,14]. Intrathecal injection of 0.5 ml of gadopentetate dimeglumine, diluted in 3-5 ml of CSF can be added for more details.ii. HRCT: Can show the bony defect and, if there is, any protruding soft tissue through it, and also accumulating fluid, if any. And in some cases pneumocephalus may be seen. It is sensitivity is 88.25 to 93% [15]. It is less sensitive in detecting the exact AbstractCerebrospinal fluid (CSF) rhinorrhea clinical approach and therapeutic techniques are rapidly growing and the literature is almost daily enriched with new studies, techniques, and trials. In this article I tried to collect, summarize and organize the updates on this topic from the English literature, and deliver it in a clinical approach manner with suggested algorithm and clarifying illustration so it can be easily understood by the readers and applied by those who are dealing with such cases. Current Approach to Cerebrospinal Fluid Rhinorrhea Diagnosis and Management 2/6Copyright: ©2017 Sumaily site of the leak when there are multiple fractures [16].iii. Combination of both HRCT and MRI-cisternography provide higher sensitivity and specificity, but usually it is not cost effective and sometimes its time consuming to wait for both to be ready. So, starting with HRCT is advised [12,13,17]. In)) injection either into the lumbar or suboccipital subdural and nasal pledgets in various highrisk areas. Head scans are acquired 2, 6, 12, and 24 hours. And follow-up scans after 48-or 72-hours. It is useful in the detection of intermittent CSF fluid leaks with sensitivity range of 50 to 100%, and specificity 100%. It is relatively poor in exact localization, therefore it is reserved for complex cases when the diagnosis is in question [24]. d) Nasal endoscopy [25]. The last choice is to explore the nasal cavity and paranasal sinuses via and endoscopic sinus surgery looking for the leak and the defect site. Valsalva maneuver and jugular compression could improve detection rate ( Figure 2). i. Extensive bone defects in the cranial base. Secondaryii. Multiple fractures of the ethmoid bone and the posterior wall of the frontal sinus.iii. Associated intracranial lesions requiring surgery.CSF leak is severe, recurrent, or not amenable to the endoscopic treatment.i. Procedure: up to date, no studies on the types of craniotomy and which type is preferred [31]. For a frontoba...

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Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: Learning from Our Failures

Cited by 86 publications

References 13 publications

Purely Endoscopic Repair of Traumatic Cerebrospinal Fluid Rhinorrhea From the Anterior Skull Base -Case Report-

Purely Endoscopic Repair of Traumatic Cerebrospinal Fluid Rhinorrhea From the Anterior Skull Base -Case Report-

Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures

Journal of ISSN: 2379-6359 JOENTR Otolaryngology-ENT Research Case Report Volume 7 Issue 1 - 2017 Current Approach to Cerebrospinal Fluid Rhinorrhea Diagnosis and Management

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