Extracranial Repair of Pediatric Traumatic Cerebrospinal Fluid Rhinorrhea

Ng, Michael K.; Maceri, Dennis R.; Levy, Michael; Crockett, Dennis M.

doi:10.1001/archotol.124.10.1125

Cited by 16 publications

(9 citation statements)

References 20 publications

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“…In transnasal endoscopic surgery, intranasal trauma is kept to a minimum, and the bony framework supporting the frontal recess and other critical areas is preserved [5, 7, 10, 15]. Nasal endoscopy has received special attention in paediatric patients.…”

Section: Discussionmentioning

confidence: 99%

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Neuroendoscopic Treatment of Paediatric Cerebrospinal Fluid Rhinorrhoea

Husain¹,

Jha²,

Husain

et al. 2002

Pediatr Neurosurg

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Endoscopic management of CSF rhinorrhoea in children is usually associated with a higher incidence of mucosal abrasion and post-operative synechiae formation due to surgical manoeuvres in narrower nasal passages. We have used the Gaab universal neuroendoscope for the treatment of CSF rhinorrhoea in children. Three patients were treated in the last 2 years with this technique. All patients became completely asymptomatic after the initial procedure without any significant complications. We conclude that the treatment of CSF rhinorrhoea in children by means of a neuroendoscope with a working sheath may be effective and less traumatic to the nasal passage.

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Section: Discussionmentioning

confidence: 99%

“…Nasal endoscopy in children has been successfully used for the treatment of CSF rhinorrhoea, repair of congenital defects of the skull base, sinus surgery and functional sinus surgery for chronic sinusitis [1, 2, 3, 4, 5, 6, 7]. It is mostly performed using 4- or 2.7-mm rigid rod and lens systems and flexible endoscopes [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Neuroendoscopic Treatment of Paediatric Cerebrospinal Fluid Rhinorrhoea

Husain¹,

Jha²,

Husain

et al. 2002

Pediatr Neurosurg

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“…Posttraumatic CSF rhinorrhea requires special attention. Initial treatment is conservative, but persisting leak after 2 weeks requires surgical repair to avoid complication Papay et al [13] 4 4 (100.0) -0 Mattox et al [12] 7 6 (86.0) 7 (100.0) 0 Stan Kiewich [14] 6 6 (100.0) -0 Kelly et al [7] 8 7 (83.0) 8 (100.0) 0 Burns et al [1] 42 35 (83.0) 38 (90.0) Not mentioned Lanza et al [8] 36 34 (94.0) 35 (97.0) 1 Mazhar Hussain et al [15] 8 8 (100.0) -0 Rohit S et al [16] 11 10 (90.0) 11 (100.0) 0 Bhalodiya [17] 20 17 (85.0) 19 (95.0) Not mentioned Singh D [3] 36 32 (90. like meningitis. Localization of leak site can be done with preoperative imaging like CT or MR cisternography which is very important for successful surgical repair.…”

Section: Discussionmentioning

confidence: 99%

Surgically repaired posttraumatic CSF rhinorrhea: An institutional experience and review of literature

Kumar¹,

Sahu²,

Srivastava³

et al. 2012

IJNS

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Posttraumatic cerebrospinal fluid (CSF) rhinorrhea frequently complicates anterior skull base fracture. Although skull base fracture is present in only about 7% cases of head injury, CSF rhinorrhea develops in 30% of cases with basal fracture.A total of 43 cases admitted in our Institute (SGPGI Lucknow) from January 2000 to June 2011with history of head trauma followed by CSF rhinorrhea. Forty one cases were included in this study as two patients refused surgery.Out of forty one cases, 26 cases (63%) were admitted with history of recurrent meningitis, 21 cases (51%) with loss of smell, 26 cases (63%) with delayed onset CSF rhinorrhea, 3 cases (7%) with early onset rhinorrhea which did not improve after trauma, 12 cases (30%) with early onset rhinorrhea which improved but reappeared after some time. Twenty cases (48.8%) were repaired by extradural approach, 10 cases (24.4%) were repaired by intradural approach and 11 cases (26.8%) were repaired by endoscopic approach. 12 cases (29.0%) required re-surgery for persistent or recurrence of CSF rhinorrhea.Although posttraumatic CSF rhinorrhea usually resolves with conservative management, its persistence makes an individual prone for further complications like meningitis, brain abscess and septicaemia. Timely surgical intervention usually gives promising results. Endoscopic repair was better than transcranial repair.

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“…Endoscopic approaches have been described and shown to be effective in certain circumstances, although we have not used these routinely. 1,19,22 The sphenoid sinus and cribriform plate region can be approached via the nasal cavity, or translabially in the case of the sphenoid, with mucosal stripping and packing with fat or muscle; a routine transsphenoidal approach allows good visualization of this region.…”

Section: Discussionmentioning

confidence: 99%

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2000

Neurosurgical FOCUS

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Object. Persistent posttraumatic cerebrospinal fluid (CSF) leakage frequently complicates skull base fractures. Although many CSF leaks will cease without treatment, patients with CSF leaks that persist greater than 24 hours may be at increased risk for meningitis, and many will require surgical intervention. The authors reviewed their 15-year experience with posttraumatic CSF leaks that persisted longer than 24 hours. Methods. The authors reviewed the medical records of 51 patients treated between 1984 and 1998 with CSF leaks that persisted for 24 hours or longer after traumatic head injury. In 27 patients (55%) spontaneous resolution of CSF leakage occurred at an average of 5 days posttrauma. In 23 patients (45%) surgery was required to resolve the leakage. Eight patients (16%) with occult CSF leaks presented with recurrent meningitis at an average of 6.5 years posttrauma. Forty-three (84%) patients with CSF leaks sustained a skull fracture, most commonly involving the frontal sinus, whereas parenchymal brain injury or extraaxial hematoma was demonstrated in only 18 patients (35%). Delayed CSF leaks, with an average onset of 13 days posttrauma, were observed in eight patients (16%). Among patients with clinically evident CSF leakage, the frequency of meningitis was 10% with antibiotic prophylaxis, and 21% without antibiotic prophylaxis. Thus, prophylactic antibiotic administration halved the risk of meningitis. A variety of surgical approaches was used, and no significant neurological morbidity occurred. Three (13%) of 23 surgically treated patients required additional surgery to treat continued CSF leakage. Conclusions. A significant proportion of patients with CSF leaks that persist greater than 24 hours will require surgical intervention. Prophylactic antibiotic therapy may be effective in this group of patients. Patients with skull base or frontal sinus fractures should be followed to detect the occurrence of delayed leakage. Surgery-related outcome is excellent.

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Extracranial Repair of Pediatric Traumatic Cerebrospinal Fluid Rhinorrhea

Abstract: In a select group of pediatric patients, the extracranial approach for the repair of CSF leaks is appropriate. Successful use of an extracranial approach in 3 of 4 patients supports this method.

Cited by 16 publications

References 20 publications

Neuroendoscopic Treatment of Paediatric Cerebrospinal Fluid Rhinorrhoea

Neuroendoscopic Treatment of Paediatric Cerebrospinal Fluid Rhinorrhoea

Surgically repaired posttraumatic CSF rhinorrhea: An institutional experience and review of literature

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