Extraordinarily Long-Term Posttraumatic Cerebrospinal Fluid Fistula

Kim, Hyoung Sub; Hur, Jin Woo; Lee, Jong Won; Lee, Hyun Koo

doi:10.3340/jkns.2007.42.5.403

Cited by 6 publications

(6 citation statements)

References 17 publications

(20 reference statements)

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“…While cutting the stick by using scissors, a bout of pus oozed out of the stick, which could possibly be the reason for developed meningitis, has also been reported. [5] CSF rhinorrhoea and otorrhoea are independent predictors of posttraumatic meningitis. [6] A systemic review of meningitis associated with transsphenoidal surgery done in the past has found that Gram-negative meningitis is associated with transsphenoidal surgery.…”

Section: Indu Kapoor Gaurav Singh Tomar Suman Sokhalmentioning

confidence: 92%

An unusual cause of post traumatic cerebrospinal fluid rhinorrhoea

Kapoor

Tomar

Sokhal

2015

Journal of Neuroanaesthesiology and Critical Care

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Section: Indu Kapoor Gaurav Singh Tomar Suman Sokhalmentioning

confidence: 92%

An unusual cause of post traumatic cerebrospinal fluid rhinorrhoea

Kapoor

Tomar

Sokhal

2015

Journal of Neuroanaesthesiology and Critical Care

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“…Cerebrospinal fluid (CSF) rhinorrhea is a well-documented complication of transsphenoidal surgery (TSS) for pituitary and parasellar lesions. 1 - 11 The risk of postoperative CSF leak ranges from 2.3% to 13% in larger series, 1 , 2 , 8 , 9 with advanced technical experience of the surgeon further reducing the incidence to approximately 2%. 2 Associated sequelae of untreated CSF leaks may include tension pneumocephaly, prolonged hospitalization, and meningitis, which may be life-threatening.…”

Section: Introductionmentioning

confidence: 99%

“… 5 - 8 Such leaks commonly present within 1 week of initial surgery; however, CSF rhinorrhea has been reported to occur up to 10 years after TSS. 6 , 11 …”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8] Such leaks commonly present within 1 week of initial surgery; however, CSF rhinorrhea has been reported to occur up to 10 years after TSS. 6,11 In this report, we describe the case of a patient who developed a CSF leak and subsequent meningitis after undergoing a robotic-assisted hysterectomy. Interestingly, the CSF leak developed in the immediate postoperative period following the robotic procedure, separated by 28 years from the initial TSS, prompting our review of potential pathophysiological mechanisms by which such a CSF leak could occur.…”

Section: Introductionmentioning

confidence: 99%

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Late Onset of CSF Rhinorrhea in a Postoperative Transsphenoidal Surgery Patient Following Robotic-Assisted Abdominal Hysterectomy

Dowdy

Moody

Cifarelli

2014

Journal of Investigative Medicine High Impact Case Reports

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Cerebrospinal fluid (CSF) leak is the most commonly encountered perioperative complication in transsphenoidal surgery for pituitary lesions. Direct closure with a combination of autologous fat, local bone, and/or synthetic grafts remains the standard of care for leaks encountered at the time of surgery as well as postoperatively. The development of the vascularized nasoseptal flap as a closure technique has increased the surgeon’s capacity to correct even larger openings in the dura of the sella as well as widely exposed anterior skull base defects. Yet these advances in the technical nuances for management of post-transsphenoidal CSF leak are useless without the ability to recognize a CSF leak by physical examination, clinical history, biochemical testing, or radiographic assessment. Here, we report a case of a patient who developed a CSF leak 28 years after transsphenoidal surgery, precipitated by a robotic-assisted hysterectomy during which increased intra-abdominal pressure and steep Trendelenberg positioning were both factors. Given the remote nature of the patient’s transsphenoidal surgery and relative paucity of data regarding such a complication, the condition went unrecognized for several months. We review the available literature regarding risk and pathophysiology of CSF leak following abdominal surgery and propose the need for increased vigilance in identification of such occurrences with the increasing acceptance and popularity of minimally invasive abdominal and pelvic surgeries as standards in the field.

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“…Left untreated, CSF leaks may lead to pseudomeningoceles, postural hypotension, wound breakdown, meningitis, and abscess. 18-21 Mortality associated with CSF-related meningitis is estimated at around 9%. 19…”

mentioning

confidence: 99%

Factors Predicting Cerebrospinal Fluid Leaks in Microvascular Decompressions: A Case Series of 1011 Patients

Materi

et al. 2022

Operative Neurosurgery

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BACKGROUND:Microvascular decompression (MVD) using a retrosigmoid approach is a highly effective, open-surgical procedure for neurovascular conflict in the posterior fossa, although there is a risk of postoperative cerebrospinal fluid (CSF) leak.OBJECTIVE:To identify factors associated with postoperative CSF leakage after MVD.METHODS:We retrospectively reviewed all patients who underwent MVDs at our institution from 2007 to 2020. Patient demographics, clinical diagnoses, and procedural characteristics were recorded and compared. Factors leading to CSF leak were analyzed using χ2, univariate, and multivariate regression.RESULTS:Of 1011 patients who underwent MVDs, 37 (3.7%) presented with postoperative CSF leaks. In univariate analysis, the use of Cranios/Norian to obliterate the air cells was protective against CSF leak (P = .01). Craniotomies (P = .002), the use of dural substitutes such as Durepair (P = .04), dural onlays such as DuraGen (P = .04), muscle/fascia (P = .03), and titanium mesh cranioplasty >5 cm (P = .03) were associated with CSF leak. On multivariate analysis, only the presence of craniotomies (P = .04) and nonprimary dural closure (P = .03) were significant risk factors for CSF leak. When excluding the 34 (3.4%) patients who underwent a craniotomy, the lack of primary dural closure still remained significantly associated with postoperative CSF leak (P = .04).CONCLUSION:Our results represent one of the largest series of posterior fossa surgeries for a uniform indication in North America. Our study demonstrates increased risk for postoperative CSF leak when craniotomies are performed and when primary dural closure is not established. Given the small sample of patients who received a craniotomy, however, future studies corroborating this finding should be performed.

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Extraordinarily Long-Term Posttraumatic Cerebrospinal Fluid Fistula

Cited by 6 publications

References 17 publications

An unusual cause of post traumatic cerebrospinal fluid rhinorrhoea

An unusual cause of post traumatic cerebrospinal fluid rhinorrhoea

Late Onset of CSF Rhinorrhea in a Postoperative Transsphenoidal Surgery Patient Following Robotic-Assisted Abdominal Hysterectomy

Factors Predicting Cerebrospinal Fluid Leaks in Microvascular Decompressions: A Case Series of 1011 Patients

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