Risk of death in patients with post-traumatic cerebrospinal fluid leakage—Analysis of 1773 cases

Liao, Kuo Hsing; Lin, Hui Wen; Lui, Tai Ngar; Chen, Kai Yun; Yen, David Hung Tsang; Jeng, Mei Jy

doi:10.1016/j.jcma.2015.10.002

Cited by 19 publications

(19 citation statements)

References 22 publications

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“…Nonsurgical treatment of CSF may occasionally utilize lumbar drainage to divert CSF and promote healing . In a retrospective analysis of 10,638 cases of TBI, the 1773 cases presenting with a posttraumatic CSF leak had significantly higher mortality . Of those patients with CSF leak, the majority had tension pneumocephalus.…”

Section: Mechanisms and Complications Of Injurymentioning

confidence: 99%

Management of moderate and severe traumatic brain injury

2019

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Traumatic brain injury (TBI) is a common disorder with high morbidity and mortality, accounting for one in every three deaths due to injury. Older adults are especially vulnerable. They have the highest rates of TBI‐related hospitalization and death. There are about 2.5 to 6.5 million US citizens living with TBI‐related disabilities. The cost of care is very high. Aside from prevention, little can be done for the initial primary injury of neurotrauma. The tissue damage incurred directly from the inciting event, for example, a blow to the head or bullet penetration, is largely complete by the time medical care can be instituted. However, this event will give rise to secondary injury, which consists of a cascade of changes on a cellular and molecular level, including cellular swelling, loss of membrane gradients, influx of immune and inflammatory mediators, excitotoxic transmitter release, and changes in calcium dynamics. Clinicians can intercede with interventions to improve outcome in the mitigating secondary injury. The fundamental concepts in critical care management of moderate and severe TBI focus on alleviating intracranial pressure and avoiding hypotension and hypoxia. In addition to these important considerations, mechanical ventilation, appropriate transfusion of blood products, management of paroxysmal sympathetic hyperactivity, using nutrition as a therapy, and, of course, venous thromboembolism and seizure prevention are all essential in the management of moderate to severe TBI patients. These concepts will be reviewed using the recent 2016 Brain Trauma Foundation Guidelines to discuss best practices and identify future research priorities.

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Section: Mechanisms and Complications Of Injurymentioning

confidence: 99%

Management of moderate and severe traumatic brain injury

2019

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“…Of note, final visual prognosis is reported to be worse in severe eye trauma with associated orbit fracture [30]. Moreover, frontal bone fractures are known to be closely related to posttraumatic pneumocephalus, which was also seen more commonly in VSI patients in our study [31]. Despite similar global burden of injuries in both cohorts, VSI exhibited longer average ICU and total hospital stay as well as higher primary care treatment expenses.…”

Section: Discussionmentioning

confidence: 55%

Damage to the eye and optic nerve in seriously traumatized patients with concomitant head injury: analysis of 84,627 cases from the TraumaRegister DGU® between 2002 and 2015

Huckhagel

Regelsberger

Westphal

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: To determine the prevalence and characteristics of prechiasmatic visual system injuries (VSI) among seriously injured patients with concomitant head trauma in Europe by means of a multinational trauma registry. Methods: The TraumaRegister DGU® was searched for patients suffering from serious trauma with a Maximum Abbreviated Injury Scale (AIS) ≥ 3 between 2002 and 2015 in Europe. After excluding cases without significant head injury defined by an AIS ≥ 2, groups were built regarding the existence of a concomitant damage to the prechiasmatic optic system comprising globe and optic nerve. Group comparisons were performed with respect to demographic, etiological, clinical and outcome characteristics. Results: 2.2% (1901/84,627) of seriously injured patients with concomitant head trauma presented with additional VSI. These subjects tended to be younger (mean age 44.7 versus 50.9 years) and were more likely of male gender (74.8% versus 70.0%) compared to their counterparts without VSI. The most frequent trauma etiologies were car accidents in VSI patients (28.5%) and falls in the control group (43.2%). VSI cases were prone to additional soft tissue trauma of the head, skull and orbit fractures as well as pneumocephalus. Primary treatment duration was significantly longer in the VSI cohort (mean 23.3 versus 20.5 days) along with higher treatment costs and a larger proportion of patients with moderate or severe impairment at hospital discharge despite there being a similar average injury severity at admission in both groups. Conclusions: A substantial proportion of patients with head injury suffers from additional VSI. The correlation between VSI and prolonged hospitalization, increased direct treatment expenditures, and having a higher probability of posttraumatic impairment demonstrates the substantial socioeconomic relevance of these types of injuries.

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“…Delayed post-traumatic CSF rhinorrhea is more inclined to surgical treatment to reduce the risk of intracranial infection [9] . There are two kinds of surgical repair methods: craniotomy and transnasal approach [10,11] .…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Repair of a Delayed Recurrent Traumatic Cerebrospinal Fluid Rhinorrhea: A Case Report of Dislocation of the Bony and Dural Defects

Liu

Chen

Wang

2020

Preprint

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Background：Dural and bony defects mostly occur in the same position in the cerebrospinal fluid（CSF）rhinorrhea of anterior cranial base fractures,and a few cases of delayed CSF leakage after repair are also reported.Case presentation：We report a case in which a pedicled temporoparietal fascial flap was used to repair the comminuted fracture of the anterior skull base with CSF leakage. Delayed CSF leakage occurred 45 days after the operation.A minimally invasive approach through an eyebrow incision was performed for reoperation,it was found that the bony defect was located in the right frontal sinus and the dural defect was located in the right ethmoid plate. Conclusions:This case suggests that delayed traumatic CSF rhinorrhea after reconstructive surgery is more complex than usual,and appropriate approach should be adopted to repair the dural and bony defects , the transeyebrow approach is a good choice.

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Risk of death in patients with post-traumatic cerebrospinal fluid leakage—Analysis of 1773 cases

Abstract: Post-traumatic CSF leakages had higher mortality rates than those without CSF leakages in TBI cases, and the cases with CSF rhinorrhea had worse outcomes compared with CSF leakages with pneumocephalus or otorrhea.

Cited by 19 publications

References 22 publications

Management of moderate and severe traumatic brain injury

Management of moderate and severe traumatic brain injury

Damage to the eye and optic nerve in seriously traumatized patients with concomitant head injury: analysis of 84,627 cases from the TraumaRegister DGU® between 2002 and 2015

Minimally Invasive Repair of a Delayed Recurrent Traumatic Cerebrospinal Fluid Rhinorrhea: A Case Report of Dislocation of the Bony and Dural Defects

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