Cerebrospinal fluid (CSF) rhinorrhea refers to the loss of CSF through the nasal cavity. Its causes can be classified as either spontaneous or non-spontaneous. Spontaneous causes of CSF rhinorrhea include congenital anatomical defects and are extremely rare, accounting for less than 4% of reported cases. Following failure of conservative management, definitive treatment most commonly involves an endoscopic transsphenoidal repair of the defect. We present a case of spontaneous CSF rhinorrhea in a previously well 52-year-old female, which required surgical intervention due to failure of conservative management.
Case HistoryA 6-year-old Afro-Caribbean female, known ITP, presented with a one-day history of a traumatic dislodged tooth with persistent bleed. Approximately 24 hours following the injury, the patient started complaining of headaches. The headaches were described as mild to moderate and was associated with nausea
Introduction and importance Juvenile xanthogranuloma (JXG) rarely presents as multifocal intracranial disease in the paediatric population. Therefore, this case of extensive tumour burden, primarily within the lateral ventricles, presented a neurosurgical challenge on numerous fronts. Presentation of case This is the case of a 9-year-old male presenting with a 2-year history of visual disturbances. Radiographic imaging demonstrated extensive intracranial masses involving both lateral ventricles, the straight sinus and right cerebellum. A staged tumour resection was planned, targeting the lesions within the right lateral ventricle initially. Complete resection was achieved during surgery. Post-operative morbidity showed a decline in the patient's functional status with respect to mobility and communication, Glasgow outcome scale 3. Extensive immunohistochemical analysis ultimately revealed a diagnosis of JXG. The patient is undergoing chemotherapy, with subsequent surgical resection being dependent on overall recovery. Clinical discussion JXG is the most common form of non-Langerhans histiocytosis and typically arises as a cutaneous disorder during early childhood. It is a rare cause of extensive intracranial tumour burden, with limited publications of this kind in the literature. This is even more atypical given the absence of any of the classic cutaneous morphology seen in JXG. Conclusion JXG involving the central nervous system is a rare encounter. Therefore, a clear algorithm for the management of a case of extensive intracranial tumours resulting from JXG has not been defined. This only amplifies the difficulty in treating these cases.
Objective: Mesh infection post laparoscopic inguinal hernia repair is an uncommon complication. This increases patient morbidity and overall cost of a relatively low risk procedure. In this article, we sought to highlight the possible relationship between mesh infection and the biological nature of the mesh.Methods: Data of laparoscopic inguinal hernia repair was collected retrospectively from two separate private institutions, which were performed over a 5-year period. All information collected, including type of mesh used and arising complications, were documented on a computerized database.Results: Over the period of January 2011 and December 2015, a total of 81 elective laparoscopic inguinal hernia repairs were performed-59 from institution A and 22 from institution B. All repairs were performed by the same surgeon, using the Trans abdominal pre-peritoneal (TAPP) approach. Twelve repairs demonstrated evidence of mesh infection during this time frame, six (6) from each institution. Of these 12 cases, all underwent laparoscopic removal of the infected mesh, except one. All removed mesh was made of a polyester material. Conclusion:The associated advantages of using mesh to repair inguinal hernias are numerous and it is a great asset in modern day surgery. The choice of the "right" mesh to use should depend on surgeon experience, personal outcome and of course, evidence-based.
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