Massive Cerebrospinal Fluid Leak of the Temporal Bone

Iannella, Giannicola; Manno, Alessandra; Pasqualitto, E; Ciofalo, Andrea; Angeletti, Diletta; Pasquariello, Benedetta; Magliulo, Giuseppe

doi:10.1155/2016/7521798

Cited by 4 publications

(5 citation statements)

References 26 publications

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“…1,3 CSF leaks, recognized intraoperatively or through imaging, can be managed conservatively or surgically. 4 Conservative management includes bed rest, an epidural blood patch, and/or fibrin glue. 1,5 Those patients for whom conservative management fails may require a neurosurgeon to either suture the tear closed, use a dural sealant such as fibrin glue, place a fat or muscle graft, insert a patch, or use a combination of techniques to achieve a watertight closure.…”

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confidence: 99%

“… 7 However, in some cases, the edges of the native dura may be so friable that suturing or clipping to the dura results in incomplete seals, tears, or leaks through the suture holes. 4 , 8 Additionally, those with a history of radiotherapy to or near the spine may have compromised dural blood supply, extensive scarring or adhesions, and/or tissue hypoxia, thereby weakening the dura mater, increasing the likelihood of CSF leaks, and requiring a more intensive dural closure. 4 , 8 Thus, this study presents a novel approach to treating a radiation-induced dural injury and CSF leak as well as expansive dural tears by the use of a two-layer intradural and extradural patch graft.…”

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confidence: 99%

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A novel two-layer, intradural and extradural patch graft approach to treating dural defects and tears: illustrative case

Lazarus

Hawks

Kumar

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Dural tears must be quickly addressed to avoid the development of positional headaches and pseudomeningoceles, among other complications. However, sizeable areas of friable or absent dura create unique challenges when attempting to achieve a watertight seal. We have developed a two-layer subdural and epidural fibrous patch technique to treat expansive or challenging dural tears as a result of our experience treating spinal fluid leaks. OBSERVATIONS The authors present the treatment of a large necrotic (5 × 1.5 cm) dural defect refractory to initial attempts at standard primary repair with dural patch grafting and requiring a revision with a dual-layer patch to manage persistent cerebrospinal fluid leakage. LESSONS The use of a two-layer (subdural and epidural) patch is both a safe and effective dural repair technique for creating a watertight seal in challenging large areas in which the dura may be damaged, scarred, or absent. We also propose that this technique may be able to be used for smaller challenging tears, as well as potentially for repairs of large blood vessels or other fluid-filled structures in the body.

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confidence: 99%

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confidence: 99%

A novel two-layer, intradural and extradural patch graft approach to treating dural defects and tears: illustrative case

Lazarus

Hawks

Kumar

et al. 2022

Journal of Neurosurgery: Case Lessons

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“…Firstly, unilateral tympanomastoid effusion is known to be associated with LTBCs, both clinically and on imaging studies. 15,22 GRE 3D T 2 W sequences such as CISS are optimal for the analysis of the differing fluid composition of tympanomastoid fluid due to the utilisation of heavier T2 weighting and increased signal-to-noise ratios. 23,24 Breen et al studied patients with temporal bone CSF leaks, although without cephaloceles in the majority of cases, and found that tympanomastoid signal isointense to CSF was 100% specific and 76% sensitive for the presence of a CSF leak.…”

Section: Discussionmentioning

confidence: 99%

MRI features to aid the identification of lateral temporal bone cephaloceles

Srinivasan,

Obholzer,

Connor

2023

The British Journal of Radiology

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Objectives: To evaluate ancillary MRI features which may aid the identification of lateral temporal bone cephaloceles (LTBCs). Methods: A retrospective cohort study analysed patients with MRI evidence of surgically confirmed spontaneous LTBCs as defined by intracranial contents traversing the tegmen tympani or mastoideum. Cases were identified from radiology and surgical databases. Two observers analysed three-dimensional T 2W temporal bone and whole brain imaging according to a priori criteria by consensus, with emphasis on the relationship of any adjacent cerebrospinal fluid (CSF) cleft to the defect. The contents, location, and clinical features of the LTBCs were recorded. Results: Eighteen patients (11 female, 7 male; mean age 59.3 years, age range 42–86 years) with 20 surgically confirmed spontaneous LTBCs (2 bilateral;16 unilateral) were evaluated. A temporal lobe sulcus or other CSF cleft extending to or traversing the defect was identified in 19/20 (95%) cases. Isointense CSF tympanomastoid signal was present in 41.2% cases, whilst superior semi-circular canal dehiscence was found in 40% of cephaloceles. At least two MRI features of idiopathic intracranial hypertension were seen in 38.9% patients. Cephaloceles were most commonly centred on the tegmen tympani (55%). Meningoencephaloceles were present in 95% cases. Conclusion: A temporal lobe sulcus or CSF cleft extending to or traversing the defect may aid the identification of LTBCs. Isointense CSF tympanomastoid signal, superior semi-circular canal dehiscence and MRI features of idiopathic intracranial hypertension are only present in under half of LTBCs. Advances in knowledge: The study details novel ancillary MRI features of LTBCs which may aid their identification.

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“…Table 1 presents a detailed description of all the PCF SL patients. Table 1 does not include (a) nonspontaneous (iatrogenic, after surgery or radiotherapy, post-traumatic) PCF liquorrhea; 7,8 (b) spontaneous PCF pneumocephalus due to bone defects that did not manifest in the form of SL; [9][10][11] (c) PCF bone defects or encephalocele (herniation) not accompanied by SL (or if this fact was not mentioned in the report); 12,13 (d) clivus defects manifesting in the form of SL, which, in turn, also can be attributed to PCF defects, but we believe that such pathology requires individual analysis; 14,15 (e) literature reviews without specifying own experience of PCF SL treatment; 16 and (f) reports where a PCF defect was mentioned for the general group of SL patients, but that had no required observation data (age, sex, symptoms, defect location, approach, complications, and so forth) 3,17,18…”

Section: Methodsmentioning

confidence: 99%

Spontaneous Cerebrospinal Fluid Leak of Posterior Surface of Temporal Bone: Review and Case Report

Sirko¹,

Berezniuk²,

Romanukha³

2017

An International Journal of Otorhinolaryngology Clinics

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Aim.To analyze the rarity of the clinical case report on spontaneous liquorrhea (SL) posterior cranial fossa (PCF) together with a review of the literature. To determine the features of PCF SL in contrast to anterior and middle cranial fossa (MCF) SL. To identify the optimal diagnostic and treatment tactics in patients with PCF SL. Materials and methods:We present clinical observations of a PCF SL patient and a detailed review of reports on SL with a defect on the posterior border of the petrous temporal bone (PTB). Results:Based on the literature review, 22 cases with a sufficient description were analyzed. PCF SL occurs more commonly in women than in men; middle-aged and elderly patients prevail. The average body mass index (BMI) was 33.3 ± 7, corresponding to a degree I obesity. The number of postoperative complications was quite large; each included recurrent liquorrhea. Conclusion:The data from our experience and a literature review for PCF SL patients are comparable with those of similar studies of SL in the anterior and MCF. Middle-aged and elderly women with excessive BMI are the most vulnerable. In most patients, the defect is located in the lateral regions of the posterior border of the PTB, namely anteriorly, medially from the sigmoid sinus, and below the upper petrosal sinus. A fairly high percentage of postoperative complications is due to insufficient preoperative diagnosis or intraoperative examination of the posterior PTB in patients with combined MCF and PCF defects, causing revision surgery.Clinical significance. If rhinorrhea, otorrhoea, and/or signs of intracranial space integrity loss (pneumocerephaly or latent liquorrhea with recurrent meningitis) are revealed, careful examination of bone structures of the anterior, middle, and also, be sure PCF is required, especially at the intersection with paranasal sinuses (frontal, ethmoidal, sphenoid) and mastoid air cells and PTB.

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Massive Cerebrospinal Fluid Leak of the Temporal Bone

Cited by 4 publications

References 26 publications

A novel two-layer, intradural and extradural patch graft approach to treating dural defects and tears: illustrative case

A novel two-layer, intradural and extradural patch graft approach to treating dural defects and tears: illustrative case

MRI features to aid the identification of lateral temporal bone cephaloceles

Spontaneous Cerebrospinal Fluid Leak of Posterior Surface of Temporal Bone: Review and Case Report

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