Meningitis and pneuomocephalus. A rare complication of external dacryocystorhinostomy

Usul, Haydar; Kuzeylı, Kayhan; Çakır, Ertuğrul; Çaylan, Refik; İmamoğlu, Hakan; Yazar, Uğur; Arslan, Erhan; Sayin, Özgür; Arslan, Selçuk

doi:10.1016/j.jocn.2003.12.020

Cited by 12 publications

(6 citation statements)

References 4 publications

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“… 2 Usul et al reported a case of pneumocephalus 1 day after external DCR surgery in a 51-year-old patient. 3 CT imaging showed a fracture of the left fovea ethmoidalis, and after 3 weeks of antibiotics therapy, the patient was discharged. The most recent case was reported by Cheong and Davies.…”

Section: Discussionmentioning

confidence: 99%

“…Both pneumocephalus and meningitis are relatively rare complications of this procedure. There are only three published case reports of meningitis secondary to external DCR, [2][3][4] and there are no published case reports of pneumocephalus secondary to endoscopic DCR. We present the first case report of delayed unilateral pneumocephalus after bilateral endoscopic DCR.…”

Section: Introductionmentioning

confidence: 99%

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Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient

Lee

2021

BMJ Case Rep

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Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient

Lee

2021

BMJ Case Rep

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“…However, case reports of more serious complications such as meningitis, pneumocephalus, and CSF leaks have been reported. 14,15 Meanwhile, a meta-analysis performed by Huang et al finds that overall complication rates of success rates of external and endoscopic DCR are comparable, both 87%, suggesting that endoscopic DCR may be preferable for lower risks of cutaneous scarring and infection. 16 The major finding of the current study is that actual malpractice trials against surgeons who perform orbital decompression or DCR surgery are incredibly rare, with only 12 cases (7 orbital decompressions and 5 DCRs) in the nearly 4 decades encompassed by the Westlaw database.…”

Section: Prevalence and Complications Of Common Endoscopic Orbital Su...mentioning

confidence: 99%

“…12,13 The recommended duration of stent placement is also highly variable, with optimal duration not clearly established. 14 However, keeping lacrimal stents for over 6 months is likely unnecessary for prevention of stenosis. Given the high success rates of DCR without stent placement, surgeons should consider this option in patients where reliable follow-up is not guaranteed.…”

Section: Medicolegal Considerations Of Endoscopic Orbital Surgerymentioning

confidence: 99%

Medical Malpractice Trends in Dacryocystorhinostomy and Orbital Decompression

Tang

Goli

Higgins

et al. 2022

Am J Rhinol�Allergy

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Background and Objective This study aims to evaluate the medicolegal trends related to 2 common orbital surgeries: orbital decompression and dacryocystorhinostomy (DCR). These procedures are performed by ophthalmologists, otolaryngologists, and multidisciplinary teams of both specialists. Methods The Westlaw database was reviewed from 1980 to 2020 for medical malpractice cases involving orbital decompression and DCR surgeries. Data were compiled on plaintiff and defendant demographics, procedure performed, legal allegation, nature of injury, and verdict or settlement awards. The Ophthalmic Mutual Insurance Company was also queried for all malpractice cases pertaining to orbital decompression and DCR from 1995 to 2021. Results The Westlaw database included 60 cases (34 orbital decompression, 26 DCR); of these, 8 orbital decompression and 6 DCR cases met inclusion criteria. Of the 7 orbital decompression cases that were tried, a verdict in favor of the plaintiff occurred in 4 cases (57%). Of the 5 DCR cases that were tried, a verdict in favor of the plaintiff occurred in 2 cases (40%). A search of all claims at OMIC yielded 31 cases (15 orbital decompression, 16 DCR). 22 of 31 cases were either dismissed or resulted in no payment. The remainder was settled out of court, with only one case being tried and the verdict supporting the defendant. Conclusion Despite several thousand orbital decompressions and DCR surgeries being performed annually in the US, very few lawsuits involving these complex surgeries have gone to trial. However, of the cases that did go to trial, a relatively high proportion of verdicts for plaintiffs was observed.

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“…პაციენტები, რომლებსაც აღენიშნებათ ცხვირ-საცრემლე გზების ობსტრუქცია, ცხვირის ღრუსა და დანამატი წიაღების ანთებითი დაავადებები, გარეგანი დაკრიოცისტორინოსტომის შემდგომი რეციდივი, კარგი კანდიდატები არიან Endo DCR-ისთვის [59]. თანდაყოლილი დაკრიოსტენოზის ატიპიური ფორმების ანატომიური ვარიაციების მქონე მოზარდებმა შეიძლება ასევე ისარგებლონ ენდოსკოპიური DCR-ით [42].…”

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Modern Operative Treatment Methods of Lacrimal System Obstruction

TSEREDIANI

KHVADAGIANI

2023

jecm

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Introduction: Dacryocystitis is a very common pathology and affects a significant part of the population. Stenosis of the nasolacrimal ducts is the most frequent cause of development of dacryocystitis, the main method of treatment is dacryocystorhinostomy.Material and methods: to study the main stages of dacryocystorhinostomy (DCR), various scientific journals (scientific journals from which we get information) were used. One of the first methods of surgical treatment of dacryocystitis was provided in the first century of our era. In 1904, the Italian professor Adeo Totti provided us with the method of external dacryocystorhinostomy.Results and conclusion: Endonasal DCR was first performed by Caldwell in 1893. Endoscopicendonasal Endo DCR was first described in 1999 by McDonor and Meiring. Endonasal endoscopic dacryocystorhinostomy (Endo DCR) is performed without an external rate and with adequate visualization of the contours of the operating structures, minimal invasion of the mucous membrane and anatomical formations with a practically "bloodless" method.

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Meningitis and pneuomocephalus. A rare complication of external dacryocystorhinostomy

Cited by 12 publications

References 4 publications

Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient

Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient

Medical Malpractice Trends in Dacryocystorhinostomy and Orbital Decompression

Modern Operative Treatment Methods of Lacrimal System Obstruction

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