Outcomes of outpatient endoscopic repair of cerebrospinal fluid rhinorrhea

Adams, Andrew A.; Francis, David O.; Russell, Paul T.

doi:10.1002/alr.21810

Cited by 9 publications

(9 citation statements)

References 17 publications

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“…The use of lumbar drains is optional; the potential therapeutic benefit and measurement of opening pressures must be carefully weighed against its considerable complications. 52,53 Day-case CSF leak repair is strongly discouraged, despite some limited and mostly anecdotal experience in its use, 54 and admission overnight with appropriate monitoring is recommended. In complex cases (giant meningoencephaloceles, large defects, or multiple associated pathologies) the statement that a CT brain should be considered during the first 24 hours after surgery was rejected after the second Delphi round.…”

Section: Surgical Technique and Immediate Managementmentioning

confidence: 99%

International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea

Georgalas

Oostra

Ahmed

et al. 2020

Int Forum Allergy Rhinol

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Background The association between spontaneous cerebrospinal fluid CSF leak/rhinorrhea and idiopathic intracranial hypertension IIH has been increasingly recognized over the last years However considerable variability of opinion regarding the assessment investigations and management of patients with spontaneous CSF rhinorrhea remains Methods A consensus group was formed from experts from Europe Asia Australia South and North America Following literature review and open discussions with members of the panel a set of statements was produced A modified Delphi method was used to refine expert opinion with rounds of questionnaires and a consensus group meeting in Santo-Rhino meeting in September Results Fi y statements of total on spontaneous CSF leak and IIH reached consensus In of statements the median response was strongly agree and in the remaining statements the median response was agree Eleven statements were excluded because they did not reach consensus and one new statement was added during SantoRhino meeting The final statements refer to patient history and clinical examination "History taking should include presence of headache tinnitus and visual defects" investigations role of Thin Slice Computed Tomography and CISS/FLAIR sequences in Magnetic Resonance Imaging principles of management watchful waiting or measures to reduce ICP are supplementary but cannot subsitute surgical closure surgical technique intraoperative early postoperative and long term management Conclusion We present fi y consensus statements on the diagnosis investigation and management of spontaneous CSF rhinorrhea based on the currently available evidence and expert opinion Although by no means comprehensive and final we believe they can contribute to the standardization of clinical practice Early diagnosis prompt surgical closure of the defect assesment for and treatment of potentially co-existing idiopathic intracranial hypertension in a comprehensive multidisciplinary approach are essential in order to successfully manage spontaneous CSF rhinorrhea reduce associated morbidity and prevent recurrence

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Section: Surgical Technique and Immediate Managementmentioning

confidence: 99%

International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea

Georgalas

Oostra

Ahmed

et al. 2020

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

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“…Usually, in approximately 7-10 days, under conservative treatment of the most posttraumatic CSF leaks, complete resolution in expected 51 , while spontaneous CSF leaks usually require surgical intervention. …”

Section: Discussionmentioning

confidence: 99%

Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

Patrascu¹,

Manea²,

Sarafoleanu³

2017

Romanian Journal of Rhinology

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A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the skull base and it is usually characterized by discharge of cerebrospinal fluid from the nose. Cerebrospinal fluid leaks may have many etiologies, the most common being trauma. The most common site of dural lesion is the cribriform plate of the ethmoid. Diagnosis can be achieved by a multitude of techniques, high-resolution computed tomography being the modality of choice and it may be completed with magnetic resonance imaging or cisternography. Treatment may be either conservative, either surgical, related to the cause, the site and the duration of CSF leak. Conservative treatment usually includes strict bed rest, elevated bed head and no straining, nose blowing or stretching, with resolution of the majority of traumatic CSF leaks in seven days. Surgical treatment consists of a variety of approaches (intracranial/extracranial, open/endoscopic). The future trend is represented by minimally invasive endoscopic approaches, with a success rate of almost 90%; however, open transcranial or extracranial interventions still have indications in the surgical management. CSF leaks must be correctly diagnosed and treated, because the risk of intracranial complications increases 10-fold when the leakage persists.

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“…Perioperative use of lumbar drainage is a controversial adjunct in the management of spontaneous CSF leaks. There is a surplus of data suggesting that the use of lumbar drainage perioperatively is not necessary for successful repair of CSF leaks 20,22–26 . Similarly, Wang et al 19 recommend against the routine use of lumbar drainage perioperatively for management of intracranial pressure (ICP) in spontaneous CSF leaks but leave it as an option for adjunctive measures such as administration of intrathecal fluorescein or in high‐risk cases.…”

Section: Introductionmentioning

confidence: 99%

An Expedited Intracranial Pressure Monitoring Protocol Following Spontaneous CSF Leak Repair

et al. 2020

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Objective Spontaneous cerebrospinal fluid (CSF) leaks represent a unique subset of skull base pathology and require distinctive management. Perioperative evaluation and management of intracranial hypertension are essential in preventing further erosion of the skull base and development of recurrent leak. The objective of this study is to evaluate the safety and utility of an expedited protocol for recording and managing intracranial hypertension following endoscopic repair of spontaneous CSF leaks. Methods Prospectively collected data was reviewed in patients undergoing endoscopic repair of spontaneous CSF leaks between January 2017 and March 2020. A standard intracranial pressure monitoring protocol was compared to an expedited protocol (EP), and data regarding the two groups was compared for leak location, short‐term success of skull base repair, complications, hospital length of stay, and cost‐based analysis. Results Fifty‐five patients (standard protocol, n = 28 vs. EP, n = 27) were included in the study. Leak location was similar between cohorts, with the lateral recess being the most common locations in both groups (37.9% vs. 40.6%; P = .90). Postoperative complications (3.6% vs. 7.4%; P = .53) and ventriculoperitoneal shunt rate (32.1% vs. 22.2%; P = .41) were similar among cohorts. There was no difference in lumbar drain complications (0% vs. 7.4%; P = .14) or recurrent leak (7.1% vs. 0%; P = .16). Length of stay was shorter in the EP group [median(interquartile range): 3(1) vs. 2 (1); P < .01]. Total hospital charges were similar between groups (median (USD/$1,000): 83.57 ± 49.58 vs. 83.93 ± 46.11; P = .18). Conclusion An expedited monitoring protocol shortened hospital stay without increased risk of complications. Level of Evidence III Laryngoscope, 131:E408–E412, 2021

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Outcomes of outpatient endoscopic repair of cerebrospinal fluid rhinorrhea

Cited by 9 publications

References 17 publications

International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea

International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea

Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

An Expedited Intracranial Pressure Monitoring Protocol Following Spontaneous CSF Leak Repair

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