Sinonasal Cerebrospinal Fluid Leaks: Management of 97 Patients Over 10 Years

Mirza, Showkat; Thaper, Amit; McClelland, Lynn; Jones, Nick

doi:10.1097/01.mlg.0000175679.68452.75

Cited by 112 publications

(163 citation statements)

References 13 publications

(30 reference statements)

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“…Endoscopic repair of CSF leaks has a high rate of success and is currently the mainstay of repair of CSF leaks. [11][12][13][14] Our series demonstrated that MPR images from 0.625-and 1.25-mm collimated sections accurately characterized the size of skull base defects in 15 (75%) of 20 patients. Of our 19 patients, 10 had MPR images based on 0.625-mm axial datasets.…”

Section: Discussionmentioning

confidence: 64%

CSF Leaks: Correlation of High-Resolution CT and Multiplanar Reformations with Intraoperative Endoscopic Findings

Fata¹,

McLean²,

Wise³

et al. 2007

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Skull base defects can result in CSF leaks, with meningitis as a potential complication. Surgeons are now routinely repairing these leaks via a nasal endoscopic approach. Accurate preoperative imaging is essential for surgical planning. A variety of imaging regimens have been employed, including axial and direct coronal CT, CT cisternography with iodinated contrast, radionuclide cisternography, and MR imaging. Now that multidetector helical CT is available, the purpose of this study was to determine how well coronal and sagittal multiplanar reformatted (MPR) images generated from a high-resolution axial dataset correlate with intraoperative findings in a group of patients with clinically proved CSF leaks.

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Section: Discussionmentioning

confidence: 64%

CSF Leaks: Correlation of High-Resolution CT and Multiplanar Reformations with Intraoperative Endoscopic Findings

Fata¹,

McLean²,

Wise³

et al. 2007

AJNR Am J Neuroradiol

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show abstract

“…4,8,12,16 This sequence of events results in effusions in the middle ear and mastoid air cells that can manifest as CSF fistulas, through a disrupted tympanic membrane or via the eustachian tube. [1][2][3]5,11,12,15 Given that intracranial hypertension has been implicated as a significant factor in temporal encephalocele formation, 7,[10][11][12]15 we hoped to clarify this correlation by reviewing a series of tegmen defects repaired surgically and the associated ICP measurements in these patients. Additionally, we aimed to determine the rate of and indications for VP shunt placement.…”

Section: Neurosurg Focus 32 (6):e6 2012mentioning

confidence: 99%

“…With a combined mastoid/middle fossa approach, we were able to achieve a high success rate (96%) of CSF fistula closure, comparable to rates in previously published reports. 2,5,8,13,14 Our surgical technique involves a robust dural closure following extradural dissection and encephalocele reduction/resection. We use a multilayer closure for direct repair of the dural and cranial base defects.…”

Section: Patient Outcomesmentioning

confidence: 99%

Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes

Kenning¹,

Willcox²,

Artz³

et al. 2012

FOC

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Object Thinning of the tegmen tympani and mastoideum components of the temporal bone may predispose to the development of meningoencephaloceles and spontaneous CSF leaks. Surgical repair of these bony defects and associated meningoencephaloceles aids in the prevention of progression and meningitis. Intracranial hypertension may be a contributing factor to this disorder and must be fully evaluated and treated when present. The purpose of this study was to establish a treatment paradigm for tegmen defects and elucidate causative factors. Methods The authors conducted a retrospective review of 23 patients undergoing a combined mastoidectomy and middle cranial fossa craniotomy for the treatment of a tegmen defect. Results The average body mass index (BMI) among all patients was 33.2 ± 7.2 kg/m2. Sixty-five percent of the patients (15 of 23) were obese (BMI > 30 kg/m2). Preoperative intracranial pressures (ICPs) averaged 21.8 ± 6.0 cm H2O, with 10 patients (43%) demonstrating an ICP > 20 cm H2O. Twenty-two patients (96%) had associated encephaloceles. Five patients underwent postoperative ventriculoperitoneal shunting. Twenty-two CSF leaks (96%) were successfully repaired at the first attempt (average follow-up 10.4 months). Conclusions Among all etiologies for CSF leaks, those occurring spontaneously have the highest rate of recurrence. The surgical treatment of temporal bone defects, as well as the recognition and treatment of accompanying intracranial hypertension, provides the greatest success rate in preventing recurrence. After tegmen dehiscence repair, ventriculoperitoneal shunting should be considered for patients with any combination of the following high-risk factors for recurrence: spontaneous CSF leak not caused by another predisposing condition (that is, trauma, chronic infections, or prior surgery), high-volume leaks, CSF opening pressure > 20 cm H2O, BMI > 30 kg/m2, preoperative imaging demonstrating additional cranial base cortical defects (that is, contralateral tegmen or anterior cranial base) and/or an empty sella turcica, and any history of an event that leads to inflammation of the arachnoid granulations and impairment of CSF absorption (that is, meningitis, intracranial hemorrhage, significant closed head injury, and so forth).

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“…No está claro el uso de antimicrobianos sistémicos como profilaxis aunque sí se recomienda su uso en casos post-cirugía endoscópica nasal debido a la contaminación previa del sitio operatorio 12 . Los diuréticos como la acetazolamida pueden ser un adyuvante terapéu-tico útil en el caso de fístulas espontáneas con presión intracraneal elevada 13 .…”

Section: Discussionunclassified

Meningitis bacteriana aguda por Streptococcus agalactiae en una mujer no embarazada asociada a una fístula de LCR: comunicación de un caso

González

Labatut

Soto

et al. 2013

Rev. chil. infectol.

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Sinonasal Cerebrospinal Fluid Leaks: Management of 97 Patients Over 10 Years

Cited by 112 publications

References 13 publications

CSF Leaks: Correlation of High-Resolution CT and Multiplanar Reformations with Intraoperative Endoscopic Findings

CSF Leaks: Correlation of High-Resolution CT and Multiplanar Reformations with Intraoperative Endoscopic Findings

Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes

Meningitis bacteriana aguda por Streptococcus agalactiae en una mujer no embarazada asociada a una fístula de LCR: comunicación de un caso

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