Spontaneous cerebrospinal fluid leaks

Woodworth, Bradford A.; Palmer, James N.

doi:10.1097/moo.0b013e3283200017

Cited by 69 publications

(66 citation statements)

References 36 publications

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“…Although this definition seems simple, the cause may remain obscured, and patients may not recollect sustaining a head trauma. There is also controversy regarding use of the terms primary, congenital, idiopathic, and spontaneous because they are loosely employed in the literature (1,(16)(17)(18). The use of these terms as synonyms may be confusing, because one may assume that all spontaneous CSF fistulas are formed through congenital dehiscences, when, in fact, dehiscences may be formed by bone remodeling or reabsorption during the patient's life and do not imply a congenital origin.…”

Section: Definition and Incidencementioning

confidence: 94%

“…Spontaneous CSF fistulas have no clear cause (1,6,10,15,16). Although this definition seems simple, the cause may remain obscured, and patients may not recollect sustaining a head trauma.…”

Section: Definition and Incidencementioning

confidence: 98%

“…dence of a mass lesion or hydrocephalus. Some patients with spontaneous CSF fistulas may not exhibit typical symptoms of IIH because they are actively leaking CSF and do not develop elevated intracranial pressure until after the CSF fistula is repaired, which probably contributes to the long-term lack of surgical success in these patients (1,5,6,8,10,11,13,16,(18)(19)(20)(21)(22)(23)(24). Signs of elevated intracranial pressure include abnormalities of the optic nerve sheath complex, prominent arachnoid granulations, dural ectasia, meningoencephalocele, and empty sella syndrome (1,5,6,8,10,16,(18)(19)(20)(21)(22)24).…”

Section: Pathophysiologic Characteristicsmentioning

confidence: 99%

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Spontaneous Skull Base Meningoencephaloceles and Cerebrospinal Fluid Fistulas

Alonso

Peña²,

Caicoya³

et al. 2013

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Cerebrospinal fluid (CSF) fistulas are characterized by the egress of CSF from the intracranial cavity through an osteodural disruption between the subarachnoid space and a pneumatized structure within the skull base. Depending on the cause, CSF fistulas are classified as acquired or congenital, and acquired fistulas are further classified as traumatic, nontraumatic, or spontaneous. Spontaneous CSF fistulas are considered to result from a multifactorial process and have been postulated to represent a variant of idiopathic intracranial hypertension. However, an anatomic predisposition involving thinning of the cranial base, such as pneumatization of the sinus walls, must also be present. This process creates areas of structural weakness that act as potential pathways for CSF leaks, which most commonly occur in the ethmoid roof, sphenoid sinus, and temporal bone. Because CSF leaks may be overlooked, a result of their asymptomatic or subtle, intermittent course, a high level of suspicion is crucial in making an early diagnosis. However, CSF fistulas may be well seen at computed tomography (CT), which depicts bone defects, and magnetic resonance cisternography, which reveals the contents of herniated tissue. Knowledge of the location and size of the bone defect and herniated contents is crucial for the selection of surgical approach and grafting material.

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Section: Definition and Incidencementioning

confidence: 94%

“…Spontaneous CSF fistulas have no clear cause (1,6,10,15,16). Although this definition seems simple, the cause may remain obscured, and patients may not recollect sustaining a head trauma.…”

Section: Definition and Incidencementioning

confidence: 98%

Section: Pathophysiologic Characteristicsmentioning

confidence: 99%

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Spontaneous Skull Base Meningoencephaloceles and Cerebrospinal Fluid Fistulas

Alonso

Peña²,

Caicoya³

et al. 2013

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“…[40]. In cases of frontal sinus defects, the modified Lethrop approach is useful either alone or with endoscopic approach [41][42][43].…”

Section: Extracranial Approachesmentioning

confidence: 99%

Journal of ISSN: 2379-6359 JOENTR Otolaryngology-ENT Research Case Report Volume 7 Issue 1 - 2017 Current Approach to Cerebrospinal Fluid Rhinorrhea Diagnosis and Management

Sumaily¹

2017

JOENTR

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Laboratory a) CSF analysis of the fluid. b) Glucose concentration is >30 mg/dl. Neither sensitive nor specific [10,11].c) Beta-2 transfer in is the gold standard (sensitivity of 94% to 100%, and specificity of 98% to 100%), unfortunately not available in many centers, needs 5-7 days [10]. ImagingThis can be classified into primary and secondary:Primary (helpful in the detection of most of the leaks) [12]:i. MRI cisternography: heavily T2-weighted, fast spin-echo, fatsaturated sequences. Better in prone position with Valsalva maneuver. FLAIR sequence is very useful in differentiating CSF (change to dark) from sinus secretions (persist whitish) without the need for contrast [13,14]. Intrathecal injection of 0.5 ml of gadopentetate dimeglumine, diluted in 3-5 ml of CSF can be added for more details.ii. HRCT: Can show the bony defect and, if there is, any protruding soft tissue through it, and also accumulating fluid, if any. And in some cases pneumocephalus may be seen. It is sensitivity is 88.25 to 93% [15]. It is less sensitive in detecting the exact AbstractCerebrospinal fluid (CSF) rhinorrhea clinical approach and therapeutic techniques are rapidly growing and the literature is almost daily enriched with new studies, techniques, and trials. In this article I tried to collect, summarize and organize the updates on this topic from the English literature, and deliver it in a clinical approach manner with suggested algorithm and clarifying illustration so it can be easily understood by the readers and applied by those who are dealing with such cases. Current Approach to Cerebrospinal Fluid Rhinorrhea Diagnosis and Management 2/6Copyright: ©2017 Sumaily site of the leak when there are multiple fractures [16].iii. Combination of both HRCT and MRI-cisternography provide higher sensitivity and specificity, but usually it is not cost effective and sometimes its time consuming to wait for both to be ready. So, starting with HRCT is advised [12,13,17]. In)) injection either into the lumbar or suboccipital subdural and nasal pledgets in various highrisk areas. Head scans are acquired 2, 6, 12, and 24 hours. And follow-up scans after 48-or 72-hours. It is useful in the detection of intermittent CSF fluid leaks with sensitivity range of 50 to 100%, and specificity 100%. It is relatively poor in exact localization, therefore it is reserved for complex cases when the diagnosis is in question [24]. d) Nasal endoscopy [25]. The last choice is to explore the nasal cavity and paranasal sinuses via and endoscopic sinus surgery looking for the leak and the defect site. Valsalva maneuver and jugular compression could improve detection rate ( Figure 2). i. Extensive bone defects in the cranial base. Secondaryii. Multiple fractures of the ethmoid bone and the posterior wall of the frontal sinus.iii. Associated intracranial lesions requiring surgery.CSF leak is severe, recurrent, or not amenable to the endoscopic treatment.i. Procedure: up to date, no studies on the types of craniotomy and which type is preferred [31]. For a frontoba...

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“…A spinal fluid leak from the intracranial space to the nasal respiratory tract is potentially very serious because of the risk of an ascending infection that could produce fulminant meningitis [2]. Therefore, identification of the fistulous tract is helpful for patient management.…”

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confidence: 99%