Trattamento delle fistole rinoliquorali: quando è richiesto un approccio chirurgico multidisciplinare al basicranio?

Abstract

Cerebrospinal fluid (CSF) leak remains a rare condition, characterized by serious complications and potentially fatal. According to different etiologies, CSF leaks may be classified into two main categories: traumatic and spontaneous. Spontaneous fistulas seem to be mainly related to obesity and idiopathic intracranial hypertension. Diagnosis is both clinical and radiological. During the last three decades, surgical treatment has mostly shifted to endonasal endoscopic approach, which widely demonstrated to be more effective than invasive intracranial ones. Post-operative complications, long-term sequelae and hospital stay are strongly reduced thanks to endoscopic approach. The diagnosis and treatment of CSF leaks represent a difficult and challenge task. The main effort seems to be related to the precise localization of the leak. An accurate assessment of both predisposing factors and comorbidities is mandatory in case of spontaneous leaks. However, a clinical multidisciplinary evaluation as well as treatment, is essential to decrease the rate of failure of surgery. The presence of a dedicated instruments, the Skull Base Team, the knowledge of reconstructive materials and techniques represents a decisive result in therapeutical management even if for each patient an effective therapeutic algorithm can be obtained considering the correct leak detection and characteristics. In conclusion the strict teamwork with neurosurgeons, neuroradiologists, ophtalmologists will enable the development also of innovative biomaterials, which could spread and standardize multi-layer techniques, nowadays still related to surgeon preferences.

Cerebrospinal fluid leak postnasopharyngeal swab for SARS-CoV-2 testing: A case report

“…Second, CSF leaks can appear spontaneously in relation to other conditions such as intracranial hypertension or CSF hypotension. [3] Spontaneous CSF fistulas are characterized by positional headache, where the headache improves in supine and worsens on sitting, related to the possible leptomeninges traction as well as nuchal rigidity, photophobia, diplopia, and even radiculopathy. e imaging diagnosis of this type of fistulae can be performed through a CT to locate the site of the bone defect; even though the patient has clear symptoms of a CSF leak, images may be normal so studies with MRI and CT myelography can be extended.…”

“…Second, CSF leaks can appear spontaneously in relation to other conditions such as intracranial hypertension or CSF hypotension. [ 3 ]…”

Symptom: Runny Nose Six Years After Acoustic Neuroma Surgery

“…The spontaneous group is further divided into high-pressure and low-pressure subgroups (according to CSF pressure). 3…”

“…In addition, screening for medication that can exacerbate IIH, including doxycycline, carbidopa, levodopa, cyclosporine, danazol, lithium, phenytoin, vitamin A, and some contraceptive drugs is also necessary. 3,4…”

Oropharyngoesophageal Scintigraphy in a Case of Complex Swallowing Disorders After a Major Oral Surgery

“…The patient was placed in an erect 80-degree right anterior oblique position in front of a gamma camera, giving to drink 10 mL of water with 18.5 MBq (0.5 mCi) of 99m Tc-DTPA and recording sequential images (480 frames in 60 seconds) from the nose to the epigastric region. [2][3][4][5][6][7][8][9][10] The qualitative analysis of the images demonstrated that the sucking ability was preserved, but with a partial oral inability to contain the liquid bolus (A, early visualization of the oropharynx in the preswallowing phase); this event has to be referred to the oral incapability to contain the liquid bolus. Oropharynx swallowing phase showed irregular movements, probably due to a novel postsurgical anatomy as well as to a superior esophageal sphincter hypertonia.…”