Treatment of cerebrospinal fluid rhinorrhea

DeConde, Adam S.; Suh, Jeffrey D.; Ramakrishnan, Vijay R.

doi:10.1097/moo.0000000000000124

Cited by 11 publications

(11 citation statements)

References 29 publications

(23 reference statements)

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“…8,9 Other etiologies include iatrogenic, tumors, spontaneous leaks, and congenital malformations. [9][10][11] Proper management aims to reduce the complications of CSF rhinorrhea including meningitis and brain abscess. 6,10,12 Typically, the cause of the CSF leak greatly impacts the management decisions, as it is generally accepted that CSF rhinorrhea from acute trauma is more like to resolve without intervention when compared with that arising spontaneously or iatrogenically.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of Patients Treated for Cerebrospinal Fluid Rhinorrhea in the United States from 2002 to 2010

et al. 2016

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The Nationwide Inpatient Sample (NIS) database was used to analyze the demographic features and concomitant diagnoses in patients admitted with cerebrospinal fluid (CSF) rhinorrhea. We analyzed the NIS database for all hospital admissions of CSF rhinorrhea between 2002 and 2010. Patient demographics, length of stay, hospital charges, concomitant diagnoses, hospital level characteristics, and complications were analyzed for patients undergoing surgical repair (group I) and for those treated without surgical repair (group II). Patients in group I were significantly older, the majority were female (67.5%), and were more likely to be obese (12.9%), have diabetes mellitus (15.7%), and hypertension (41.6%). Lengths of stay were similar between the two groups, but group I patients incurred higher hospital charges ( < 0.001). Group I patients were more likely classified as an elective admission (59.8 vs. 38.6%), and were more frequently admitted to a teaching hospital (83.6%) with a large bed size (79.0%). Acute medical complications and concomitant diagnosis of meningitis were similar in both groups. Rates of meningitis did not differ between the two groups. Patients who underwent surgical repair were more likely to be an elective admission and admitted to a teaching hospital. Hospital charges were higher in patients undergoing repair.

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Section: Discussionmentioning

confidence: 99%

An Analysis of Patients Treated for Cerebrospinal Fluid Rhinorrhea in the United States from 2002 to 2010

et al. 2016

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Section: Discussionmentioning

confidence: 99%

“…9 The choice of the materials and the techniques used also depends on the experience and preference of the surgeon. Different techniques and their outcomes have been thoroughly reviewed elsewhere, 4,6–9 with most studies reporting success rates around 90%. According to Zweig et al 11 , location and size of the skull base defect, its etiology, and the technique and choice of repair material did not significantly affect surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…9 The time to resumption of activity without restriction, and potentially the time for use of medical therapy to treat intracranial hypertension, may depend on the type of repair utilized and its incorporation into the surrounding skull base. Free bone grafts may be used as a rigid repair to recapitulate the native skull base with the implication that the patient may resume normal activity without the risk of recurrent leak or encephalocele at that site.…”

Section: Introductionmentioning

confidence: 99%

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Osseous Repair in Minimally Invasive Reconstruction of Anterior Skull Base Defects

Ramakrishnan

Terella

Poonia

et al. 2017

Journal of Craniofacial Surgery

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Management of anterior skull base defects is an area of continued innovation for skull base surgeons. Various grafting materials have been advocated for the repair of skull base defects depending on needs, availability, harvest site morbidity, and surgeon preference. Spontaneous bony closure of small skull defects is known to occur in animal models without bone grafts, but this phenomenon has been unexplored in the human skull base. The objective of this study was to evaluate osseous skull base closure in patients undergoing endoscopic repair of skull base defects. A retrospective review was performed on 13 patients who underwent endoscopic repair of skull base defects with free bone grafts who were followed with post-operative CT scans. This cohort was compared to postoperative radiology from patients undergoing transsphenoidal surgery without rigid reconstruction to evaluate for spontaneous osseous closure of sellar defects. Free bone grafts incorporated into the bony skull base in the majority of cases (84.6% with at least partial incorporation) at mean of 5.3 years postoperatively. By comparison, patients undergoing pituitary surgery did not demonstrate spontaneous osseous closure on postoperative imaging. Human anterior skull base defects do not appear to spontaneously close, even when small, suggesting that there is no “critical size defect” in the human skull base, in contrast to the robust wound healing in animal models of skull convexity and mandibular defects. Free bone grafts incorporate into the skull base over the long-term and may be utilized whenever a rigid skull base reconstruction is desired, regardless of the defect size.

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“…13,44,65,72 Simple defects (ie, small 4 mm, low-flow leaks, and easily accessible sites) are generally reconstructed with a free soft tissue overlay graft (Fig. 5).…”

Section: Skull Base Reconstructionmentioning

confidence: 99%

Endoscopic Endonasal Repair of Spontaneous and Traumatic Cerebrospinal Fluid Rhinorrhea

Gonen

Monteiro

Klironomos

et al. 2015

Neurosurgery Clinics of North America

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Treatment of cerebrospinal fluid rhinorrhea

Cited by 11 publications

References 29 publications

An Analysis of Patients Treated for Cerebrospinal Fluid Rhinorrhea in the United States from 2002 to 2010

An Analysis of Patients Treated for Cerebrospinal Fluid Rhinorrhea in the United States from 2002 to 2010

Osseous Repair in Minimally Invasive Reconstruction of Anterior Skull Base Defects

Endoscopic Endonasal Repair of Spontaneous and Traumatic Cerebrospinal Fluid Rhinorrhea

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