In the other patients, the examination revealed which nasal cavity had a wetter and shinier nasal mucosa and permitted collection of transparent fluid in the nasopharynx, but did not allow precise visualization of the source of liquorrhea. Laryngoscope. Factors determining the appearance of glucose in upper and lower respiratory tract secretions. Minimally invasive endoscopic pericranial flap: A new method for endonasal skull base reconstruction. Laryngoscope. Laryngoscope 2004;114:1833-7.  RMosler To analyze possible etiological factors of spontaneous cerebrospinal fluid (CSF) rhinorrhea and to assess the outcomes of endonasal endoscopic repair. In 2002, Dunn et al12 reported that, in a series of 29 consecutive patients with CSF, rhinorrhea was spontaneous in 10. providing a seal that prevents spinal fluid from escaping. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: ten-year experience. © 2020 American Medical Association.  PMauri Managing cerebrospinal fluid rhinorrhea after lateral skull base surgery via endoscopic endonasal eustachian tube closure. Am J Rhinol 2003;17:91-6. Hassab Minim Invasive Neurosurg 2011;54:110-4. Most of the recent publications dealing with endonasal surgical treatment of CSF rhinorrhea reported the efficacy of the method to be 85% to 95%,1,2,8,16 but most of these publications dealt with all types of CSF leaks. Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas: An analysis of 420 administrations and reported complications in Europe and the United States. [Medline]. [Medline]. James Stankiewicz, MD Professor, Chair, Program Director, Department of Otolaryngology-Head and Neck Surgery, Loyola University Chicago School of Medicine Developments in endonasal endoscopic surgery have made endonasal procedures less invasive, and CSF rhinorrhea is now one of its well-established indications.1,2 In most cases, endoscopic nasal surgery for CSF leak repair has almost completely replaced more traumatic transcranial and extracranial procedures. Laryngoscope 2009;119:13-8. Of the 21 patients, only 5 were obese; and in all patients with an overpneumatized sphenoid sinus, cerebrospinal pressure was normal. Endoscopic management of cerebrospinal fluid rhinorrhea. Dallas, TX 75390, © 2020 The University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd., Endoscopic management of spontaneous CSF rhinorrhea with septal graft and middle turbinate rotational flap technique: a review of 31 cases. Is acetazolamide really useful in the management of traumatic cerebrospinal fluid rhinorrhea?. It is essential to precisely locate the CSF fistula whenever surgical closure is considered. Lieberman SM, Chen S, Jethanamest D, Casiano RR. A thick, leathery tissue called dura lines the inside of the skull, Neurol India 2011;59:74-7. As there is no universal technique, specific surgical options and choice of plastic materials depend on the fistula's size and location. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: Ten-year experience. or 817-882-2700, 5323 Harry Hines Blvd. J Laryngol Otol 1997;111:1042-6. Gassner HG, Ponikau JU, Sherris DA, Kern EB.  SLund Bol Asoc MedPR 2009;101:29-33. The lumbar drain was kept for 5 to 8 days and CSF was evacuated by the drain at the rate of 5 mL/h. Ann Otol Rhinol Laryngol 2008;117:32-9. To confirm the diagnosis and locate the CSF leak, your doctor may also order imaging studies such as: Many CSF leaks repair themselves within a week to six months, especially those that have a traumatic origin.  R Primary spontaneous cerebrospinal fluid rhinorrhea. Cassano M, Felippu A. Endoscopic treatment of cerebrospinal fluid leaks with the use of lower turbinate grafts: A retrospective review of 125 cases. Curr Opin Otolaryngol Head Neck Surg 2007;15:28-34. CSF rhinorrhea is a condition where cerebrospinal fluid (CSF) leaks through the nose. 2020 Apr 10. Br J Neurosurg 2003;17:79-83.  DBullock CSF leaks from the ear typically require open surgery. Nadieska Caballero, MD Fellow in Rhinology and Skull Base Surgery, Sinus and Nasal Institute of Florida Zweig JL, Carrau RL, Celin SE, Schaitkin BM, Pollice PA, Snyderman CH,, American Journal of Otolaryngology.  LLoughran Our personal experience also indicates that spontaneous CSF rhinorrhea is not a condition as infrequent as was formerly believed. Patients were allowed to stand on the day after surgery but they were asked to avoid blowing their noses and coughing. With 161 cases, Schick and coauthors8 presented probably the largest series of surgically treated CSF leaks; of these 161 cases, 70 were caused by trauma, 36 by tumors, and 47 were complications of paranasal sinus surgery. If you have drainage, your doctor may collect a sample for testing. Accessibility Statement, Location of CSF Fistulas and Results of Surgical Repair. Preoperative nasal endoscopic examination with the patient in the supine position located a CSF fistula in 1 patient. The last 2 etiological factors may coexist. Factors associated with increased recurrences are middle age, obese female, raised ICP, diabetes mellitus, lateral sphenoid leaks, superior and lateral extension in frontal sinus, multiple leaks, and extensive skull base defects. Mostafa BE, Khafagi A. If the bone defect was precisely visualized, several layers of abdominal fat were placed inside the defect, which was then closed with a piece of autogenous fascia lata in an on lay fashion. One patient previously had 2 endonasal and 1 transcranial operations in combination with lumboperitoneal shunting. Endoscopic management of cerebrospinal fluid leaks. [Medline]. Radiology 2008;248:725-36. Lanza DC, O'Brien DA, Kennedy DW. Untreated CSF leaks can lead to life-threatening Curr Opin Otolaryngol Head Neck Surg. BioGlue for prevention of postoperative cerebrospinal fluid leaks in transsphenoidal surgery: A case series.  DEmanuelli eye tearing), Infection spreading to the brain, resulting in meningitis. 2017 Feb. 78 (1):18-23. treatment of CSF leaks depends on the location of the leak. The duration of undiagnosed CSF rhinorrhea ranged from 15 years to 4 days 5, 11, 13with the exception of cases in which the CSF leak was identified at the time of occurrence and repaired intraoperatively (e.g., endoscopic sinus surgery or tumor ablative surgery). Med Oral Patol Oral Cir Bucal 2007;12:E397-400. We now know that the reason for recurrences is intracranial hypertension; treating it may be the key to positive long-term results, with a success rate that may even reach 100% in certain cases.”, The cutting-edge HYGEIA Endoscopic Paranasal & Skull Base Surgery Department offers comprehensive and quality care for the entire range of conditions affecting the nose, paranasal sinuses and skull base. The locations of CSF fistulas in this series of patients are listed in Table 1. accurately pinpoint its location. In 5 cases, a bone defect and/or a small meningocele appearing to be the source of the CSF leak were found in the lateral wall of the overpneumatized sphenoid sinus. Submitted for publication October 1, 2002; accepted November 12, 2002. In contrast, our series, as well as some other recent reports,13,14 shows that aside from innate skull base malformations, which usually occur in the cribriform plate, posterior and lateral walls of the sphenoid sinus are typical sites for spontaneous CSF fistulas. J Neurosurg. Acta Otorhinolaryngol Belg 2000;54:179-89. Hubbard Possible etiological factors of this disease include obesity, congenital malformations of the skull base, an overpneumatized sphenoid sinus (particularly in its lateral extensions), and the empty sella syndrome. Minim Invasive Neurosurg 2004;47:173-7. Kerr JT, Chu FW, Bayles SW. Cerebrospinal fluid rhinorrhea: Diagnosis and management. Neurol India 2010;58:280-83. An Analysis of Patients Treated for Cerebrospinal Fluid Rhinorrhea in the United States from 2002 to 2010. In this Br J Neurosurg 2000;14:49-52. J Laryngol Otol 2009;123:145-7. Laryngoscope 2005;115:205-12. [Medline]. It was a common opinion that the cribriform plate and ethmoidal roof were the sites of the fistula in most patients with CSF, and the sphenoid sinus was rarely implicated in spontaneous CSF fistula. Kirtane MV, Gautham K, Upadhyaya SR. Endoscopic CSF rhinorrheaclosure: Our experience in 267 cases. Bachert C, Verhaeghe B, van Cauwenberge P, Daele J. Endoscopic endonasal surgery (EES) in skull base repairs and CSF leakage. Spontaneous nasal cerebrospinal fluid leaks and empty sella syndrome: A clinical association. There were no postoperative complications. Intensive Care Med 2003;29:2204-10. Fleischman GM, Ambrose EC, Rawal RB, et al. None of these attempts achieved steady positive results. Bumm K, Heupel J, Bozzato A, Iro H, Hornung J. Localization and infliction pattern of iatrogenic skull base defects following endoscopic sinus surgery at a teaching hospital. More than one half of the patients (11) in our series experienced at least 1 episode of meningitis, and 4 patients reported recurrent episodes. We’re ranked as the top Repair of the leak can be performed with an underlay fascia graft and an anterior-based pedicled mucosa flap. Treatment outcomes of endoscopic repairs of sinonasal cerebrospinal fluid leaks. Objective   MMSahani Pittsburgh, PA 15213 Marshall AH, Jones NS, Robertson IJ. 2019; 84(1): 51, Ear, Nose & Throat Journal. In no case did the operation begin with resection of the middle turbinate.

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