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Shah MJ, Beck J, Meckel S, Urbach H, Duman IE, Ketterer MC, Hildenbrand T. Reliability of High-resolution Gadolinium-enhanced MR Cisternography and Gasket-seal Technique for Management of Anterior Skull Base Defects. Clin Neuroradiol 2024; 34:115-123. [PMID: 37656200 PMCID: PMC10881784 DOI: 10.1007/s00062-023-01339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Precise preoperative localization of anterior skull base defects is important to plan surgical access, increase the success rate and reduce complications. A stable closure of the defect is vital to prevent recurrence of cerebrospinal fluid (CSF) rhinorrhea. The purpose of this retrospective case series was to evaluate the reliability of a new high-resolution gadolinium-enhanced compressed-sensing SPACE technique (CS T1 SPACE) for magnetic resonance (MR) cisternography to detect cerebrospinal fluid leaks of the anterior skull base and to assess the long-term success rate of the gasket-seal technique for closure of skull base defects. METHOD All patients with spontaneous or postoperative cerebrospinal fluid rhinorrhea and defects of the anterior skull base presenting to the Departments of Otorhinolaryngology and Neurosurgery between 2019 and 2020, receiving a computed tomography (CT) cisternography and MR cisternography (on a 3T whole-body MR scanner using a 64-channel head and neck coil) with CS T1 SPACE sequence and closure of the defect with the gasket-seal technique, were enrolled in the study. For the cisternography, iodinated contrast agent (15 ml Solutrast 250 M®), saline (4 mL) mixed with a 0.5 mL of gadoteridol was injected into the lumbar subarachnoid space. RESULTS A total of four patients were included in the study and MR cisternography with CS T1 SPACE sequence was able to precisely localize CSF leaks in all patients. The imaging results correlated with intraoperative findings. All defects could be successfully closed with the gasket-seal technique. The mean follow-up was 35.25 months (range 33-37 months). CONCLUSION MR cisternography with CS T1 SPACE sequence could be a promising technique for precise localization of CSF leaks and the gasket-seal technique resulted in good closure of the CSF fistula in this case series.
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Affiliation(s)
- Mukesch Johannes Shah
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Stephan Meckel
- Institute for Diagnostic and Interventional Neuroradiology, RKH Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Germany
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Ikram Eda Duman
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Manuel Christoph Ketterer
- Department of Oto-Rhino-Laryngology, Medical Center, University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Tanja Hildenbrand
- Department of Oto-Rhino-Laryngology, Medical Center, University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany.
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Shah A, Dhar A, Prasad A, Goel A. 3-D Printed Skull Model: Role in Identification of Site of Bone Defect in Cases with CSF Rhinorrhea. Neurol India 2024; 72:391-394. [PMID: 38817177 DOI: 10.4103/neuroindia.ni_280_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 12/14/2020] [Indexed: 06/01/2024]
Abstract
Role of 3-D models in the identification of the site and extent of bone defects in the skull base for the treatment of CSF rhinorrhea is analyzed. Such models were used successfully in the management of two patients who failed previous attempts at basal reconstruction. The principal advantage of the models was in exact delineation of the size and site of bone defect and deciphering of its relationship with adjoining critical regions of the brain.
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Affiliation(s)
- Abhidha Shah
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, Maharashtra, India
| | - Arjun Dhar
- Consultant Neurosurgeon, Lilavati Hospital and Research Centre, Bandra (E), Mumbai, Maharashtra, India
| | - Apurva Prasad
- Consultant Neurosurgeon, Lilavati Hospital and Research Centre, Bandra (E), Mumbai, Maharashtra, India
| | - Atul Goel
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, Maharashtra, India
- Consultant Neurosurgeon, Lilavati Hospital and Research Centre, Bandra (E), Mumbai, Maharashtra, India
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Bonomo G, Bussone G, Gans A, Iess G, Bonomo R, Restelli F, Falco J, Mazzapicchi E, Stanziano M, Amato A, Broggi M, Acerbi F, Ferroli P, Schiariti M. Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension. BRAIN & SPINE 2023; 3:102676. [PMID: 38021026 PMCID: PMC10668106 DOI: 10.1016/j.bas.2023.102676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/07/2023] [Accepted: 09/17/2023] [Indexed: 12/01/2023]
Abstract
Background Meningoencephalocele is defined as an abnormal sac of brain tissue and meninges extending beyond natural skull margins, often leading to cerebrospinal fluid (CSF) leakage. When this condition arises in the spheno-ethmoidal region, the diagnosis becomes more challenging as it can be mistaken for other nasal pathologies, such as mucocele. Research question We show in this case report a non-congenital sphenoethmoidal meningoencephalocele causing rhinoliquoral fistula and spontaneous intracranial hypotension. Results this 65-year-old woman presented with sporadic rhinoliquorrhoea associated with orthostatic headache, nausea and dizziness. Brain MRI revealed a small lesion of an ethmoidal sinus, which was successfully treated with endoscopic endonasal surgery. Histology confirmed the presence of meningoencephalic tissue positive for S100 protein on immunohistochemistry. Conclusions When dealing with lesions of the paranasal sinuses in contact with the anterior skull base, rhinoliquorrhoea presence suggests meningoencephalocele. In dubious cases, a proper workup, including a thorough clinical history and neurological examination, specific imaging, and a direct search of CSF-like markers, is essential to support the differential diagnosis. In such cases, a transnasal endoscopic surgical approach is recommended to obtain a final histological diagnosis and to perform eventual dural plastic surgery.
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Affiliation(s)
- Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
- Department of Neurological Surgery, Policlinico “G. Rodolico-S. Marco” University Hospital, Catania, Italy
| | - Gennaro Bussone
- Department of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Alessandro Gans
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Guglielmo Iess
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Roberta Bonomo
- Department of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- School of Medicine and Surgery, Kore University of Enna, Enna, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Mario Stanziano
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- Neurosciences Department “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Alessia Amato
- Department of Child Neuropsychiatry, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
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Kim DH, Kim SW, Han JS, Kim GJ, Basurrah MA, Hwang SH. High-Resolution Computed Tomography as an Initial Diagnostic and Localization Tool in Patients with Cerebrospinal Fluid Rhinorrhea: A Meta-Analysis. Medicina (B Aires) 2023; 59:medicina59030540. [PMID: 36984541 PMCID: PMC10052363 DOI: 10.3390/medicina59030540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Background and Objectives: This study was performed to investigate the utility of high-resolution computed tomography (HRCT) for the initial localization of cerebrospinal fluid rhinorrhea. Methods: HRCT data regarding the point of cerebrospinal fluid leakage (as confirmed in the operating room), collected up to December 2022, were extracted from five databases. The risk of bias of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: The search revealed eight relevant studies with a total of 254 patients. The diagnostic odds ratio of the imaging studies was 10.0729 (95% confidence interval [CI]: 2.4486; 41.4376; I2 = 54.1%). The area under the summary receiver operating characteristic curve was 0.8. Sensitivity, specificity, the negative predictive value, and the positive predictive value were 0.7550 (95% CI: 0.6163; 0.8553; I2 = 69.8%), 0.8502 (95% CI: 0.5986; 0.9557, I2 = 49.3%), 0.4106 (95% CI: 0.2418; 0.6035; I2 = 59.0%), and 0.9575 (95% CI: 0.8955; 0.9834; I2 = 27.7%), respectively. Conclusions: HRCT can be used to accurately localize cerebrospinal fluid rhinorrhea because it shows bony defects in high detail. However, it has limited utility for the evaluation of active leakage, and localization is difficult in the presence of coexisting lesions.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea
| | - Jae Sang Han
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea
| | | | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea
- Correspondence: ; Tel.: +82-32-340-7044; Fax: +82-32-340-2674
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Sommer F, Brand M, Scheithauer MO, Hoffmann TK, Theodoraki MN, Weber R. [Diagnosis and Treatment in frontobasal fractures]. HNO 2023; 71:35-47. [PMID: 36525033 DOI: 10.1007/s00106-022-01256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
Traumatic brain injury can result in frontobasal fractures (FBF). The goals of treatment for FBF are to eliminate primary morbidity and/or prevent secondary morbidity. Of particular importance in this regard is the proximity of important sensory organs for hearing, vision, smell, and taste, as well as their supplying nervous structures. Medical history, clinical findings, or CT scan are necessary and should lead to an individual evaluation. Depending on the severity of the fractures, the following disciplines may be involved in the treatment of FBF: neurosurgery, plastic surgery, oral and maxillofacial surgery, and/or otorhinolaryngology. Particularly less invasive endoscopic endonasal therapy is a specialty of otorhinolaryngologic surgeons and has not been widely established in other disciplines. The present work provides an overview of the current state of the art in terms of the following aspects, taking into account the current literature: anatomic principles, classification of fractures, diagnostics (in particular clinical examination, imaging, and laboratory chemistry tests), clinical symptoms, and treatment.
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Affiliation(s)
- F Sommer
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89075, Ulm, Deutschland.
| | - M Brand
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - M O Scheithauer
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - T K Hoffmann
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - M-N Theodoraki
- Universitätsklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - R Weber
- Hals-Nasen-Ohrenklinik des Städtischen Klinikums Karlsruhe, Karlsruhe, Deutschland
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Hwang SH, Kim SW, Kim DH. Efficacy of Imaging Methods in the Detection and Diagnosis of Cerebrospinal Fluid Rhinorrhea. Laryngoscope 2022; 133:1281-1287. [PMID: 36125276 DOI: 10.1002/lary.30388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the diagnostic efficacy of various imaging methods in patients with suspected cerebrospinal fluid (CSF) rhinorrhea. DATA SOURCES The PubMed, EMBASE, SCOPUS, Web of Science, Cochrane Trials, and Google Scholar databases were searched up to December 2021. REVIEW METHODS Diagnostic accuracy was compared among seven radiological methods: computed tomography (CT), CT cisternography (CTC), magnetic resonance imaging (MRI), magnetic resonance cisternography (MRC), CT + MRI, radionuclide cisternography, and intrathecal gadolinium (Gd)-MRC. Sensitivity, specificity, and accuracy were used as outcomes of the analysis. Both a traditional pairwise meta-analysis and a network meta-analysis were performed. RESULTS Twenty-three trials were included in the analysis. The results of a network meta-analysis performed on a network consisting of seven diagnostic methods showed that all imaging modalities had greater diagnostic accuracy than CT, with the exception of CTC, which had lower sensitivity. Only intrathecal Gd-MRC was significantly superior to other imaging methods with regard to sensitivity and accuracy. Gd-MRC also showed the greatest surface under the cumulative ranking curve values for all of the outcomes (sensitivity: 0.9200; specificity: 0.8364; accuracy: 0.8920). CONCLUSION This network meta-analysis demonstrates that intrathecal Gd-MRC is the most useful diagnostic method to detect CSF rhinorrhea. Laryngoscope, 2022.
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Affiliation(s)
- Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sun Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Surgical Repair of Skull Base CSF Leaks after Cisternography Diagnosis: Analysis of Validity and Surgical Outcome and Impact on Future Treatment Strategies. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8740352. [PMID: 35528177 PMCID: PMC9076329 DOI: 10.1155/2022/8740352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/09/2022] [Indexed: 11/22/2022]
Abstract
Skull base cerebrospinal fluid (CSF) leaks can lead to severe complications and require appropriate diagnosis and treatment. Cisternography is applied when exact localization via conventional imaging is not successful. The present study is aimed at identifying factors with potential impact on radiological results and surgical success. Cisternography followed by surgical repair due to skull base CSF leaks was performed in 63 cases between 2002 and 2020. The clinical and radiological findings were analyzed retrospectively. The etiology of CSF leaks was traumatic in 30.2%, spontaneous in 36.5%, and iatrogenic in 33.3%. The sensitivity of cisternography was 87.9%. Spontaneous CSF leaks tended to be diagnosed less frequently via cisternography and were significantly less frequently localized intraoperatively. The median postoperative follow-up period was 34 months. The primary surgical success rate was 79.4%, with a significantly higher success rate for lateral than for anterior skull base defects. Surgical failure tended to be lower in iatrogenic and higher in traumatic defects. Cisternography proved to be a highly sensitive method to localize skull base CSF leaks and can be recommended for advanced diagnostics. Iatrogenic leaks seemed to be more likely to have a favorable surgical outcome, whereas traumatic leaks tended to have a lower surgical success rate.
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Wei X, Zhang F, Qiu Y, Shen H, Ilyasova T, Liu L. Intraoperative Injection of Normal Saline Through Lumbar Drainage for Transnasal Endoscopic Repair of Complex CSF Leaks. Front Surg 2022; 9:861406. [PMID: 35388360 PMCID: PMC8977469 DOI: 10.3389/fsurg.2022.861406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective It is well known that accurate location of the leak in the operation is crucial for repairing cerebrospinal fluid leakage. The study aims to investigate the application of intraoperative injection of normal saline through lumbar drainage in repairing complex leaks. Methods The fistulas of all patients with CSF leak were located by computed tomography cisternography (CTC) or heavy T2 magnetic resonance imaging (MRI) before surgery. Before anesthesia, the patient underwent lumbar drainage implantation, and then 20 ml of normal saline was slowly injected through the lumbar drainage to observe the patient's response. The surgical approach was designed based on the preoperative imaging data. When the operation was near to the suspected fistula, normal saline was injected through lumbar drainage (20 ml each time) to confirm the leak location. After CSF leak repair, saline was injected again to confirm whether the repair was successfully. Result Of the 5 patients with complex leaks, 4 cases were repaired by transnasal endoscopy method, and 1 case was repaired by transnasal endoscopy method and epidural method. A total of 7 leaks were found during the operation. During the operation, 40–120 ml of normal saline was injected through lumbar drainage. Cauda equina neuralgia was developed in patients who received 120 ml normal saline, which was relieved by intrathecal injection of dexamethasone. During the follow-up of 3 months, 1 case suffered from brain abscess, which was controlled by vancomycin. There was no recurrence of rhinorrhea. Conclusion Intraoperative injection of normal saline through lumbar drainage can not only better expose the complex leak but also check the repair effect of the leak during transnasal endoscopic repair, which is effective and avoids side effects.
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Affiliation(s)
- Xiaoming Wei
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Department of Neurosurgery, First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Fan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yankai Qiu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Shen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tatiana Ilyasova
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - Li Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Kinoshita K, Nishida H, Kanegi R, Nakamoto Y, Tanaka T, Shimamura S, Kusumoto K, Akiyoshi H. Case Report: Detection of Transferrin in a Dog Suspected of Having Cerebrospinal Fluid Rhinorrhea. Front Vet Sci 2022; 9:845809. [PMID: 35310418 PMCID: PMC8931393 DOI: 10.3389/fvets.2022.845809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/31/2022] [Indexed: 11/24/2022] Open
Abstract
A 12-year-old Yorkshire terrier was referred for epileptic seizures and nasal discharge. The fluid was clear and serous. Cerebrospinal fluid (CSF) rhinorrhea was suspected, based on clinical signs and MRI findings. In humans, analysis of nasal secretions to determine the concentration of glucose and brain-type transferrin has been widely used clinically in order to confirm the presence of CSF rhinorrhea. The glucose concentration in the nasal discharge was 74 mg/dL. Serum-type and brain-type isoforms of transferrin were detectable in the nasal sample. The concentration of glucose and brain-type transferrin could be useful for diagnosing CSF rhinorrhea.
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Affiliation(s)
- Kosuke Kinoshita
- Veterinary Medical Center, Osaka Prefecture University, Izumisano, Japan
| | - Hidetaka Nishida
- Veterinary Medical Center, Osaka Prefecture University, Izumisano, Japan
- Laboratory of Veterinary Surgery, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Japan
- *Correspondence: Hidetaka Nishida
| | - Ryoji Kanegi
- Veterinary Medical Center, Osaka Prefecture University, Izumisano, Japan
| | - Yuya Nakamoto
- Veterinary Medical Center, Osaka Prefecture University, Izumisano, Japan
- Neuro Vets Animal Neurology Clinic, Kyoto, Japan
| | - Toshiyuki Tanaka
- Veterinary Medical Center, Osaka Prefecture University, Izumisano, Japan
| | - Shunsuke Shimamura
- Veterinary Medical Center, Osaka Prefecture University, Izumisano, Japan
| | | | - Hideo Akiyoshi
- Veterinary Medical Center, Osaka Prefecture University, Izumisano, Japan
- Laboratory of Veterinary Surgery, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Japan
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Duan H, Jiang X, Li C, Chen M, Zhang B, Huang Y, Zhao Q, Mou Y. Application of a three-dimensional printed model to localize a cranial cerebrospinal fluid leak: a case report. J Int Med Res 2022; 50:3000605221078412. [PMID: 35220787 PMCID: PMC8987368 DOI: 10.1177/03000605221078412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Localization of defect sites is a major challenge for surgical repair of cerebrospinal
fluid (CSF) leaks. Here, we report a case in which we applied a 3-dimensional (3D) printed
model to accurately identify the defect sites and facilitate the successful repair of a
cranial CSF leak. A 37-year-old female patient diagnosed with recurrent nasopharyngeal
carcinoma suffered CSF rhinorrhea and severe bacterial meningitis. Lumbar drainage and
antibiotic administration failed to control the condition. In addition to high resolution
computed tomography and magnetic resonance imaging, we applied a 3D printed model of the
skull to improve the understanding of the osseous destruction at the skull base and aid in
accurately localizing the defect sites of the right middle fossa. Accordingly, a right
temporalis pedicled flap combined with an autogenous fascia lata flap was applied to cover
the defect sites. The leak stopped postoperatively, and meningitis was relieved by
enhanced antibacterial treatment. As a complement to high resolution computed tomography
and magnetic resonance imaging, a 3D printed model may improve localization of complex
defect sites and surgical planning by allowing preoperative visualization of the skull
condition.
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Affiliation(s)
- Hao Duan
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangzhou, China
| | - Xiaobing Jiang
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangzhou, China
| | - Chang Li
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangzhou, China
| | - Mingyuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangzhou, China
| | - Bei Zhang
- VIP Department, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangzhou, China
| | - Yuanyuan Huang
- VIP Department, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangzhou, China
| | - Qingyu Zhao
- Intensive Care Unit, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangzhou, China
| | - Yonggao Mou
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangzhou, China
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Chou CH, Huang TH, Hsieh PC, Ho NYJ, Chen CA, Wu K, Tsai TT. Quantitative lateral flow immunoassay for rapid detection and monitoring of cerebrospinal fluid leakage following incidental durotomy. Anal Chim Acta 2022; 1196:339544. [DOI: 10.1016/j.aca.2022.339544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
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12
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Kim DH, Kim SW, Kim SH, Jung JH, Hwang SH. Usefulness of imaging studies for diagnosing and localizing cerebrospinal fluid rhinorrhea: A systematic review and meta-analysis. Int Forum Allergy Rhinol 2021; 12:828-837. [PMID: 34889068 DOI: 10.1002/alr.22932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/23/2021] [Accepted: 12/01/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To evaluate the usefulness of diagnosis by imaging studies for the localization of cerebrospinal fluid rhinorrhea. METHODS PubMed, SCOPUS, Embase, Web of Science, and Cochrane library databases were searched up to July 2021. True and false positive and negative data were collected along with the characteristics of each study. Methodological quality was assessed using the QADAS-2 tool. RESULTS Sixteen studies involving 472 patients were included. The diagnostic odds ratio of imaging studies was 13.6195 (95% confidence interval [7.4756; 24.8129]; I2 = 28.1%). The area under the summary receiver operating characteristic curve was 0.712. Sensitivity, specificity, negative predictive value, and positive predictive value were 0.8507 ([0.7773; 0.9029]; 72.1%), 0.7827 ([0.6865; 0.8556], 26.8%), 0.5828 ([0.4398; 0.7132]; 67.4%), and 0.9407 ([0.8935; 0.9678]; 59.1%), respectively. In subgroup analysis, there were significant differences in sensitivity (computed tomography, 0.7421; computed tomography cisternography, 0.8872; magnetic resonance imaging, 0.8365; magnetic resonance cisternography, 0.8565; and intrathecal gadolinium magnetic resonance cisternography, 0.9307; radionuclide cisteronography, 0.7097; p = 0.0481), and negative predictive value among imaging modalities (computed tomography, 0.3028; computed tomography cisternography, 0.4848; magnetic resonance imaging, 0.4658; magnetic resonance cisternography, 0.7465; and intrathecal gadolinium magnetic resonance cisternography, 0.8611, and radionuclide cisteronography, 0.5263; p = 0.0046). There were no significant differences among imaging modalities in specificity, positive predictive value, or diagnostic odds ratio (p > 0.05). CONCLUSION Imaging studies can be used in the diagnosis of cerebrospinal fluid rhinorrhea. Gadolinium magnetic resonance cisternography showed the highest diagnostic accuracy. Also, magnetic resonance cisternography showed fair diagnostic accuracy without intrathecal injection. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So-Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hoon Jung
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Xie M, Zhou K, Kachra S, McHugh T, Sommer DD. Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review. Am J Rhinol Allergy 2021; 36:397-406. [PMID: 34846218 PMCID: PMC8972957 DOI: 10.1177/19458924211060918] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Cerebrospinal fluid (CSF) rhinorrhea results from abnormal communications between the subarachnoid and sinonasal spaces. Accurate preoperative diagnosis and localization are vital for positive clinical outcomes. However, the diagnosis and localization of CSF rhinorrhea remain suboptimal due to a lack of accurate understanding of test characteristics. Objective This systematic review aims to assess the diagnostic accuracy of various tests and imaging modalities for diagnosing and localizing CSF rhinorrhea. Methods A systematic review of the MEDLINE and EMBASE databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Our search identified 4039 articles—53 cohort studies and 24 case series describing 1622 patients were included. The studies were heterogeneous and had a wide range of sensitivities and specificities. Many specificities were incalculable due to a lack of true negative and false positive results, thus precluding a meta-analysis. Median sensitivities and specificities were calculated for cohort studies of the following investigations: high-resolution computed tomography (HRCT) 0.93/0.50 (sensitivity/specificity), magnetic resonance cisternography (MRC) 0.94/0.77, computed tomography cisternography (CTC) 0.95/1.00, radionuclide cisternography (RNC) 0.90/0.50, and contrast-enhanced magnetic resonance cisternography (CEMRC) 0.99/1.00, endoscopy 0.58/1.00, topical intranasal fluorescein (TIF) 1.00/incalculable, intrathecal fluorescein (ITF) 0.96/1.00. Case series were reviewed separately. Etiology and site-specific data were also analyzed. Conclusion MR cisternography is more accurate than high-resolution CT at diagnosing and localizing CSF rhinorrhea. CT cisternography, contrast-enhanced MR cisternography, and radionuclide cisternography have good diagnostic characteristics but are invasive. Intrathecal fluorescein shows promising data but has not been widely adopted for purely diagnostic use. Office endoscopy has limited data but does not sufficiently diagnose CSF rhinorrhea independently. These findings confirm with current guidelines and evidence.
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Affiliation(s)
- Michael Xie
- Division of Otolaryngology - Head and Neck Surgery, 3710McMaster University, Hamilton, ON, Canada
| | - Kelvin Zhou
- Division of Otolaryngology - Head and Neck Surgery, 3710McMaster University, Hamilton, ON, Canada
| | - Shamez Kachra
- 12362Michael G. DeGroote School of Medicine, 3710McMaster University, Hamilton, ON, Canada
| | - Tobial McHugh
- Division of Otolaryngology - Head and Neck Surgery, 3710McMaster University, Hamilton, ON, Canada
| | - Doron D Sommer
- Division of Otolaryngology - Head and Neck Surgery, 3710McMaster University, Hamilton, ON, Canada
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14
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Albaharna H, Alshareef M, Alromaih S, Aloulah M, Alsaleh S, Alroqi A. Topical Intranasal Fluorescein to Diagnose and Localize Cerebrospinal Fluid Leak: A Systematic Review. Turk Arch Otorhinolaryngol 2021; 59:223-229. [PMID: 34713008 PMCID: PMC8527542 DOI: 10.4274/tao.2021.2021-3-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: This study evaluates the available evidence regarding using topical intranasal fluorescein (TINF) to diagnose and localize nasal cerebrospinal fluid (CSF) leak. Methods: A literature search was conducted through PubMed, the Cochrane Database, Scopus, and Ovid to identify the articles providing insight into using TINF to diagnose CSF leak preoperatively or to localize the leak intraoperatively. The articles from the database were screened and filtered by two authors according to the selection criteria. A spreadsheet was created to collect the data including demographic characteristics, the sensitivity and specificity of TINF for diagnosing and localizing a CSF leak, the protocol of applying TINF, and the complications. Results: After excluding duplicates and articles that did not meet our selection criteria, we included five reports in the final analysis. The average age of the 94 participants was 39.5, and there was an equal distribution of males and females. The sensitivity of TINF to make a preoperative diagnosis of CSF leak was 100%, and it was 97% to localize the site intraoperatively. Complications associated with TINF were not reported in any of the reports. This review showed a grade C recommendation based on five case series. Conclusion: Based on the current evidence, TINF cannot be recommended for standard clinical practice. It can, however, be considered in situations where other gold standard tools are unavailable since it is feasible and easy to use. A standardized control trial should be conducted to yield additional unbiased evidence.
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Affiliation(s)
- Hussain Albaharna
- Department of Otolaryngology-Head and Neck surgery, Qatif Central Hospital, Qatif, Eastern province, Saudi Arabia.,Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alshareef
- Department of Otolaryngology-Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushait City, Saudi Arabia.,Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
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15
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Galli J, Morelli F, Rigante M, Paludetti G. Management of cerebrospinal fluid leak: the importance of multidisciplinary approach. ACTA ACUST UNITED AC 2021; 41:S18-S29. [PMID: 34060517 PMCID: PMC8172102 DOI: 10.14639/0392-100x-suppl.1-41-2021-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/08/2021] [Indexed: 01/20/2023]
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.
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Affiliation(s)
- Jacopo Galli
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Morelli
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Rigante
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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16
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Yushvayev E, Delman BN, Kirsch CFE. Special MRI Techniques to Suss out Spontaneous Cerebrospinal Fluid Leaks. Top Magn Reson Imaging 2021; 30:159-166. [PMID: 34096899 DOI: 10.1097/rmr.0000000000000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Anterior skull base cerebrospinal fluid (CSF) fistulas result from skull base osteodural defects, allowing subarachnoid space CSF to escape into pneumatized cavities such as the paranasal sinuses and nasal fossa. Precise localization, characterization, and effective treatment of CSF leaks is essential to prevent meningitis, treatment failure, or recurrence. Advances in magnetic resonance imaging have improved radiologists' ability to localize and characterize anterior skull base CSF fistulas. This article reviews new imaging techniques enabling diagnostic location of CSF fistulas, with an emphasis on magnetic resonance imaging-based techniques.
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17
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Duman IE, Demerath T, Stadler A, Elsheikh S, Raithel E, Forman C, Hildenbrand T, Shah M, Grauvogel J, Scheiwe C, Urbach H, Meckel S. High-Resolution Gadolinium-Enhanced MR Cisternography Using Compressed-Sensing T1 SPACE Technique for Detection of Intracranial CSF Leaks. AJNR Am J Neuroradiol 2020; 42:116-118. [PMID: 33122210 DOI: 10.3174/ajnr.a6852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/16/2020] [Indexed: 11/07/2022]
Abstract
In patients with CSF rhinorrhea, accurate identification of the CSF leakage site is crucial for surgical planning. We describe the application of a novel gadolinium-enhanced high-resolution 3D compressed-sensing T1 SPACE technique for MR cisternography and compare findings with CT cisternography and intraoperative results. In our pilot experience with 7 patients, precise detection of CSF leaks was feasible using compressed-sensing T1 SPACE, which appeared to be superior to CT cisternography.
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Affiliation(s)
- I E Duman
- From the Departments of Neuroradiology (I.E.D., T.D., A.S., S.E., H.U., S.M.)
| | - T Demerath
- From the Departments of Neuroradiology (I.E.D., T.D., A.S., S.E., H.U., S.M.)
| | - A Stadler
- From the Departments of Neuroradiology (I.E.D., T.D., A.S., S.E., H.U., S.M.)
| | - S Elsheikh
- From the Departments of Neuroradiology (I.E.D., T.D., A.S., S.E., H.U., S.M.)
| | - E Raithel
- Siemens Healthcare GmbH (E.R., C.F.), Erlangen, Germany
| | - C Forman
- Siemens Healthcare GmbH (E.R., C.F.), Erlangen, Germany
| | | | - M Shah
- Neurosurgery (M.S., J.G., C.S.), University of Freiburg Medical Center, Faculty of Medicine, University of Freiburg, Freiberg, Germany
| | - J Grauvogel
- Neurosurgery (M.S., J.G., C.S.), University of Freiburg Medical Center, Faculty of Medicine, University of Freiburg, Freiberg, Germany
| | - C Scheiwe
- Neurosurgery (M.S., J.G., C.S.), University of Freiburg Medical Center, Faculty of Medicine, University of Freiburg, Freiberg, Germany
| | - H Urbach
- From the Departments of Neuroradiology (I.E.D., T.D., A.S., S.E., H.U., S.M.)
| | - S Meckel
- From the Departments of Neuroradiology (I.E.D., T.D., A.S., S.E., H.U., S.M.)
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18
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International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea. Int Forum Allergy Rhinol 2020; 11:794-803. [DOI: 10.1002/alr.22704] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 01/03/2023]
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19
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Le Roux MK, Thollon L, Godio-Raboutet Y, Carbonnel E, Guyot L, Graillon N, Foletti JM. The association of Le Fort midfacial fractures with frontobasal injuries: a 17-year review of 125 cases, reflections on biomechanics, classifications and treatment. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:561-565. [PMID: 33035710 DOI: 10.1016/j.jormas.2020.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
The frequency of midface and frontobasal fractures has increased over the past 40 years despite the improvement and stringent regulation implemented on modern safety equipment (belts, helmets…). This observation might be correlated with the progress of radiodiagnosis tools. Literature was reviewed according to Prisma guidelines. We searched for reviewed articles, published between January 2000 and December 2017, through Medline (Pubmed) online databases and ScienceDirect, using the following MeSH Keywords: "Le Fort classification", "Le Fort fracture", "Frontobasal fracture", "skull base fracture", "Midface Fractures". Among 652 patients with frontobasal fractures, 125 (19.1%) were associated with a Le Fort fracture. 59 (9%) were associated with Le Fort III fracture, 51 (7.8%) with Le Fort II fracture and 15 (2.3%) with Le Fort I fracture. When frontobasal fractures were associated with midfacial fractures, we found 18 cerebrospinal fluid leaks (11.8 %) and 19 cases of meningitis (12.5 %). When only the frontobasal area was involved, there were 6 cerebrospinal fluid leaks (4.3 %) and 6 meningitis (4.3 %). Our results highlight a regular association between Le Fort fractures and frontobasal fractures for stages II and stage III of Le Fort fractures and also found a higher rate of neuro-septic complication. Further research shall investigate treatment and monitoring recommendations fitting modern epidemiology of craniofacial traumatology.
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Affiliation(s)
- Marc-Kevin Le Roux
- Surgery Department Maxillofacial and Stomatology of Pr Chossegros. CHU Conception, 147 Boulevard Baille, 13005 Marseille. France; Aix Marseille University, SPMC EA 3279, Jardin du Pharo - 58, Boulevard Charles Livon, 13284 Marseille Cedex 07, France; Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.
| | - Lionel Thollon
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | | | - Emeric Carbonnel
- Surgery Department Maxillofacial and Stomatology of Pr Chossegros. CHU Conception, 147 Boulevard Baille, 13005 Marseille. France; Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | - Laurent Guyot
- Surgery Department Maxillofacial and Stomatology of Pr Chossegros. CHU Conception, 147 Boulevard Baille, 13005 Marseille. France; Aix Marseille University, SPMC EA 3279, Jardin du Pharo - 58, Boulevard Charles Livon, 13284 Marseille Cedex 07, France
| | - Nicolas Graillon
- Surgery Department Maxillofacial and Stomatology of Pr Chossegros. CHU Conception, 147 Boulevard Baille, 13005 Marseille. France; Aix Marseille University, SPMC EA 3279, Jardin du Pharo - 58, Boulevard Charles Livon, 13284 Marseille Cedex 07, France
| | - Jean-Marc Foletti
- Surgery Department Maxillofacial and Stomatology of Pr Chossegros. CHU Conception, 147 Boulevard Baille, 13005 Marseille. France; Aix Marseille University, SPMC EA 3279, Jardin du Pharo - 58, Boulevard Charles Livon, 13284 Marseille Cedex 07, France; Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
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20
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Ohara K, Terao T, Michishita S, Sato K, Sasaki Y, Murayama Y. Spontaneous cerebrospinal fluid otorrhea and pneumocephalus on the contralateral side of the previous cranial surgery. Surg Neurol Int 2020; 11:245. [PMID: 32905268 PMCID: PMC7468192 DOI: 10.25259/sni_268_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/30/2020] [Indexed: 11/04/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) leaks and pneumocephalus commonly occur due to head trauma or surgical procedures. Spontaneous CSF (sCSF) leaks, however, occur without any clear etiology and are relatively uncommon. Case Description An 84-year-old woman presented with the right-sided otorrhea. The patient had a history of a ventriculoperitoneal shunt placement following a subarachnoid hemorrhage treated by clip ligation of a left-sided ruptured cerebral aneurysm 7 years before presentation, with shunt catheter ligation after evidence of intraventricular pneumocephalus 6 years before presentation. At admission, computed tomography (CT) imaging of the head showed enlargement of the lateral ventricles, a right mastoid fluid collection, and a defect of the superior wall of the right petrous bone. We performed a right temporal craniotomy for the repair of the CSF leak. Intraoperatively, it was noted that temporal lobe parenchyma herniated into the mastoid air cells through lacerated dura and a partially defective tegmen mastoideum. The leak point was successfully obliterated with a pericranial graft and reinforced by a collagen sheet and fibrin glue. There was no recurrence of otorrhea postoperatively. Conclusion This report presents a very unique case of a patient with a CSF leak and pneumocephalus occurring on the contralateral side of a previous cranial surgery. We accurately identified the defect site with CT imaging and repaired the CSF leak by temporal craniotomy. Awareness of the mechanisms by which sCSF leaks can be caused by aberrant arachnoid granulations is imperative for neurosurgeons.
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Affiliation(s)
- Keiichiro Ohara
- Department of Neurosurgery, Atsugi City Hospital, Atsugi, Kanagawa, Japan
| | - Tohru Terao
- Department of Neurosurgery, Atsugi City Hospital, Atsugi, Kanagawa, Japan
| | - Shotaro Michishita
- Department of Neurosurgery, Atsugi City Hospital, Atsugi, Kanagawa, Japan
| | - Kunitomo Sato
- Department of Neurosurgery, Atsugi City Hospital, Atsugi, Kanagawa, Japan
| | - Yuichi Sasaki
- Department of Neurosurgery, Atsugi City Hospital, Atsugi, Kanagawa, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Nishi-Shimbashi, Tokyo, Japan
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21
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Chastanet S, Goga D, Paré A. Headache after septoplasty. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:139-141. [PMID: 31862429 DOI: 10.1016/j.anorl.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Chastanet
- François Rabelais University, Maxillofacial and Facial Plastic Surgery Department, Trousseau Hospital, CHU Tours, 37000, Tours, France.
| | - D Goga
- François Rabelais University, Maxillofacial and Facial Plastic Surgery Department, Trousseau Hospital, CHU Tours, 37000, Tours, France
| | - A Paré
- François Rabelais University, Maxillofacial and Facial Plastic Surgery Department, Trousseau Hospital, CHU Tours, 37000, Tours, France
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22
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Touska P, Connor SEJ. Recent advances in MRI of the head and neck, skull base and cranial nerves: new and evolving sequences, analyses and clinical applications. Br J Radiol 2019; 92:20190513. [PMID: 31529977 PMCID: PMC6913354 DOI: 10.1259/bjr.20190513] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022] Open
Abstract
MRI is an invaluable diagnostic tool in the investigation and management of patients with pathology of the head and neck. However, numerous technical challenges exist, owing to a combination of fine anatomical detail, complex geometry (that is subject to frequent motion) and susceptibility effects from both endogenous structures and exogenous implants. Over recent years, there have been rapid developments in several aspects of head and neck imaging including higher resolution, isotropic 3D sequences, diffusion-weighted and diffusion-tensor imaging as well as permeability and perfusion imaging. These have led to improvements in anatomic, dynamic and functional imaging. Further developments using contrast-enhanced 3D FLAIR for the delineation of endolymphatic structures and black bone imaging for osseous structures are opening new diagnostic avenues. Furthermore, technical advances in compressed sensing and metal artefact reduction have the capacity to improve imaging speed and quality, respectively. This review explores novel and evolving MRI sequences that can be employed to evaluate diseases of the head and neck, including the skull base.
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Affiliation(s)
- Philip Touska
- Department of Radiology, Guy’s and St. Thomas’ NHS Foundation Trust, Guy’s Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
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23
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Laboratory testing and imaging in the evaluation of cranial cerebrospinal fluid leaks and encephaloceles. Curr Opin Otolaryngol Head Neck Surg 2019; 27:339-343. [DOI: 10.1097/moo.0000000000000578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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24
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Bradbury DW, Kita AE, Hirota K, St John MA, Kamei DT. Rapid Diagnostic Test Kit for Point-of-Care Cerebrospinal Fluid Leak Detection. SLAS Technol 2019; 25:67-74. [PMID: 31544595 DOI: 10.1177/2472630319877377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cerebrospinal fluid (CSF) leaks can occur when there is communication between the intracranial cavities and the external environment. They are a common and serious complication of numerous procedures in otolaryngology, and if not treated, persistent leaks can increase a patient's risk of developing life-threatening complications such as meningitis. As it is not uncommon for patients to exhibit increased secretions postoperatively, distinguishing normal secretions from those containing CSF can be difficult. Currently, there are no proven, available tests that allow a medical provider concerned about a CSF leak to inexpensively, rapidly, and noninvasively rule out the presence of a leak. The gold standard laboratory-based test requires that a sample be sent to a tertiary site for analysis, where days to weeks may pass before results return. To address this, our group recently developed a semiquantitative, barcode-style lateral-flow immunoassay (LFA) for the quantification of the beta-trace protein, which has been reported to be an indicator of the presence of CSF leaks. In the work presented here, we created a rapid diagnostic test kit composed of our LFA, a collection swab, dilution buffers, disposable pipettes, and instructions. Validation studies demonstrated excellent predictive capabilities of this kit in distinguishing between clinical specimens containing CSF and those that did not. Our diagnostic kit for CSF leak detection can be operated by an untrained user, does not require any external equipment, and can be performed in approximately 20 min, making it well suited for use at the point of care. This kit has the potential to transform patient outcomes.
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Affiliation(s)
- Daniel W Bradbury
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Ashley E Kita
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kensuke Hirota
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Maie A St John
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, USA.,Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,UCLA Head and Neck Cancer Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel T Kamei
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, USA
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