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Ali M, Elgassim MA, Faisal HM, Saied ASS, Elgassim M. Spontaneous Cerebrospinal Fluid Rhinorrhea Secondary to Idiopathic Intracranial Hypertension. Cureus 2023; 15:e42353. [PMID: 37621837 PMCID: PMC10445175 DOI: 10.7759/cureus.42353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
The cerebrospinal fluid (CSF) is a physiological fluid that functions to protect the brain tissue and maintain intracranial pressure. Defects between the subarachnoid spaces and other spaces can cause CSF leaks. We report the case of a 37-year-old female with no known past medical history who presented to the emergency department with a history of headaches for two months, nasal drip for 1.5 months, and recurrent fevers. Idiopathic intracranial hypertension was confirmed by cranial magnetic resonance imaging (MRI) and transnasal endoscopic repair of a CSF leak defect, and an abdomen fat graft was performed followed by an Axium navigation-guided right ventriculoperitoneal shunt (VPS).
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Affiliation(s)
- Mohamed Ali
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Moayad A Elgassim
- Medical School, Taylor's University Lakeside Campus, Subang Jaya, MYS
| | | | | | - Mohamed Elgassim
- Medical School, Taylor's University Lakeside Campus, Subang Jaya, MYS
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Karki B, Acharya U, Pun B, Shrestha PS. Delayed CSF rhinorrhea presenting as a lethal acute bacterial meningitis 5 years post trauma. Clin Case Rep 2023; 11:e7320. [PMID: 37180318 PMCID: PMC10167611 DOI: 10.1002/ccr3.7320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/16/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
Key clinical message Delayed presentation of cerebrospinal fluid rhinorrhea is rare following head trauma. It is frequently complicated by meningitis if not addressed in time. This report highlights the importance of its timely management, the lack of which can lead to a fatal outcome. Abstract A 33-year-old man presented with meningitis in septic shock. He had a history of severe traumatic brain injury 5 years back following which he had a history of intermittent nasal discharge for the past 1 year. On investigation, he was found to have Streptococcus pneumoniae meningitis, and CT scan of his head showed defects in the cribriform plate which established the diagnosis of meningoencephalitis secondary to cerebrospinal fluid rhinorrhea. The patient did not survive despite appropriate antibiotics.
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Affiliation(s)
- Bipin Karki
- Department of Critical Care Medicine, Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Utsav Acharya
- Department of Anaesthesia, Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Bishika Pun
- Department of RadiologyOm Hospital and Research CenterKathmanduNepal
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Gao W, Wang X, Fang Y, Hong Y, Yan W, Zhang S, Li C. Diagnostic Value of Non-Contrast CT in Cerebrospinal Fluid Leakage After Endoscopic Transnasal Surgery for Sellar and Suprasellar Tumors. Front Oncol 2022; 11:735778. [PMID: 35127466 PMCID: PMC8810488 DOI: 10.3389/fonc.2021.735778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022] Open
Abstract
We aimed to study the relationship between pneumocephalus on non-contrast CT (NCCT) and post-operative cerebrospinal fluid leakage (p-CFL) after endoscopic transsphenoidal sellar and suprasellar tumor surgeries. Data from patients who underwent endoscopic treatment for sellar or suprasellar tumors from January 2018 to March 2020 were consecutively collected and reviewed. The NCCT pneumocephalus (NP) was measured the first day after operation and the first day after the expansive sponge was extracted. p-CFL was determined according to post-operative clinical symptoms, high resolution CT and glucose test, and expert consensus. Of the 253 patients enrolled in this study, 32 (12.6%) had p-CFL. Compared with patients without p-CFL, patients with p-CFL had a higher occurrence of intra-operative CFL, a longer operation time, a higher rate of pneumocephalus on first-day NCCT after operation (i.e., first-day NP), and a higher rate of NP volume change between two NCCT measurements (referred to as the NP change) (all p < 0.05). In multivariate regression analysis, first-day NP was independently associated with p-CFL occurrence [odds ratio (OR)=6.395, 95% confidence interval (CI)=2.236-18.290, p=0.001). After adding the NP change into the regression model, first-day NP was no longer independently associated with p-CFL, and NP change (OR = 19.457, 95% CI = 6.095–62.107, p<0.001) was independently associated with p-CFL. The receiver operating characteristic curve comparison analysis showed that NP change had a significantly better predicting value than first-day NP (area under the curve: 0.988 vs. 0.642, Z=6.451, p=0.001). NP is an effective imaging marker for predicting p-CFL after endoscopic sellar and suprasellar tumors operation, and the NP change has a better predicting value.
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Affiliation(s)
- Wei Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
- Department of Neurosurgery, Changxing People’s Hospital, Changxing, China
| | - Xiaoyu Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yuanjian Fang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yuan Hong
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Wei Yan
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Sheng Zhang
- Department of Neurology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
- *Correspondence: Sheng Zhang, ; Chenguang Li,
| | - Chenguang Li
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
- *Correspondence: Sheng Zhang, ; Chenguang Li,
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Ogasawara CT, Young K, Bonilla PJ, Noh T, Cho J. Primary Spontaneous Inferior Clival Cerebrospinal Fluid Leak. Cureus 2021; 13:e17967. [PMID: 34660152 PMCID: PMC8516020 DOI: 10.7759/cureus.17967] [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] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Primary, spontaneous cerebrospinal fluid (CSF) leaks secondary to defects in the clivus are exceedingly rare. Additionally, primary, spontaneous CSF leaks are typically present in obese women with idiopathic intracranial hypertension (IIH). In the present study, we report the first case of a primary, spontaneous CSF leak in the inferior-posterior wall of the clivus in an atypical patient with a BMI of 18.9 kg/m2 without IIH. Accurate diagnoses of CSF leaks are imperative in the context of preventing meningitis, and delays in diagnosis and treatment are associated with worse outcomes. Improved characterization of rare, spontaneous CSF leaks may prove beneficial in correctly diagnosing affected patients.
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Affiliation(s)
- Christian T Ogasawara
- Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Kurtis Young
- Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | | | - Thomas Noh
- Neurological Surgery, Henry Ford Hospital, Detroit, USA
| | - John Cho
- Otolaryngology - Head and Neck Surgery, Straub Medical Center, Honolulu, USA
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Heiler U, Pitzen T, Ruf M. Iatrogenic Intracranial Hypotension after Surgery of Adolescent Idiopathic Scoliosis due to a Misplaced Screw within the Thoracic Thecal Sac. J Neurol Surg A Cent Eur Neurosurg 2021; 83:507-510. [PMID: 34192782 DOI: 10.1055/s-0041-1728765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present the case of a postoperative intracranial hypotension due to a misplaced intrathecal screw. Although typical symptoms such as orthostatic headache were present immediately after surgery, diagnosis was hidden until 20 years later, resulting in a disastrous clinical course.
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Affiliation(s)
- Ute Heiler
- Department of Spine Surgery, SRH Klinikum Karlsbad-Langensteinbach GmbH, Karlsbad, Germany
| | - Tobias Pitzen
- Department of Spine Surgery, SRH Klinikum Karlsbad-Langensteinbach GmbH, Karlsbad, Germany
| | - Michael Ruf
- Department of Spine Surgery, SRH Klinikum Karlsbad-Langensteinbach GmbH, Karlsbad, Germany
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Tang R, Mao S, Li D, Ye H, Zhang W. Treatment and Outcomes of Iatrogenic Cerebrospinal Fluid Leak Caused by Different Surgical Procedures. World Neurosurg 2020; 143:e667-e675. [PMID: 32805467 DOI: 10.1016/j.wneu.2020.08.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Iatrogenic cerebrospinal fluid (CSF) leaks are associated with serious sequelae. We analyzed the causes, complications, treatments, and outcomes of iatrogenic CSF leaks. Furthermore, the comorbidities and outcomes between timely and delayed repairs of iatrogenic CSF leaks were also compared. METHODS Medical records of patients with iatrogenic CSF leaks from January 2010 to January 2020 were reviewed. RESULTS Iatrogenic CSF leaks can be attributed to endoscopic sinus surgery (ESS), transsphenoidal pituitary surgery, open craniotomy, or postradiation necrosis. Twenty-nine patients diagnosed with iatrogenic CSF leak were recruited. The primary diagnoses included 12 (41.4%) nasal lesions, 7 (24.2%) pituitary tumors, 3 (10.3%) anterior cranial fossa lesions, 4 (13.8%) cerebellopontine angle lesions, and 3 (10.3%) clival lesions. The longest interval from symptom onset to presentation at our hospital was observed after craniotomy, followed by transsphenoidal surgery and ESS, increasing the risks of meningitis in these patients. The most common leakage sites after ESS and transsphenoidal surgery were the cribriform plate/ethmoid roof and sella turcica, respectively, whereas the defect sites related to open craniotomy varied. The grafts used for repair varied according to the defect location and prior surgical history. Additionally, patients in whom repair was delayed had a higher incidence of meningitis (P = 0.003), than those with timely repair. CONCLUSIONS Delayed intervention of CSF leak after transsphenoidal surgery and craniotomy was observed, increasing the risks of meningitis. Timely intervention with grafts based on the defect sites and patient prior surgical history is crucial for avoiding life-threatening comorbidities.
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Affiliation(s)
- Ru Tang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Song Mao
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Dawei Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haibo Ye
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weitian Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Voultsos P, Oliva A, Grassi S, Palmiero D, Spagnolo AG. Are errors in otorhinolaryngology always a sign of medical malpractice? Review of the literature and new perspectives in the SARS-CoV-2 (COVID-19) era. ACTA ACUST UNITED AC 2020; 40:157-163. [PMID: 32519993 PMCID: PMC7416369 DOI: 10.14639/0392-100x-n0674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 05/05/2020] [Indexed: 01/16/2023]
Abstract
In medical practice, during certain procedures that usually are not regarded highly demanding, some skill-based errors, that might not be considered as medical malpractice, may occur. In fact, such errors can be caused by factors beyond the physician’s control.A review of Greek case law regarding medical malpractice in otorhinolaryngology was performed to identify cases of lawsuits that concerned medical errors during routine procedures. The analysis of the cases showed that some medical errors may cause serious complications, even if deviation from the standard of medical care is minimal. Thus, in some cases it may be difficult to make a distinction between preventable and unpreventable complications. Certain medical errors from routine medical procedures might be considered unpreventable and, therefore, classified as almost no-fault errors. A brief commentary regarding opportunities to further improve the medical liability system after the SARS-CoV-2 emergency is also given.
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Affiliation(s)
- Polychronis Voultsos
- Department of Medical Ethics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonio Oliva
- Department of Healthcare Surveillance and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Simone Grassi
- Department of Healthcare Surveillance and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Debora Palmiero
- Department of Healthcare Surveillance and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
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