Multiple spontaneous cerebrospinal fluid leaks: a rare case report and review of literature.

While a spontaneous cerebrospinal fluid leak (sCSFL) is a rare phenomenon, patients who present with multiple cerebrospinal fluid leaks (mCSFLs) are an even rarer entity. There have been documented cases reported over the last decades, but many with only limited descriptions of each patient. We present a mCSFL patient as a case report and demonstrate the need for future prospective studies to improve further understanding and management of the condition. This is explored through summarizing the literature on mCSFLs to the present time. A 45-year-old obese female presented with a 5-week history of bilateral clear nasal discharge with no previous surgery or trauma. Initially misdiagnosed as allergic rhinitis, nasal discharge was later confirmed positive for beta-2-transferrin and a CT scan revealed multiple bony areas of skull base erosion. The patient underwent image guided endoscopic sinus surgery with multilayer skull base defect repair of three active CSFLs. Three months post-operatively the patient had no evidence of a recurrence. As mCSFL tend to be sporadic and asymptomatic in nature, it is likely they are underreported. Future prospective studies in the area of mCSFLs that take into consideration demographic and geographical information are needed for more accurate interpretation and better recruitment. Additionally, studies need to ensure longer follow-up time due to the underlying chronicity of increased intracranial pressure (ICP) and investigate whether or not a non-active leak site should be repaired or left alone.

Which Tool Is Best: 3D Scanning or Photogrammetry - It Depends on the Task.

In many educational and clinical settings we are increasingly looking into methodologies for accurate 3D representations of structures and specimens. This is relevant for anatomy teaching, pathology, forensic and anthropological sciences, and various clinical fields. The question then arises which tool best suits the task at hand - both 3D scanning and photogrammetry are options. For the use in medical education the aim is to create 3D models of anatomical specimens with high quality and resolution. Various qualitative and quantitative criteria determine the performance fidelity and results of 3D scanning versus photogrammetry. In our work we found that photogrammetry provides more realistic surface textures and very good geometries for most specimens. 3D surface scanning captures more accurate geometries of complex specimens and in specimens with reflective surfaces. The 3D scanning workflow and capture method is more practical for soft specimens where movement of the sample can lead to distortions. Overall, both methods are highly recommended dependent on the nature of the specimen and the use case of the 3D model.