Laser-assisted cerebrospinal fluid leak repair: an animal model to test feasibility.

OBJECTIVES: To test the feasibility of laser tissue welding as a method of creating an endonasal tissue bond for the purpose of cerebrospinal fluid leak repair. STUDY DESIGN AND SETTING: An 808 nm diode laser was used with a 42% albumin solder to create laser welds in sheep nasal septal mucosa, periosteum, and in situ rabbit maxillary sinus mucosa. Each condition was tested five times. Groups were compared with Kruskal-Wallis nonparametric analysis of variance (ANOVA) and post-hoc multiple-comparisons testing with the Bonferroni test. RESULTS: The burst pressures of sheep septal mucosa (34.88 +/- 3.49 mmHg) and periosteum (30.02 +/- 2.23 mmHg) were significantly higher than suture repair. A burst pressure of 69.58 +/- 2.85 mmHg was achieved in rabbit in situ maxillary sinus mucosa. CONCLUSION: Laser welding is capable of producing tissue bonds whose burst strength exceeds that of human intracranial pressure. SIGNIFICANCE: This is the first study to examine the feasibility of laser tissue welding in endonasal tissues. The ability to produce instant transnasal tissue bonds with burst pressures that exceed human intracranial pressure make this technology ideal for cerebrospinal fluid leak repair.

Intracranial complications of sinusitis in children and adolescents and their outcomes.

OBJECTIVE: To gain insight into patterns of presentation, imaging, microbiological aspects, therapy, disease course, and outcome of intracranial complications of sinusitis (ICS), which are challenging conditions with the potential to cause significant morbidity and mortality. We reviewed our experience with ICS in children and adolescents. DESIGN: Consecutive case series with a mean follow-up of 12 months. SETTING: Tertiary pediatric referral center. PATIENTS: Consecutive sample of 25 children and adolescents treated for 35 intracranial complications (mean age, 13.2 years [range, 4-18 years]). INTERVENTIONS: Medical and surgical management. MAIN OUTCOME MEASURES: Survival and temporary and permanent neurologic sequelae. RESULTS: Most patients were adolescents (n = 19; 76%) and male (n = 19; 76%). Epidural abscess was most common (13 complications), followed by subdural empyema (n = 9), meningitis (n = 6), encephalitis (n = 2), intracerebral abscess (n = 2), and dural sinus thrombophlebitis (n = 2). Abscesses were primarily located in the frontal or frontoparietal regions. Magnetic resonance imaging was extensively used and was superior to contrast computed tomography in diagnosis. All patients received intravenous antibiotics, 21 underwent endoscopic sinus surgery, and 13 underwent neurosurgical drainage. Only 1 death occurred from sepsis secondary to meningitis (mortality, 4%). Overall, neurologic outcome was excellent. Although 10 patients (40%) had neurologic deficits, most resolved within 2 months. Only 2 patients had permanent neurologic sequelae. Among ICS, epidural abscess appeared to be a distinct clinical entity. Epidural abscesses typically presented without specific neurologic symptoms or signs, were more often associated with orbital complications, and had outcomes considerably better than the other ICS. CONCLUSION: Intracranial complications of sinusitis are challenging, but prognosis can be favorable in children and adolescents by using aggressive medical and surgical management.