ABSTRACT
ABSTRACT Resection of the anterior clinoid process results in the creation of the clinoid space, an important surgical step in the exposure and clipping of clinoidal and supraclinoidal internal carotid artery aneurysms. Cerebrospinal fluid rhinorrhea is an undesired and potentially serious complication. Conservative measures may be unsuccesful, and there is no consensus on the most appropriate surgical treatment. Two patients with persistent transclinoidal CSF rhinorrhea after aneurysm surgery were successfully treated with a combined endoscopic transnasal/transeptal binostril approach using a fat graft and ipsilateral mucosal nasal septal flap. Anatomical considerations and details of the surgical technique employed are discussed, and a management plan is proposed.
RESUMO A ressecção da clinóide anterior resulta na criação do espaço clinoideo, um passo cirúrgico importante na exposição e clipagem de aneurismas dos segmentos clinoideo e supraclinoideo da artéria carótida interna. Fístula liquórica é uma das complicaçoes mais indesejadas e é potencialmente grave. O manejo com medidas conservadoras pode ser bem sucedido, e não há consenso sobre o tratamento cirúrgico mais adequado. Dois pacientes com rinorréia persistente secundária a fistula liquórica transclinoidal após cirurgia de aneurisma foram tratados com sucesso por uma abordagem endoscópica combinada transnasal/transseptal binostril usando um enxerto de gordura e retalho de mucosa naso-septal ipsilateral. Considerações anatômicas e detalhes da técnica cirúrgica empregada são discutidos, e um plano de manejo destes tipo de fistula líquorica é proposto.
Subject(s)
Humans , Female , Adult , Middle Aged , Carotid Artery Diseases/surgery , Intracranial Aneurysm/surgery , Cerebrospinal Fluid Rhinorrhea/surgery , Cerebrospinal Fluid Rhinorrhea/etiology , Craniotomy/adverse effects , Transanal Endoscopic Surgery/methods , Aneurysm/surgery , Postoperative Complications/surgery , Sphenoid Bone/anatomy & histology , Sphenoid Bone/surgery , Surgical Flaps , Carotid Artery Diseases/complications , Intracranial Aneurysm/complications , Reproducibility of Results , Treatment Outcome , Aneurysm/complications , Nasal Septum/surgeryABSTRACT
A seventy eight year old male patient was admitted in our hospital with headache, vomiting, irritability and confusion. Initially he was diagnosed as a case of pyogenic encephalitis. Further investigations revealed that patient had cerebrospinal fluid rhinorrhea and coronary artery disease. He successfully underwent coronary artery bypass grafting and cerebrospinal fluid leak repair.
Subject(s)
Aged , Cerebrospinal Fluid Leak , Cerebrospinal Fluid Rhinorrhea/etiology , Cerebrospinal Fluid Rhinorrhea/surgery , Coronary Artery Bypass, Off-Pump/methods , Humans , MaleABSTRACT
To present a rare case of cerebral venous sinus thrombosis [CVST]. A 43-year-old woman presented with coma and was diagnosed as a case of CVST. She recovered in a few days with heparin treatment. Many possible risk factors for CSVT were negative in the patient but intermittent cerebrospinal fluid [CSF] rhinorrhea was accidentally noticed. Cerebral computed tomography and magnetic resonance imaging were done. The patient was diagnosed as having spontaneous intermittent CSF rhinorrhea due to a defect in the base of the skull. This case showed the importance of being aware that a defect in the base of the skull may lead to intermittent CSF rhinorrhea in patients with CVST
Subject(s)
Humans , Female , Cerebral Veins , Cerebrospinal Fluid Rhinorrhea/etiology , Tomography, X-Ray Computed , Magnetic Resonance Imaging , Skull Base , Risk FactorsABSTRACT
Introducción: La fístula de líquido cefalorraquídeo (FLCR) no quirúrgica es una patología que requiere tratamiento quirúrgico en un alto porcentaje de los casos, siendo el abordaje endoscópico una buena alternativa. Objetivo: Describir la experiencia de nuestro hospital en el manejo endoscópico de esta patología. Material y método: Mediante estudio retrospectivo descriptivo se analizan 11 casos clínicos. Se describen antecedentes demográficos, forma de presentación, estudio, etiología, técnica quirúrgica, seguimiento, tasa de éxito y complicaciones. Resultados: Once pacientes, 9 de sexo femenino, edad promedio 44,5 años. Localización fosa anterior 8/11 y fosa media 3/11. El tamaño del defecto fue menor a 10 mm en todos los casos. La etiología fue traumática en 2/11, espontánea en 5/11 y congénita en 4/11, de éstas 3 por persistencia del conducto de Sternberg. El injerto fue mucosa más grasa 6/11 y mucosa sola en 5/11. La técnica fue overlay 8/11 y underlay en los 3 restantes. El injerto se colocó libre en 9/11 ypediculado en 2 casos. El seguimiento promedio fue 14 meses. Tasa de éxito de cierre de 100 por ciento en la primera cirugía en todos los casos (11/11). No se evidenciaron complicaciones precoces ni tardías. Conclusiones: La reparación endoscópica de FLCR no quirúrgica es una técnica poco agresiva, efectiva y de bajo riesgo.
Introduction: The cerebrospinal fluid leak (CSFL) not surgical is a pathology that needs surgical treatment in a high percentage of the cases, being the endoscopic repair a good alternative. Aim: Describe the experience of our hospital in the endoscopic repair of this pathology. Material and method: Retrospective descriptive study, 11 clinical cases are analyzed. There are described demographic antecedents, form of presentation, study, etiology, surgical technology, follow-up, rate of success and complications. Results: Eleven patients, 9 females, average age 44,5 years. Anterior skull base defect 8/11 and medial skull base 3/11. The size of the defect was less than 10 mm in all cases. The etiology was traumatic in 2/11, spontaneous 5/11 and congenital in 4/11, these 2 was Sternberg ductus. The gran was mucosa plus fat 6/11 and mucosa alone in 5/11. The overlay thecnique was 8/11 and underlay in 3 case. The gran was free on 9/11 and pedicle In 2 cases. Mean follow-up was 14 months. Success rate of close to 100 percent in the first surgery In all cases (11/11). There were no early or late complications. Conclusions: Endoscopic repair CSFL not surgical is a slightly aggressive, effective and low risk technique.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Skull Base/surgery , Endoscopy/methods , Nose/surgery , Cerebrospinal Fluid Rhinorrhea/surgery , Postoperative Complications , Postoperative Care , Preoperative Care , Drainage , Retrospective Studies , Follow-Up Studies , Fistula , Chemotherapy, Adjuvant , Cerebrospinal Fluid Rhinorrhea/etiology , Cerebrospinal Fluid Rhinorrhea/therapy , TransplantsABSTRACT
BACKGROUND: Postoperative cerebrospinal fluid (CSF) fistula is the most serious complication after transsphenoidal surgery. OBJECTIVE: To analyze the incidence of CSF fistula after endoscopic transsphenoidal surgery for tumor removal in sellar region; to discuss associated factors and methods used for sellar closure. METHOD: Retrospective study of 67 patients (73 surgeries) operated via transsphenoidal endoscopy at Hospital Vall D'Hebron and Hospital Clinic of the Universidad de Barcelona, Spain. The data collected included: age, sex, hospitalization stay, suprasellar extension of the lesion, type of tumor, evidence of intraoperative CSF fistula, complications of postoperative CSF fistula, previous surgery and radiotherapy. RESULTS: Six patients (8.2 percent) had postoperative CSF fistula, and their average hospitalization was 5 days longer with resulting complications: two of whom had pneumoencephalus and two with meningitis. No association was found between the data collected and postoperative CSF fistula. CONCLUSION: The rate of CSF fistula after endoscopic transsphenoidal surgery from the present study is contained within the literature. Unlike other reports, no association between the variables and postoperative CSF fistula was found in this report.
A fístula liquórica pós-operatória é a complicação mais séria após cirurgia transesfenoidal. OBJETIVO: Analisar a incidência de fístula liquórica após cirurgia endoscópica transesfenoidal para remoção de tumores selares, discutir fatores associados e método utilizado para fechamento selar. MÉTODO: Estudo retrospectivo de 67 pacientes (73 cirurgias) operados via endoscopia transesfenoidal no Hospital Vall D'Hebron e Hospital Clínic da Universidad de Barcelona, Espanha. Os dados coletados foram: idade, sexo, dias de internação, extensão supra-selar da lesão, tipo de tumor, evidência de fístula liquórica intra-operatória, complicações da fístula liquórica pós-operatória, cirurgia e radioterapia prévias. RESULTADOS: Seis pacientes (8.2 por cento) tiveram fístula liquórica pós-operatória. Nestes a média de internação hospitalar foi 5 dias maior e tendo complicações decorrentes: dois com pneumoencéfalo e dois com meningite. Não se encontrou associação entre os dados coletados e fístula liquórica pós-operatória. CONCLUSÃO: A taxa de fistula liquórica após cirurgia transesfenoidal endoscópica do presente estudo está dentro da literatura. Ao contrário de outros relatos, nesta pesquisa não foi encontrada associação entre as variáveis e fístula liquórica pós-operatória.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Young Adult , Cerebrospinal Fluid Rhinorrhea/etiology , Fistula/etiology , Neuroendoscopy/adverse effects , Pituitary Neoplasms/surgery , Sphenoid Bone/surgery , Neuroendoscopy/methods , Retrospective Studies , Young AdultABSTRACT
O implante auditivo de tronco cerebral foi desenvolvido para restaurar alguma audição útil em pacientes que apresentam ausência de nervo coclear bilateralmente. OBJETIVOS: Discutir a indicação, cirurgia e resultados em quatro pacientes submetidos à cirurgia para colocação de implante auditivo de tronco cerebral. CASUÍSTICA E MÉTODOS: Quatro pacientes com diagnóstico de schwannomas vestibulares bilaterais foram submetidos à cirurgia para colocação de Implante Auditivo de Tronco Cerebral durante o mesmo ato cirúrgico utilizado para a exérese de um dos tumores. Aspectos clínicos e técnicos e as referências anatômicas da cirurgia e os resultados auditivos foram analisados. RESULTADOS: Em todos os casos foram identificados as referências anatômicas ao forame de Luschka. As complicações cirúrgicas se resumiram à fístula liquórica em dois pacientes. Os eletrodos foram bem posicionados e a sensação auditiva foi suficiente para reconhecimento de sons e auxílio à leitura labial. CONCLUSÃO: Os resultados auditivos de nossos pacientes abrem uma perspectiva importante aos pacientes com surdez profunda bilateral sem integridade anatômica das vias auditivas centrais.
Auditory Brainstem Implants were developed to partially restore the hearing capabilities of patients without cochlear nerves bilaterally. AIM: this paper aims to discuss the clinical and surgical findings of four ABI patients. MATERIALS AND METHOD: four patients diagnosed with bilateral schwannomas received auditory brainstem implants (ABI) and had one of their tumors resected in the same surgical procedure. Clinical aspects, surgical technique, anatomic landmarks, and outcomes were analyzed. RESULTS: the anatomic landmarks were identified in all four patients in relation to the foramina of Luschka. Two patients had CSF leaks. The electrodes were well positioned and hearing sensation was good enough to allow for sound recognition and assist patients perform lip reading. CONCLUSION: the outcomes observed in our patients were quite encouraging and offer great perspectives for those suffering from deep bilateral deafness and impaired central auditory pathways.
Subject(s)
Adult , Female , Humans , Male , Auditory Brain Stem Implants , Cranial Nerve Neoplasms/surgery , /surgery , Cerebrospinal Fluid Rhinorrhea/etiology , Cranial Nerve Neoplasms/complications , Electric Stimulation , Hearing Tests , Magnetic Resonance Imaging , /complicationsABSTRACT
We report two children presenting with intermittent CSF rhinorrhea and recurrent meningitis. CT scan showed transethmoidal meningoencephalocele.
Subject(s)
Cerebrospinal Fluid Rhinorrhea/etiology , Child , Encephalocele/complications , Humans , Male , Meningitis/etiology , Meningocele/complications , Recurrence , Tomography, X-Ray ComputedABSTRACT
A comunicação entre o espaço subaracnóideo e a cavidade nasal ou seios frontal, etmoidal e esfenoidal denomina-se fístula liquórica rinogênica. A fístula liquórica rinogênica tem potencial de complicação com importante morbidade e mortalidade. Ela pode apresentar um verdadeiro desafio no diagnóstico, na sua localização e no seu tratamento. FORMA DE ESTUDO: estudo de série. MATERIAL E MÉTODO: Entre 1993 a 2004, 44 pacientes com fístula liquórica rinogênica foram submetidos à abordagem endoscópica no Hospital das Clínicas da Universidade de São Paulo. Os prontuários de todos os pacientes tratados foram revisados. RESULTADO: Quarenta e quatro pacientes, 16 mulheres (36 por cento) e 28 homens (64 por cento) foram incluídos no estudo. A idade variou de 02 a 68 anos (média =40,3). A etiologia, o sítio da fístula, o diagnóstico, a técnica empregada e o seguimento pós-operatório foram discutidos. CONCLUSÃO: Os autores concluíram que a técnica cirúrgica endoscópica endonasal para o tratamento de fístula liquórica rinogênica apresenta elevado sucesso, baixa morbidade e resultados em longo prazo confiáveis.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Endoscopy/methods , Cerebrospinal Fluid Rhinorrhea/surgery , Follow-Up Studies , Postoperative Period , Cerebrospinal Fluid Rhinorrhea/diagnosis , Cerebrospinal Fluid Rhinorrhea/etiology , Surgical Flaps , Sphenoid Sinus/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Although the majority of cerebrospinal [CSF] fistulas in the anterior skull base are traumatic in nature, the minority is non-traumatic or primary. Non-traumatic CSF leak can be a diagnostic and treatment challenge. We describe the diagnosis, modified methods of localization, and surgical repair of a series of nine patients who presented with non-traumatic CSF rhinorrhea and were managed between July 2000 and October 2002. Eight patients were managed via an endoscopic approach and one patient through an intracranial approach. The RI/T2-FLAIR test was used for localization of the site of the leak. The test confirmed the site of CSF leak in 6 patients. Successful repair of CSF rhinorrhea was achieved in 7 of 8 patients with a single endoscopic procedure; one patient required two procedures after a re-leak 18 months following the first repair. Non-traumatic CSF rhinorrhea is a relatively rare condition and occurs secondary to different etiologies. Among multiple techniques available for localization, MRI/FLAIR is effective, but requires further evaluation and polishing. In the absence of a large skull base lesion or tumor, endoscopic repair of CSF fistula carries a high success rate with a high margin of safety and low morbidity rate
Subject(s)
Humans , Male , Female , Cerebrospinal Fluid Rhinorrhea/etiology , Disease Management , Cerebrospinal Fluid Rhinorrhea/surgery , Tomography, X-Ray Computed , Endoscopy , EncephaloceleABSTRACT
We report the case of a young woman who presented with cerebrospinal fluid (CSF) rhinorrhea due to an undiagnosed and untreated pituitary adenoma. The tumor had extended well beyond sella turcica and caused bony erosion. The patient initially refused surgery and was treated with bromocriptine and a radiation therapy. CSF leakage did not improved and she was submitted to surgery by the transsphenoidal approach with removal of a tumor mass located in sphenoid sinus and sellar region. Origin of the leak was localized and repaired with fascia lata and a lumbar subarachnoid drain was left in place for 5 days. After 4 years she has normal serum PRL levels and no rhinorrhea. The management, complications and mechanisms involved in this rare condition are discussed
Subject(s)
Humans , Female , Adult , Adenoma/complications , Cerebrospinal Fluid Rhinorrhea/etiology , Pituitary Neoplasms/complications , Adenoma/diagnosis , Adenoma/surgery , Fistula , Follow-Up Studies , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/surgery , Sella Turcica/surgery , Sphenoid Sinus/surgeryABSTRACT
Os autores estudam uma série de pacientes com fístula do líquido céfalo-raquiano (LCR). Analisam as etiologias mais comuns desse tipo de fístula e as classificam didaticamente em dois grandes grupos: espontâneas e traumáticas. O objetivo deste estudo é discutir a conduta terapêutica e chamar a atenção para as principais dificuldades no diagnóstico dessas lesões.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Cerebrospinal Fluid Rhinorrhea/diagnosis , Fistula/diagnosis , Cerebrospinal Fluid Rhinorrhea/etiology , Cerebrospinal Fluid Rhinorrhea/therapy , Fistula/etiology , Fistula/therapyABSTRACT
É apresentado um caso de rinoliquorréia, que surgiu 12 anos após traumatismo craniano. Tendo o paciente apresentado nos últimos anos, duas meningites. A perda líquida nasal, cessou apenas após a correçäo cirúrgica de três lesöes encontradas: a nível das células da mastóide, a nível da lâmina crivosa do etmóide e por correçäo de meningoencefalocele frontal. Trata-se de um caso peculiar, para o qual näo encontramos semelhante na literatura consultada
Subject(s)
Humans , Female , Middle Aged , Cerebrospinal Fluid Rhinorrhea/diagnosis , Cerebrospinal Fluid Rhinorrhea/etiology , Cerebrospinal Fluid Rhinorrhea/surgery , Skull , Encephalocele/complications , Encephalocele/surgery , Meningocele/complications , Meningocele/surgery , Paranasal Sinuses , Postoperative Complications , Recurrence , Tomography, X-Ray ComputedABSTRACT
A case of non-traumatic "high pressure" cerebrospinal fluid rhinorrhea is reported. There was a huge fibroblastic meningioma in the left parieto-occipital region along with hydrocephalus. Initially a ventriculoperitoneal shunt was done and then 12 days later the tumor mass was removed totally. After the operations the patient became free of leakage and a direct approach for the cerebrospinal fluid rhinorrhea was not needed.