Endoscopic transnasal cerebrospinal fluid leak repair: a 10 year experience.
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BACKGROUND: Endoscopic techniques have gained popularity for the repair of anterior skull base defects. OBJECTIVE: To describe the 10 year experience with endoscopic surgical repair of cerebrospinal fluid (CSF) rhinorrhea in a tertiary medical center. METHODS: The files of all patients who underwent endoscopic transnasal CSF leak repair in our institution between 1996 and 2006 were reviewed. RESULTS: Twenty-four patients were identified: 16 women and 7 men with a mean age of 48 years and one child aged 9.5 years. The leak was trauma-induced in 17 patients and occurred spontaneously in the other 7. The defect was localized by preoperative computed tomography or CT/cysternography in 86% of cases. A fascia lata graft was the dominant choice for defect closure, and it was combined with a conchal or septal flap, fat, periosteum, or fibrin glue in 15 patients. The success rate was 83% after the first closure attempt and 91% after the second. Two patients required a craniotomy at the third attempt. Mean hospitalization time was 6.7 days. There were two minor complications. Two patients were lost to follow-up; none of the others had a recurrence during 2 years of follow-up. CONCLUSIONS: The endoscopic transnasal technique for the repair of CSF rhinorrhea is associated with a high success rate and low morbidity, and it should be considered for the majority of cases. Repeated attempts may improve success. (+info)
Effects of phenytoin sodium on dura mater healing in a rat model of CSF leakage.
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Prevention of postoperative intracranial infection in patients with cerebrospinal fluid rhinorrhea.
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BACKGROUND: Intracranial infection is a common postoperative complication of neurosurgery. This study aimed to identify risk factors of postoperative intracranial infection in patients with cerebrospinal fluid rhinorrhea and to suggest proposals for the prevention. METHODS: A total of 167 patients (113 males and 54 males, average age of 34.4 years) with cerebrospinal fluid rhinorrhea operated on by the senior author were retrospectively reviewed. The data collected included etiology, previous history, clinical manifestation, site of bone defect, operative approach, and postoperative complications. Risk factor(s) for postoperative infection were analyzed using the stepwise multiple Logistic regression. RESULTS: Eighteen (10.8%) patients were infected post-operatively. The independent risk factors for infection were the site of defect (RR = 0.508, 95%CI 0.306 - 0.843, P = 0.009) and historical meningitis (RR = 0.290, 95%CI 0.094 - 0.893, P = 0.031). Patients with multiple defects and saddle floor defects had a higher infection rate. The germiculture was positive in 11 patients, and vancomycin was sensitive to all the pathogenesis. Nine infected patients needed lumbar drainage. Ten patients had hyponatremia, and hydrocephalus occurred in two patients with serious trauma. CONCLUSIONS: To prevent the infection, we should pay closer attention to the high-risk patients pre-operation. During the operation, the methods those can improve wound healing, such as using blood-supply materials, reliable fixation, and eliminating dead space are all helpful. Conducting lumbar drainage and choosing effective prophylactic antibiotics in the early postoperative stage for the high-risk patients are methods of postoperative management. (+info)
Supra-diaphragmatic pituitary adenoma removed through the trans-tuberculum sellae approach. Case report.
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A 59-year-old woman presented with a rare supra-diaphragmatic pituitary adenoma manifesting as a mass lesion. Her baseline data and the response of anterior pituitary hormones to the provocation test were within the normal range. Magnetic resonance imaging showed a homogeneously enhanced tumor located on the diaphragma sellae. The tumor was totally removed by the endonasal trans-tuberculum sellae approach under combined microscopic and endoscopic observation. Her postoperative course was uneventful and the histological diagnosis was pituitary adenoma located in the suprasellar region. The trans-tuberculum sellae approach is a less invasive method to remove pituitary adenoma located in the suprasellar region. (+info)
Transcranial approach for spontaneous CSF rhinorrhea due to Sternberg's canal intrasphenoidal meningoencephalocele: case report and review of the literature.
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