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At least 19 recordsLinked to original sources
PubMed2003

[Endoscopic reconstruction of the anterior skull base in cerebrospinal rhinorrhea].

Cerebrospinal rhinorrhea is a discharge of cerebrospinal fluid caused by the break continuity in dura mater and by bone defect in the base of anterior skull base. The pathological connections appear mainly in the regions of the skull base with the weaker bone structure (the roof of the frontal, ethmoid, sphenoid sinus and cribriform plate). The aim of the study was presenting the possibility of the endoscopic-surgical closing the fistula within the ethmoid roof. The E.N.T Department in Poznań treated 5 patients with cerebrospinal rhinorrhea. In four cases, cerebrospinal rhinorrhea was caused by operative trauma. In one case the rhinorrhea could not be established. All patients with traumatic rhinorrhea underwent operation treatment based on covering of the loss in dura mater with a piece of mucous membrane together with perichondrium of nasal septum or lyophilised dura. The material used for the plastic operation was sealed by tissue adhesive. In 2 cases rhinorrhea recurred. Using the endoscopic technique, after the identification the leak of the cerebrospinal fluid within ethmoid roof, the fistula has been reconstructed with use of the adipose tissue and temporal muscle fascia. Both cases led to complete recovery. Easy access, precision and accuracy of performance the surgery, the approach without external incision of the patient, makes the endoscopic technique very valuable method in treating rhinorrhea caused by the loss in ethmoid roof and cribriform plate.

Adult↗
PubMed1995

['Cerebral running nose': cerebrospinal rhinorrhea].

Cerebrospinal fluid rhinorrhoea was diagnosed in two patients, a man of 19 and a woman of 45 years old. This is a relatively rare phenomenon and clinically often difficult to differentiate from nasal secretions caused by a rhinopathy. Although cerebrospinal fluid (CSF) fistulae usually are of traumatic origin as in the first patient, they can also be caused by a congenital malformation as in the second one or by a condition with chronic increased intracranial pressure. With adequate treatment the prognosis is good. CSF can be identified very specifically by beta-transferrin determination.

Adult↗
PubMed1998

[Rhinosurgical concept in management of fronto-basal defects with cerebrospinal rhinorrhea].

BACKGROUND: Cerebrospinal fluid (CSF) leak, with its potential infectious complications remains today a challenge in diagnosis and surgical treatment. With the introduction of endonasal microsurgery, new minimally invasive techniques for the repair of these defects have been pioneered. Nasal approaches to the anterior skull base include external-transfacial as well as endonasal approaches for reconstruction. It is important to have multiple possible approaches for the correction so that the optimal method for the individual pathology may be selected. The purpose of this paper is to clarify the decision process for selecting the safest procedure with the least possible morbidity and functional compromise. METHOD: In a retrospective study we assessed a group of 69 patients treated from 1988 to 1996. Patient records, CT scans, postoperative clinical follow-up and a questionnaire, sent to the patients, were evaluated. The various external and endonasal approaches are presented and the closure techniques are discussed in detail. RESULTS: Of the 69 operations, 40 (58%) were external and 29 (42%) were endonasal. There were three failures in the external approach group (4.4%) and no failures in the endonasal group. No major complications in the intraoperative or postoperative course occurred. Of importance, olfaction was retained in 94% of patients in at least one side. The average duration of hospitalization was 6 days. CONCLUSIONS: Nasal approaches to the anterior skull base for treatment of CSF leaks are highly effective, safe, and cause minimal morbidity. The optimal surgical approach is chosen according to the precise location and extent of the defect. We are now increasing using endonasal microsurgical approaches. The open, transfacial approaches are still indicated for fractures of the posterior wall of the frontal sinus as well as larger multi-fragmented fractures of the anterior skull base.

Adolescent↗
PubMed2005

[Diagnosis and therapy experience of cerebrospinal rhinorrhea in 15 cases].

OBJECTIVE: To research the diagnosis and treatment of cerebrospinal rhinorrhea. METHOD: Fifteen cerebrospinal rhinorrhea cases were retrospectively analyzed. RESULT: All 15 cases were cured in follow-up from 3 months to 5 years. Different therapeutic approaches were adopted in these cases: conservative therapeutic (4 cases), external nose approach (7 cases), and endoscopic approach (4 cases). CONCLUSION: There are several advantages in adopting endoscopic method such as operating simply, small wound, fixing cerebrospinal rhinorrhea position accurately, and fast post-operation recovering. In some cases adopting external nose approach meanwhile can make up the shortcoming of endoscope and improving operation success probability.

Adolescent↗
PubMed1977

Cerebrospinal rhinorrhea: extracranial surgical repair.

Cerebrospinal rhinorrhea is an uncommon complication of head trauma or of diverse types of intracranial diseases. Because of the risk of meningitis, this condition warrants immediate attention. If the leak fails to stop spontaneously in a short time, the precise site of the leak must be ascertained and surgical repair attempted. For the past 50 years craniotomy has been the principal operative approach; however, this method carries the risk of significant morbidity and protracted hospital stays, as well as a disappointing incidence of persistent leak. During the past decade extracranial operations for dural repair have been devised, and experience in the management of patients by a variety of such procedures illustrates the success of these operations.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1985

Diagnosis and management of ethmoid cerebrospinal rhinorrhea.

In most instances of cerebrospinal rhinorrhea, the dural defect occurs at or near the region of the ethmoid roof. The skills of the otolaryngologist are of primary importance in the diagnosis and management of this condition. In almost all cases, the dura can be repaired exclusively by an extracranial approach.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1988

[Cerebrospinal otorrhea--cerebrospinal rhinorrhea. The Salzburg concept of cerebrospinal fluid diagnosis].

The three following cerebrospinal fluid (CSF) examinations make it possible to identify even the smallest amounts of CSF in case of CSF otorrhoea and rhinorrhoea. 1. Immunological identification of beta 2-transferrin (Oberascher/Arrer) 2. Laboratory fluorescein identification (Oberascher/Arrer) 3. Endoscopic fluorescein detection according to Messerklinger. For screening, and as the method of choice, beta 2-transferrin identification is always used as a first step if there is a suspicion of liquorrhoea. Depending on the result and on further measures, both fluorescein tests are used additionally in diagnosis. Basing on practical experience gained recently, special attention is given to test analysis, the various possibilities of taking samples, and their means of transport or mailing. A newly developed diagnostic step-by-step plan is intended to emphasise the clinical significance by means of practical examples. This concept represents the present state of the art in CSF diagnosis and demonstrates that a much mor precise range of indication is possible in surgery of fractures of the base of the skull and CSF leaks if it is combined with an appropriate x-ray examination.

Brain Concussion↗
PubMed2000

[Treatment of traumatic cerebrospinal rhinorrhea in frontal sinus].

OBJECTIVE: To evaluate the indication, operative technique and advantages of the treatment of traumatic cerebrospinal rhinorrhea in frontal sinus by intranasal endoscopic surgery. METHOD: Treatment of 6 cases of traumatic cerebrospinal rhinorrhea in frontal sinus by intranasal endoscopic surgery was reported. We adopt a procedure to open and enlarge the nasofrontal duct under direct vision by intranasal endoscopic surgery firstly and find the fistula, then repair it with its own smashed muscle, and support it with muscular membrane and gelfoam, iodoform Sponges. RESULTS: Four cases were repaired successively in one procedure with intranasal endoscopic surgery, 2 cases were solved by combined external and intranasal procedure. CONCLUSIONS: The advantages of treatment of traumatic cerebrospinal rhinorrhea in frontal sinus by intranasal endoscopic surgery included easily operation, easily confirmation of fistula and high success rate, combination of frontal sinus incision may deal with its demerit to the un-reach-able site sometimes.

Adult↗
PubMed2006

[Surgical approach and materials in reparation of cerebrospinal rhinorrhea (54 cases reports)].

OBJECTIVE: To find out the best surgical approach and repair material in repairing cerebrospinal rhinorrhea by comparing their characteristics. METHOD: The clinical data of 54 cases from March 1983 to June 2001 with continuous cerebrospinal rhinorrhea treated by different approaches and repair materials were retrospective analyzed. RESULT: The highest recurrent rate was by anterior cranial fossa approach, while the lowest was by nasal endoscope. The bleeding volume in nasal endoscope approach was less than other surgical approaches with the significant differences (P <0.01). Galea frontalis myofascial flap and fascia lata were often used to repair fistula in operation. CONCLUSION: Nasal endoscope is the best approach. Cranionasal combination approach can be used in cases with larger defect in basis crania by galea frontalis myofascial flap reparation. The proper approach and repair materials should be selected according to the practical situation.

Adolescent↗
PubMed1994

[Intranasal endoscopic management of cerebrospinal rhinorrhea].

The excellent visualization and atraumatic surgical techniques of endoscopic sinus surgery have been applied to the management of five cases of cerebrospinal rhinorrhea in the last 3 years. In all the cases, the exact sites of the lesion were identified on ethmoid roof (2 cases) or sphenoid sinus (3 cases). The procedures of the operation were as follows: to enlarge the leak and at the same time to block up it with the muscles, and then covering the muscles with fascia. All of the five cases were cured by one-step surgery. The techniques and indications for endoscopic management of cerebrospinal rhinorrhea are discussed.

Adolescent↗
PubMed1975

Cerebrospinal rhinorrhea: diagnosis and management.

The role of the otolaryngologist in the diagnosis and management of cerebrospinal fluid rhinorrhea is discussed. One hundred eight cases of cerebrospinal rhinorrhea were studied with emphasis on cause, localization, and treatment. Extracranial approaches produce minimal morbidity and should be considered as possible treatment for every patient with cerebrospinal rhinorrhea with leaks located in the frontoethmoid complex, cribriform plate, or sphenoid sinus region.

Cerebrospinal Fluid Rhinorrhea↗
PubMedDate not supplied

Spontaneous cerebrospinal rhinorrhea from the sphenoid sinus.

A case of spontaneous cerebrospinal rhinorrhea from the sphenoid sinus is presented. Surgical exploration of the sinus revealed a defect of the clivus leading into the posterior fossa. Intrathecal fluorescein dye intraoperatively enabled easy identification of the site. Leakage was stopped by tamponading the sinus, using muscle from the anterior thigh.

Cerebrospinal Fluid Rhinorrhea↗
PubMed2006

[Cerebrospinal rhinorrhea--etiology, clinical signs and laboratory diagnosis].

Last studies have shown unsatisfactory diagnosis of cerebrospinal rhinorrhea. Although the majority of cerebrospinal (CSF) fistulas in the anterior skuli base are traumatic in nature, the minority is non-traumatic or primary. The authors have made an attempt of presenting on the basis of scientific reports of the physiopathology, imagin and diagnosis of cerebrospinal fluid leaks. This article introduces rapid, accurate and non-invasive biochemical methods for detection of cerebrospinal fluid leakage using combined determination of glucose, beta-trace-protein and beta-2-transferrin in secretion and serum. There are presented new invasive techniques for detection and localization of the cerebrospinal fluid leaks: CT and CT with contrast, MR cisternography and MRI cisternography in combination with single photon emission tomography. Finally, discusses different opinion in the management of the problem once it occurs.

Cerebrospinal Fluid Rhinorrhea↗
PubMed2004

New techniques and technology to repair cerebrospinal fluid rhinorrhea.

Cerebrospinal fluid rhinorrhea occurs as a result of abnormal communication between the subarachnoid space and the pneumatized portion of the skull base, the paranasal sinuses and the middle ear. Conservative measures may be sufficient in the management of cerebrospinal fluid rhinorrhea, but, in some cases, surgical treatment may be required. Transnasal endoscopic techniques are constantly being used in preference to the intra- and extracranial approaches. Recently, image guidance systems have been adopted in neurosurgery, skull base and paranasal sinus surgery. The present report refers to 4 cases of nasal cerebrospinal fluid rhinorrhea leak successfully treated with a transnasal endoscopic approach using various techniques and materials to close the bone defect, in 2 of which, the navigation system (Stealth Station Treon ENT Image Guidance System with Landmark X, Software, Medtronic, XOMED, Jacksonville, FL, USA) was also used. In all cases, correct localization and repair of the leak was achieved and no major complications occurred. Following a review of the literature, the Authors conclude that, at present, transnasal endoscopic repair of cerebrospinal fluid rhinorrhea is the surgical treatment of choice when the techniques and materials are correctly used. Furthermore, preliminary findings indicate that it is possible to make routine use of the navigation systems and that this technology may be usefully employed, above all, in the management of cerebrospinal fluid leaks.

Adult↗