Left Cribriform Plate Research Articles

Factors That Predict Recurrence Following Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea

BackgroundThe endoscopic approach has gained popularity in CSF rhinorrhea repair with high success rates, yet recurrence is frequent. In this report, we analyze our cases to determine the outcomes of endoscopic repair of CSF rhinorrhea and the effect of several perioperative factors on the success of repair. MethodsA retrospective review of 50 patients who underwent endoscopic repair of CSF rhinorrhea between January 2013 and July 2023 was performed, collecting details of presentation, surgery, and postoperative period. ResultsThe most frequent etiology was non-traumatic CSF rhinorrhea (76%) wherein the defect was most commonly located at the left cribriform plate, followed by traumatic CSF rhinorrhea (24%) wherein sphenoid defects were most frequent. Traumatic CSF rhinorrhea was more common among males and was significantly associated with anosmia. Success rate at first attempt of repair was 84%. Three patients (6%) had persistent CSF rhinorrhea, and 5 patients (10%) developed recurrence of CSF rhinorrhea. Overall, 7 patients required resurgery, with success rate after 2nd surgery of 100%. The use of 3-layered repair with fat, fascia lata and mucosal flap was protective against failure of repair, whereas bilateral defects and duration of complaints greater than 1 year were significantly associated with failure of repair. The use of lumbar drain did not demonstrate a difference in success rate of repair. ConclusionEndoscopic repair of CSF rhinorrhea appears to be safe and effective when performed with accurate localization of the site of the lesion and multi-layered repair. Potential predictors of recurrence include bilateral and long-standing defects.

Intranasal meningoencephalocele in a 1‐year‐old Staffordshire Bull Terrier with unilateral destructive rhinitis

AbstractAn 18‐month‐old male neutered Staffordshire Bull Terrier presented for chronic sneezing, left‐sided rhinorrhea and epistaxis associated with previous nasal planum depigmentation and pruritus. Physical examination did not demonstrate bone asymmetry or depigmentation, but showed reduced airflow through the left nostril. No neurologic abnormalities were present. CT identified severe destruction of the left nasal turbinates and defect of the left cribriform plate, with protrusion of the left olfactory lobe into the caudal part of the nasal cavity. Rhinoscopy did not identify fungal plaques or foreign material, and nasal biopsies were consistent with lymphoplasmacytic destructive rhinitis. Tissue cultures were negative. Clinical signs completely resolved after 2 weeks of doxycycline treatment and did not recur. There was no development of neurologic abnormalities in the 12 months after diagnosis. This is the first case report of canine meningoencephalocele presenting with rhinitis‐associated signs without detectable neurologic abnormalities.

Endoscopic endonasal cerebrospinal fluid rhinorrhea repair: a cohort study in Iraq

BackgroundCerebrospinal fluid (CSF) rhinorrhea is a condition where the protective fluid that surrounds the brain finds its way into the nose and sinuses, often appearing as a very watery runny nose. The main surgical approaches for the surgical repair of CSF leaks are intracranial and extracranial. Over the last decade, endoscopic surgery has established itself as the most widely used technique for the repair of CSF fistula. The current study aimed to describe the use of nasal endoscopic technique in the management of cerebrospinal fluid rhinorrhea repair.ResultsResults of our study showed that in addition to CSF leak, 40% of the patients had headache and 17.5% had repeated meningitis. Half of the etiologies for the CSF leak were spontaneous, 35% were congenital, and 15% were traumatic. The more frequent site of leak was left cribriform plate (37.5%). In the majority of patients, 37/40 (92.5%), the type of graft was tensor fascia lata and fat, while in the remaining 3 patients, type of graft was tensor fascia lata and bone, bone and fat, and tensor fascia lata. The repair succeeded in 35 patients giving a success rate of 87.5%.ConclusionIt can be concluded that wide range of age groups from 2–62 years presented as CSF rhinorrhea with female predominance, and there was high success rate of endoscopic CSF rhinorrhea repair with low morbidity.

NUT carcinoma of the sinonasal tract infiltrating the orbit in a man with birdshot chorioretinitis

A 48-year-old man with a history of birdshot chorioretinitis presented with blurry vision, retro-bulbar pain and sinusitis. Though visual acuity was unaffected, he had left optic disc oedema and mild restriction of left eye abduction. His symptoms progressed quickly, with diplopia in primary gaze, epistaxis from his left nostril, and a left relative afferent pupillary defect (RAPD). On computed tomography, there was a mass in the nasal cavity that extended through the left cribriform plate and lamina papyracea and posteriorly into the optic canal.Pathological examination of biopsy specimens revealed sheets of undifferentiated cells with extensive areas of necrosis and islands of squamous differentiation. The tumour cells expressed monokeratin, p63, CD34, and p16. Molecular testing indicated rearrangement of the NUTM1 (15q14) locus and fusion of the NUTM1 and BRD4 (19p13.12) loci, confirming the diagnosis of NUT carcinoma of the sinonasal tract.This is the first reported case of NUT carcinoma in a patient with birdshot chorioretinitis. The onset of chorioretinitis may have been the earliest sign of the effects of the BRD4-NUTM1 fusion protein, resulting in expression of HLA-A29. There is evidence that bromodomain and extra terminal (BET) family proteins play a role in inflammatory marker expression.

Surgical outcome of endoscopic repair of cerebrospinal fluid rhinorrhea

Background Many surgeons have practiced endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea in past decade and have gained popularity. There are several centers that adopt endoscopic repair as a first-line treatment for CSF rhinorrhea with high success rate. Objective The aim of this study was to detect the role of the transnasal endoscopic approach in the repair of the CSF rhinorrhea and assess its surgical outcome. Patients and methods A prospective study of 40 patients having CSF rhinorrhea was conducted. All patients were treated with endoscopic repair for CSF rhinorrhea at Neurosurgery Departments of Al-Azher University and specialized Hospital of Otorhinolaryngology and Neurosurgery from January 2016 to January 2018. The majority of them were men. The defects were closed in multilayers using fascia lata, septal cartilage graft, and nasal mucosa in most patients. Results The left cribriform plate area was found as the most common site of CSF leak. The spontaneous CSF leak was the most common cause of CSF rhinorrhea in this study, and post-traumatic (iatrogenic) CSF leak was the second most common cause. Our success rate of the first attempt at endoscopic repair was 90%, and in the second attempt was 97.5%. The causes that lead to recurrence of leak were large defect, failure of localization of the defect, and comorbid conditions such as bone erosion and chronic cough that developed postoperatively. Conclusion Endoscopic endonasal approach is a safe and effective way to repair CSF leaks of different causes. Multilayer repair technique is safe and effective, with low complications and preservation of nasal and neurological functions. However, more studies and long series are recommended.

Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience.

Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. The aim of our study was to analyze the etiopathogenesis of CSF rhinorrhea, the outcome of treatment and the causes of failure in a developing-country setting. A retrospective review of patients treated with endoscopic repair for CSF rhinorrhea at a tertiary care hospital in southern India from January 2002 to December 2009 identified 36 patients, the majority of them being women. The defects were closed in three layers using fat, fascia lata and nasal mucosa along with a fibrin sealant in the majority of the patients. Per-operatively, a subarachnoid drain was placed in all patients. Patients were followed up for 1 year. Spontaneous onset of CSF rhinorrhea was noted in 61% of patients. The most common site of leak was found to be the left cribriform plate area. Hence the most common cause of CSF rhinorrhea in our study was spontaneous and the second most common was post-traumatic. Our success rate on the first attempt at endoscopic repair was 100%, with a recurrence rate of 6%. A large defect, failure of localization of the defect, or other co-morbid conditions such as chronic cough may be the most likely causes of recurrence of leak. Accurate localization of the site of lesion using a high-resolution computed tomography (CT) scan with magnetic resonance imaging (MRI) and confirmation of the site of leak by intraoperative Valsalva maneuver along with multilayered closure of the dural defect and post-operative lumbar drain appear to be essential for the successful endoscopic repair of CSF rhinorrhea.

Antleroma in a Free-ranging White-tailed Deer (Odocoileus virginianus)

A 2-year-old male free-ranging white-tailed deer (Odocoileus virginianus) was diagnosed with bilateral expansile tumors of antler origin. The deer was found dead by a landowner in High Springs, Florida. Two roughly spherical, multilobular, broad-based, bony, velvet-covered masses originated from each antler pedicle. These masses replaced or displaced many of the bones and soft tissues of the skull and extended through the left cribriform plate and the right petrous temporal bone, compressing portions of the brain. Microscopically, the masses closely resembled normal-growing antler, containing all the elements thereof but with areas of necrosis and hemorrhage suggestive of ischemi or trauma. Tumorlike outgrowths termed antleromas have been described in free-ranging and captive cervids and typically are associated with disruptions in the seasonal rise and fall of circulating testosterone necessary for normal antler growth, casting, and regeneration.

Is there a relationship between cribriform plate dimensions and septal deviation angle?

The aim of this retrospective study was to investigate the relationship between cribriform plate (CP) dimensions and septal deviation degree. Coronal paranasal CT scans of 99 patients were reviewed. We measured depth and width of cribriform plate on both sides and compared with septal deviation side and septal deviation degree. Deviation angles were 6.85±1.47° for right deviations; and 7.11±1.63° for the left deviations. The mean depth of CP was 5.08±1.57mm at the right side and 5.06±1.59mm at the left side; and the mean width of CP was found 4.71±1.36mm at the right side and 4.56±1.51mm at the left side. When CP dimensions were evaluated according to the septal deviation side, mean width of CP was 4.69±1.36mm at ipsilateral side (deviated side); and 4.58±1.51mm at the contralateral side. The mean depth of CP was 4.9±1.56mm at the ipsilateral side (deviated side); and 5.22±1.58mm at the contralateral side. The CP depth at the contralateral side was significantly higher than that of the ipsilateral side (deviated side). In right SD, ipsilateral and contralateral CP depth increased. As deviation angle increased, ipsilateral and contralateral CP width, right and left CP width increased. Ipsilateral and contralateral CP width; and additionally ipsilateral and contralateral CP depth increased together. In other words, right and left CP width; and CP depth increased simultaneously. It is well known that the higher incidence of intracranial penetration is on the side where the position of the ethmoid roof (ER) is lower. The presence of septal deviation, the possibility of the deeper CP at the contralateral side should be taken into consideration to avoid iatrogenic injury.

Malignant Solitary Fibrous Tumor of the Nasal Cavity

Solitary fibrous tumors (SFTs) are unusual mesenchymal tumors that were first described as primary spindle-cell neoplasms of the pleura. These tumors have been described in many other locations, including the urogenital system, orbit, mediastinum, and upper respiratory tract. Twenty-two cases of an SFT of the paranasal sinuses and nasal cavity have been reported, but none described a malignant SFT extending through the anterior skull base. A 70-year-old man had a 6-month history of unilateral left-sided epiphora and nasal obstruction. Computed tomography and magnetic resonance imaging showed a large left-sided nasal cavity mass with extension into the left extraconal orbit and intracranial extension through the left cribriform plate and ethmoid roof. The patient underwent preoperative embolization of the internal maxillary artery and a subsequent anterior craniofacial resection via a midfacial degloving approach and a left anterior craniotomy. Histopathological analysis of the specimen was consistent with a malignant SFT.

Death related to the septorhinoplasty procedure

A 23-year-old lady was referred to a plastic surgeon with complaints of asymmetrical nostrils and a nasal hump. Septorhinoplasty surgery was performed under local anesthesia. After osteotomy and at the end of the operation, she developed unusual bleeding from the site of the operation and her neurologic condition appeared to have worsened, as indicated by deep coma, bilateral pupillary mydriasis, and lack of reflexes. Computed tomography (CT) scan revealed the presence of air within the anterior cranial fossa, an irregular defect in the floor of the anterior cranial fossa, third and fourth ventricular hemorrhage, and subarachnoid hemorrhage in the posterior cranial fossa. Unfortunately, she died on the 7th day of intensive care unit (ICU) admission. Medicolegal autopsy revealed a 2×2 cm crushed region associated with hemorrhage around it in the orbital portion of the left frontal lobe. A fracture of the left cribriform plate of the ethmoid bone was also seen. The patient's death was therefore determined to have been caused by traumatic brain injury and its complications.

鼻腔内に突出した前頭蓋底髄膜脳りゅう例

A polyp-like mass was found in the left nasal cavity of a 5-year-old girl with acute otitis media. She had had tetanic seizures several months earlier. Coronal CT scan showed a bony defect in the left cribriform plate and a soft tissue mass in the left nasal cavity. MRI revealed brain tissue protruding into the ethmoid sinus and nasal cavity and inflammatory changes in the left maxillary and ethmoid sinuses.An operation was performed via the anterior cranial fossa after conservative therapy for sinusitis. The protruding brain tissue and surrounding dura were transected at the base. Since this lesion seemed to be related to her previous seizures, a small part of the brain substance around the base of the protrusion was removed until abnormal spikes in electroencephalogram disappeared. Then an endonasal ethmoidectomy was done under endoscopic control. The bony defect of the skull base was closed successfully with a fascia lata and galeo-pericranial flap. The postoperative course was uneventful.We emphasize that meningoencephalocele must be kept in mind in the differential diagnosis when a polyp-like mass is seen in the nasal cavity of an infant. To prevent postoperative rhinogenic intracranial infection, treatment for accompanying sinusitis such as endoscopic sinus surgery is necessary.

Anterior fossa dural arteriovenous malformation supplied by bilateral ethmoidal arteries

Two cases of dural arteriovenous malformation (AVM) involving the base of the anterior cranial fossa are reported. The nidi in both cases were located in the region of the left cribriform plate and mainly supplied by the anterior ethmoidal arteries of both sides, draining through pial veins into either the cavernous sinus or the superior sagittal sinus. In the first case neurologic symptoms resulted from transient frontal lobe dysfunction presumably due to abnormal venous drainage, and the second case presented with subarachnoid hemorrhage caused by rupture of dural AVM at the base of the anterior fossa. Both cases were surgically managed and the AVMs were successfully obliterated. This unique subgroup of dural AVM in the anterior fossa is thoroughly reviewed in the literature, and the epidemiology, symptomatology, neuroradiology, surgical treatment, and associated vascular lesions are discussed.