Post-traumatic Cerebrospinal Fluid Rhinorrhea Research Articles

Postoperative Cerebrospinal Fluid Rhinorrhea with Purulent Meningitis in a Child: A Case Report

Cerebrospinal fluid rhinorrhea is a disruption of the hypopituitarism barrier that causes cerebrospinal fluid to flow through the arachnoid, dura mater and skull base into the nasal cavity or sinuses and out of the nostrils or nasopharynx exit. In patients with nasal leakage of cerebrospinal fluid, a We report a case of a boy who had intermittent and regular fever after surgery, which was treated with We report a case of a boy who had intermittent and regular fever after surgery, which was treated with oral medication but was not effective, accompanied by headache and diplopia, which resolved when the cerebrospinal fluid flowed through the nose. Clinical practice, we often see febrile children and often report spontaneous or post-traumatic cerebrospinal fluid rhinorrhoea, which can allow As a paediatrician, the clinical signs are often atypical and nowadays children often suffer from allergic rhinorrhoea, which can be caused by the presence of bacteria, viruses or atypical pathogens to retrograde into the skull and cause meningitis. Nowadays children often suffer from allergic rhinitis with similar features to cerebrospinal fluid rhinorrhoea, which requires prompt clinical The clinical signs are often atypical and nowadays children often suffer from allergic rhinitis with similar features to cerebrospinal fluid rhinorrhoea, which requires prompt clinical judgment and treatment.
 Our case shows that in children with regular fever and a regular flow of clear fluid from the nasal cavity, we need to be alert for this disease and differentiate it from diseases such as allergic rhinitis.

The Frequency of Early Post Traumatic Cerebrospinal Fluid Rhinorrhea in Patients with Head Trauma

Objective: To determine the frequency of early post-traumatic CSF (cerebrospinal fluid) rhinorrhea in patients with head trauma. Materials and Methods: A prospective study was conducted in the Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi from 13th December 2019 to 12th December 2020. This study comprised 155 patients who had suffered head trauma. All patients were followed for one week. If patients developed clear, watery discharge from the nose, this was documented as being CSF rhinorrhea. The frequency was then further divided into immediate and early. Results: The ages of the patients were 34.28 ± 14.20 years on average. The prevalence of CSF rhinorrhea was observed in 3.2% (5/155) patients. In all the patients, the CSF leak presented within the first 48 hours i.e. it was immediate. Conclusion: Although rare, this post-traumatic complication continues to be a challenge in terms of morbidity and subsequent mortality. Key Words: Cerebrospinal fluid, Rhinorrhea, Head Trauma.

Efficacy Of Conservative Management Of Early Post Traumatic Cerebrospinal Fluid Rhinorrhoea.

The incidence of Post-traumatic Cerebrospinal Fluid Rhinorrhoea (PCSFR) has been decreased due to advanced therapeutic measures. The current investigative study has been arranged to assess the efficacy of conservative management of early PCSFR. This cross-sectional study was conducted at departmental of Neurosurgery, Ayub Medical Institute, Abbottabad. Patients with traumatic brain injury having Cerebrospinal fluid rhinorrhoea with either gender having age 5-50 year and presenting within seven days of traumatic brain injury were included. Moreover, those with nasal fractures, penetrating head injuries having fever and neck stiffness were also included in the study. A total number of 120 patients having male dominancy, i.e., 86 (72%) were included in the study with the mean age of 27 years ± 8.741 in which 77 (92%) patients were in the age range of 2nd to 4th decades. The commonest cause was trauma due to Road Traffic Accidents (RTA) having 65 (54%) patients. Conservative treatment was effective in 62 (52%) patients predominantly in the patients of 3rd decade, i.e., 31 (50%), in which the effectiveness in male gender was revealed to be 52.32% (45) and effectiveness in RTA patients was recorded to be 54.83%. Similarly, the Chi-Square value was calculated for the PCSFR patients for four groups of patients (5-20, 21-30, 31-40, 41-50) to be 48.27 having critical value of 7.81 with the p-value of 1.87e-10, which completely rejects the Null-hypothesis for the patients of various ages. Based on the current investigative study, it may be concluded that PCSFR is common in middle age population with slight male dominancy. It may also be inferred that RTA is the leading cause of PCSFR in our set up and majority of the patients shows improvement after conservative management. Moreover, the effectiveness of conservative management of PCSFR could be predominantly observed in the patients of 3rd decade.

A retrospective study to analyze treatment of post traumatic cerebro spinal fluid rhinorrhea and role of trans cranial pedicled pericranial repair in present day context

: Skull base fractures are a major cause of morbidity and mortality in head injury. Anterior cranial Fossa (ACF) skull base fracture, leading to Cerebro Spinal Fluid (CSF) Rhinorrhea is one of the most commonly encountered presentation in ACF base fractures. The key to successful management of such cases lies in early diagnosis and surgical management before it leads to meningitis and avoidable mortality.To evaluate the cases of post traumatic CSF rhinorrhea and analyze the parameters utilized to guide the management strategies. An attempt was made to come up with guidelines for its management in a tertiary care hospital.This was a retrospective study in which all cases of traumatic CSF Rhinorrhea admitted to Tertiary care hospital were included. Patients were divided into three groups. First group was conservatively managed in which the rhinorrhea and serial imaging findings showed favourable response.In thesecond group patients were subjected to endoscopic repair by the ENT surgeon based on anatomical considerations. The third group included patients who were had failed the trial of conservative management and the site of leak did not favor endoscopic repair.The outcomes in all these groups were analyzed and conclusions drawn.A total of 54 patients were included in the study which was conducted between Jan 2014 to 2020. 24 were successfully managed conservatively,10 were managed with endoscopic repair and 20 were managed by bifrontal craniotomy and pedicled pericranial ACF Base repair. There was one case from the first group who developed CSF leak after one month necessitating ACF base repair. There was no recurrence reportedin the cases managed endoscopically, whereas one case subjected to craniotomy had recurrence requiring lumbar drain placement. With each transcranial surgery there was a refinement in the technique further minimizing complications. We have elaborated on the surgical nuances to ensurebetter outcomes. : Pedicledpericranial flap ACF base repair is an elegant approach which requires an understanding of the mechanism of CSF leak from skull base fractures. This procedure can easily be mastered and when performed correctly provides best results for cases where there are multiple ACF defects, those not accessible by endoscope and also in those cases where imaging is not able to localize the exact site of defect leading to CSF rhinorrhea. Anosmia is an in evitable complication of this procedure. However, the trade off between mortality resulting from meningitis versus anosmia makes it a viable and attractive treatment option.

Post-traumatic cerebrospinal fluid rhinorrhea and Transcranial approach surgical outcomes.

Objective: To assess the outcomes of the transcranial approach in traumatic cerebrospinal fluid rhinorrhea. Study Design: Descriptive study. Setting: J.P.M.C, Karachi. Period: 15-1-2017 to 17-7- 2019. Material & Method: Total of 57 patient were included. Including criteria were patient with a history of trauma, fall, assault, and delayed onset, however, patients presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea, brain abscess, brain space-occupying lesion, skull base surgery operated elsewhere were excluded. fasia lata, Pericranial flaps were used for the surgical repair. Data were analyzed on SPSS version 22.0. Result: Patients gone through the surgical approach having intradural repair in all patients, 25 (43.85%) patients with fasia lata graft while pericranium in 32 (56.1%) and the defect was filled with small bone pieces. In 38(66.6%) unilateral sub frontal approach was done while in 19 patients (33.3 %%) bicoronal craniotomy was carried out. All patient had dura defected, 37 patients (64.9%) had a fractured cribriform plate, 9 (15%) patient had fovea ethmoidal fracture. 30(52.63%) had right side leak, 20 had left side leak (35%), 7(12.28%) had bilateral from both nasals leakage. No reoperation was done. 93% procedure showed successfully. Conclusions: This method is effective with the low rate of morbidity in patients, it can be preferred for traumatic cerebrospinal fluid (CSF) leaks with the injuries associated with the brain, recurrent leak cases with a success rate of > 93%

Endoscopic endonasal resection of midline cranial base tumors

Objective: The advent of the endoscope in transsphenoidalsurgery has permitted to expand the indications of such approach also for the treatment of on tumors located in supra, para, retro and infrasellar regions, enabling the neurosurgeon to work under direct visual control in a minimally invasive way. Since 2004 we have started to use the extended endonasal transsphenoidal approach for a variety of lesions involving the midline skull base and, in particular, the suprasellar area, the cavernous sinus and the retroclival prepontine region. Methods: Over a 36-month period, sixty-four procedures have been performed. The series consisted of 29 males and 35 females, aged from 24 to 80 years (median 49.8 years). The mean follow-up was of 18 months (ranging from 3 to 36 months). Among the patients with midline lesions, who were 90.6 % of the total, seven patients had a pituitary adenoma, sixteen patients were affected by a craniopharyngioma, six patients had a suprasellar Rathke’s cleft cyst, seven subjects had a tuberculum sellae meningioma, four had an olfactorygroove meningioma, and six a clival tumor. Other lesions ofthe midline skull base were, 1 chiasmatic astrocytoma, 1 neuroendocrine tumor, 4 post-traumatic cerebro-spinal fluid rhinorrhea, and one optic nerve glioma. Three other patients had anterior cranial base meningoencephaloceles. Results: Overall, gross total removal of the lesion was achieved in 30/49 tumoral lesions (61.2%); subtotal removal was achieved in 12/49 cases (24.5%). The three cases of meningoencephaloceles were all successfully treated. Among the patients with preoperative visual deficits, most of them fully recovered or improved and only two worsened in one eye. Major complications consisted in 2 deaths (one not directly related with the surgical procedure), 6 postoperative CSF leak (one complicated with bacterial meningitis), one ICA injury, and 6 cases of permanent diabetes insipidus.Conclusion: The extended transsphenoidal approach tothe supra and parasellar lesions seems Endoscopy; Transsphenoidal surgery; Extended approach; Parasellar; Tumors; Anterior skull base. A promising minimally invasivetechnique for the removal of lesions affecting these areas,once thought to be suitable only of the transcranial routes.Concerning the lesion removal and the recurrence rate compared with the transcranial routes, it is too early to pose a definitive word, since the follow-up is still too short.

Late Post-Traumatic Cerebrospinal Rhinorrhoea

Cerebrospinal fluid (CSF) rhinorrhoea results from anatomical breach between the subarachnoid space and air sinus cavities of the skull base and traumatic CSF rhinorrhoea accounts for 80% - 90% of all cases of CSF leaks. We sought to report the case of a 16-year-old patient with a history of head injury following a fall from a tree, who developed a post-traumatic CSF rhinorrhoea after an onset of meningitis. The patient sustained a fall from a 6-meter tree in 2008, and was reviewed by our neurosurgical team in February 2016 for a 1-month history of progressive headaches associated with fever, asthenia and left CSF rhinorrhoea. Clinical examination revealed frank meningism and abundant CSF leak from the left nostril. CT scanning showed fractures of the left frontal bone and sinus wall associated with a massive pneumocephalus. The patient benefited from surgical repair of the tear and post-operative lumbar punctures at day 15. The patient’s guardian was informed that non-identifiable information from the case would be submitted for publication and he provided consent.

Post-Traumatic Cerebrospinal Fluid Rhinorrhea Associated with Craniofacial Fibrous Dysplasia: Case Report and Literature Review

ObjectiveFibrous dysplasia (FD) is an unusual developmental abnormality of the skeleton. When facial and cranial bones are involved in FD, it is termed craniofacial fibrous dysplasia (CFD). Although several reports have reported that CFD has a tendency for spontaneous cerebrospinal fluid (CSF) leakage, there have been no related English-language case reports. We present the first case of post-traumatic CSF rhinorrhea associated with CFD.MethodsA 30-year-old man presented with CSF rhinorrhea after a mild head trauma. Computed tomography cisternogram located a defect in the posterior wall of the right frontal sinus. Imaging examination also showed the evident expansion of multiple skull bones, spinal scoliosis, and multiple local enlargements of ribs. Without café-au-lait cutaneous spots and endocrine abnormalities, polyostotic FD was diagnosed instead of McCune-Albright syndrome (MAS). The patient underwent craniotomy fistula repair surgery. The excised bone was contoured to be thinner to increase the cranial cavity. The patient recovered well and CSF leakage did not recur. But during a nineteen-month follow up, sight in the patient's left eye was decreased. MAS was suspected. Unfortunately the patient refused to take the proposed decompression surgery and laboratory tests of serum hormones.ConclusionsCFD, if the wall of the paranasal sinus is involved and the cranial cavity is decreased, may increase the risk of CSF rhinorrhea after head trauma. Expectant management is recommended in asymptomatic CFD patients even in the presence of optic nerve compression. As MAS may cause more problems, it should be precluded before polyostotic FD is diagnosed.

Post-traumatic cerebrospinal fluid rhinorrhea associated with craniofacial fibrous dysplasia: Case report and literature review

Post-traumatic cerebrospinal fluid rhinorrhea associated with craniofacial fibrous dysplasia: Case report and literature review

Spontaneous Recovery of Post-Traumatic Cerebrospinal Fluid Rhinorrhea Following Meningitis : A Case Report

The aim of the present report was to present the patient with an anterior cranial base fracture who developed post-traumatic cerebrospinal fluid rhinorrhea, which recovered after onset of meningitis complication. A 26-year-old male patient who had a traffic accident one week ago was sent to our clinic because of his rhinorrhea persisting for 4 days. On cranial computed tomography, fracture of the left frontal skull base and sinus walls, a fracture line on temporal bone, parenchymal bleeding in the vicinity of the frontal sinus, subarachnoidal bleeding and left temporal extradural hematoma were detected. Then he underwent sinus wall repair and extradural hematoma was drained through bifrontal craniotomy. However, rhinorrhea persisted which resulted a deterioration in consciousness and he entered into a deep somnolent state. When his symptoms of meningitis became apparent, rhinorrhea of the patient disappeared. The patient transferred in intensive care unit and re-connected to a lumbar drainage system. On cerebral magnetic resonance imaging, regression of contrast-enhanced lesions localized in the left anterotemporal and frontal and in the regions lateral to the right trigon and medial to the right thalamus and in the right posteroparietal regions was observed. Despite repair of the anterior cranial fracture and lumbar drainage, rhinorrhea may persist. Herein, development of meningitis caused disappearing of rhinorrhea symptoms without any need for surgical intervention.

Intracranial repair of posttraumatic cerebrospinal fluid rhinorrhea associated with recurrent meningitis.

The purposes of this study are to assess the efficacy of our intracranial surgery and evaluate the association between failure after first surgical repair and the risk factors that have been applied on a group of 13 patients affected by posttraumatic cerebrospinal fluid rhinorrhea associated with recurrent meningitis. We retrospectively collected data on 13 patients referred to our institution. All patients had history of head trauma and experienced 2 or more episodes of meningitis. Three of the 13 patients had craniectomy defect due to previous trauma and surgery, 9 patients had linear fracture, and 1 patient had no apparent fracture line on preoperative radiologic evaluation. Ten of the 13 patients had identified frontal bone fracture involving the frontal sinus during surgery. Dural tear was identified intradurally and was repaired using a fascia lata graft with or without fibrin glue. Fibrin glue was applied over the suture in 7 patients. Three of the 13 patients had large dural defects. The size of bone and dural defect seems to be an important prognostic factor of episodes of meningitis. The use of fibrin glue to fixate fascia lata graft did not benefit the outcome.

Endoscopic Endonasal Management of Cerebrospinal Fluid Rhinorrhea

The authors review their 5 years' experience with endonasal endoscopic repair of the anterior skull base fistulas presenting with cerebrospinal fluid (CSF) rhinorrhea. A total of 12 patients were managed endoscopically between 2004 and 2008. Seven patients (58.3%) had nonsurgical posttraumatic CSF rhinorrhea, 2 patients (16.7%) had CSF rhinorrhea due to surgical/iatrogenic trauma, and 3 patients (25%) had spontaneous onset of CSF rhinorrhea. Radiosurgical correlation for CSF fistula identification was positive in all patients. The most common site of leak was the fovea ethmoidalis. The repair method consisted of an extradural underlay closure of a defect with fascia lata. The largest diameter of a defect to be closed was 15 mm. Immediate results were good in all patients, but later in the follow-up, CSF rhinorrhea recurred in 2 patients, and each patient had a revision 2 times. In the first revisions, transcranial approach was used, whereas in the second revisions endonasal endoscopic route was resorted. The primary closure rate was 83.3%, and the overall closure rate was 100%. The average follow-up period thus far is 21 months. Endonasal endoscopic technique well known to otolaryngologists should be considered as the first choice of surgery in the repair of CSF rhinorrhea because of low morbidity and a higher closure rate. The possibility of revision with the same technique makes this approach ideal for the repair of cranionasal osteodural defects.

Surgically repaired posttraumatic CSF rhinorrhea: An institutional experience and review of literature

AbstractPosttraumatic cerebrospinal fluid (CSF) rhinorrhea frequently complicates anterior skull base fracture. Although skull base fracture is present in only about 7% cases of head injury, CSF rhinorrhea develops in 30% of cases with basal fracture.A total of 43 cases admitted in our Institute (SGPGI Lucknow) from January 2000 to June 2011with history of head trauma followed by CSF rhinorrhea. Forty one cases were included in this study as two patients refused surgery.Out of forty one cases, 26 cases (63%) were admitted with history of recurrent meningitis, 21 cases (51%) with loss of smell, 26 cases (63%) with delayed onset CSF rhinorrhea, 3 cases (7%) with early onset rhinorrhea which did not improve after trauma, 12 cases (30%) with early onset rhinorrhea which improved but reappeared after some time. Twenty cases (48.8%) were repaired by extradural approach, 10 cases (24.4%) were repaired by intradural approach and 11 cases (26.8%) were repaired by endoscopic approach. 12 cases (29.0%) required re-surgery for persistent or recurrence of CSF rhinorrhea.Although posttraumatic CSF rhinorrhea usually resolves with conservative management, its persistence makes an individual prone for further complications like meningitis, brain abscess and septicaemia. Timely surgical intervention usually gives promising results. Endoscopic repair was better than transcranial repair.

Purely Endoscopic Repair of Traumatic Cerebrospinal Fluid Rhinorrhea From the Anterior Skull Base -Case Report-

A 38-year-old woman presented with a case of post-traumatic ethmoidal cerebrospinal fluid (CSF) leak that was repaired using a purely endoscopic endonasal approach. Six weeks after a mild domestic maxillofacial trauma, she started complaining of clear, watery discharge from the left nostril and headache. Neuroimaging investigations disclosed a linear fracture of the left anterior ethmoidal roof without evidence of large bony breaches or any brain tissue damage. After conservative medical treatment with carbonic anhydrase inhibitors failed, she was referred to our hospital for surgical repair of the osteodural defect. An endoscopic endonasal transethmoidal approach was successfully performed, and an overlay technique was used to reconstruct the defect. The patient was discharged without clinical evidence of CSF rhinorrhea and no leaks were apparent at the 3-month follow-up clinical and radiological examinations. Post-traumatic CSF rhinorrhea occurs in cases of dural tears associated with small bone breaks, most frequently involving the anterior skull base. Recovery is often spontaneous following only bed rest, or with medical treatments such as inhibitors of carbonic anhydrase diuretics, steroids, or eventually stool softeners to help reduce CSF pressure. Surgical repair is required when first-line conservative treatment proves ineffective. The present case shows that the endoscopic endonasal technique for the management of CSF leaks provides a less invasive surgical route to achieve valid dural repair.

Unusually delayed posttraumatic CSF rhinorrhoea

Cerebrospinal fluid (CSF) rhinorrhoea is not uncommon after traumatic brain injury. It usually occurs within first two days of trauma and subsides spontaneously. Delayed leak beyond three months of trauma is rare. We describe a case of posttraumatic CSF rhinorrhoea which presented 44 years after injury.

The application nasal endoscopy and high resolution CT in the diagnosis and treatment of cerebrospinal fluid rhinorrhea

Objective To evaluate the endoscopic repair of cerebrospinal fluid rhinorrhea accurately and combined therapy after operation. Methods Collected our department endoscopic repair of cerebrospinal fluid rhinorrhea clinical data of 28 patients from 2005 to 2009, with post-traumatic cerebrospinal fluid rhinorrhea in 20 cases, idiopathic in 8 cases of cerebrospinal fluid rhinorrhea. By thin-layer spiral CT and endoscopic mucosal leakage characteristics of the mouth to determine the location of mouth leakage, using thigh fascia lata as a repair material. Results All 28 patients were followed up for more than 3 months, the initial surgery in 27 cases, 1 case was re-surgery. The sites of cerebrospinal fluid is located in the Ethmoid roof wall of 11 cases, 6 cases of cribriform plate, sphenoid sinus in 6 cases, frontal sinus openings in 4 cases, 1 case of Ethmoid and sphenoid sinus. All patients were successfully treated once. Conclusion Thin spiral CT and endoscopic drain mouth pale edema mouth mucosa is essential for determining the leakage. The combined treatment after operation will help ensure a successful surgical repair. Key words: Endoscopic surgery; High-resolution CT; Mucosal edema; Cerebrospinal fluid rhinorrhea

A Case of Post-Traumatic Cerebrospinal Fluid Rhinorrhea with Encephalocele

Posttraumatic cerebrospinal fluid (CSF) leakage may frequently develop after a skull base frac-ture. A patient with a 1-month history of intermittent watery rhinorrhea was referred to our de-partment from the Department of Neurosurgery. He had been treated for 8 months due to a skull base fracture after a motor vehicle accident. He had undergone cranial trephination due to brain abscess prior to this presentation. On radiologic examination, a large skull base defect with enc-ephalocele was observed. Using the nasal endoscopic approach, we identified a large protruding mass of soft brain tissue with pulsating CSF in the ethmoid roof. CSF lumbar drainage was per-formed in order to reduce the protruding mass by decreasing intracranial pressure. After CSF lum-bar drainage, the protruding brain tissue was returned to the cranial cavity, and the leak site was successfully repaired with septal cartilage and graft material.

Post-traumatic cerebrospinal fluid rhinorrhea revealing an asymptomatic pituitary adenoma

Post-traumatic cerebrospinal fluid rhinorrhea revealing an asymptomatic pituitary adenoma

Post-traumatic cerebrospinal fluid rhinorrhoea: Modern high-definition computed tomography is all that is required for the effective demonstration of the site of leakage

Accurate definition of the site of cerebrospinal fluid (CSF) leakage is essential for the successful surgical management of CSF rhinorrhoea and associated recurrent meningitis. Previous attempts to image the sites of leakage, including conventional computed tomography (CT) and cisternography using either iodine-containing contrast media or radionuclides, have given disappointing results. A dedicated high-resolution computed tomographic (CT) technique combining fine slices in two planes with a bone algorithm for data manipulation is described and the results in 15 consecutive patients are recorded. This technique promises to render all other diagnostic methods obsolete.

The significance of fluid-gas displacement in the sphenoid sinus in post-traumatic cerebrospinal fluid rhinorrhea.

A pneumonencephalographic technique is described for the diagnosis of cerebrospinal fluid rhinorrhea and localization of the precise site of leak. The procedure is a modification of routine pneumoencephalography with no additional discomfort to the patient. The advantages of this technique in comparison with others are discussed.