Surgical treatment of mixed cervical spondylosis with spontaneous cerebrospinal fluid leakage: A case report

BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.Here,we review the literature and describe the surgical treatment of a 70-year-old woman who presented with a CSF leak due to a cervical spine spur.CASE SUMMARY A 70-year-old female patient who was treated for a cerebral infarction,presented with complains of weakness in the right lower extremity and a feeling of stepping on cotton.The patient underwent regular neck massage and presented with neck and right shoulder pain radiating to the right upper extremity one-month ago.Magnetic resonance imaging showed a strip of leaking cerebrospinal fluid posterior to the C1-4 vertebrae,and computed tomography showed a“sickleshaped”disc prolapse with calcification in C4/5.We chose to perform an anterior cervical discectomy.When the prolapsed C4/5 disc was scraped,clear fluid leakage was observed,and exploration revealed a 1 mm diameter rupture in the anterior aspect of the dura mater,which was compressed continuously with cotton patties,with no significant cerebrospinal fluid leakage after 1 h.CONCLUSION Three months after surgery,the patient was asymptomatic and follow-up imaging demonstrated complete resolution.

The causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenomas surgery

Objective To analyze the causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenoma surgery. Methods Retrospective study of 260 cases of microscopic transsphenoidal surgery and 274 cases of endoscopic surgery for resection of the pituitary adenomas was performed. CSF leak occurred

Clinical management of dural defects:A review

Dural defects are common in spinal and cranial neurosurgery.A series of complications,such as cerebrospinal fluid leakage,occur after rupture of the dura.Therefore,treatment strategies are necessary to reduce or avoid complications.This review comprehensively summarizes the common causes,risk factors,clinical complications,and repair methods of dural defects.The latest research progress on dural repair methods and materials is summarized,including direct sutures,grafts,biomaterials,non-biomaterial materials,and composites formed by different materials.The characteristics and efficacy of these dural substitutes are reviewed,and these materials and methods are systematically evaluated.Finally,the best methods for dural repair and the challenges and future prospects of new dural repair materials are discussed.

Drainage by urostomy bag after blockage of abdominal drain in patients with cirrhosis undergoing hepatectomy

Abdominal drainage was previously recommended as a post-hepatectomy procedure for patients with cirrhosis.This report introduces a simple technique that prevents leakage of ascitic fluid after cirrhotic hepatectomy complicated by blockage of the abdominal drain.In 59 patients who had had cirrhotic hepatectomy complicated by leakage of ascites in the drain site after drainage removal between January 2001 and April 2011,31 underwent suture ligation(sutured group) and 28 were given urostomy bag at the abdominal drainage site(drainage group).The mean length of postoperative hospital stay in the drainage group was shorter than in the sutured group(16.11±2.61 vs 34.23±4.86 days,P=0.000).Meanwhile,the drainage group showed decreased postoperative complications,including leakage of ascites,wound infection,and collection of ascites.Drainage by urostomy bag can prevent prolonged leakage of ascitic fluid after the blockage of abdominal drains in patients undergoing cirrhotic hepatectomy.

Bath-plug technique for the endoscopic management of cerebrospinal fluid leaks in children

Importance:The safety and efficacy of the bath-plug technique for the closure of cerebrospinal fluid(CSF)leaks in children remain unknown.Objective:We undertook this study to ascertain whether the bath-plug technique was safe and effective for the repair of CSF leaks.Methods:We retrospectively reviewed patients who underwent endoscopic repair of CSF leaks with the fat graft as a plug-in at Beijing Children’s Hospital from March 2016 to May 2020.Demographic data,medical history,defect sites and sizes,interventions,and clinical outcomes were analyzed.One representative clinical case was additionally selected to highlight the procedure and the healing process.Results:A total of 18 pediatric patients were included in this study.The group was composed of 11 boys and seven girls,aged from 5 to 123 months.The etiologies included congenital CSF leaks(n=9)and head trauma(n=9).Among all patients,12 fistulas(66.7%)were located at the cribriform plate area,two(11.1%)at the roof of the ethmoid sinuses,two(11.1%)in the sphenoid sinus,and two(11.1%)at the frontal sinus.The maximum diameters of fistulas ranged from 5 to 20 mm,with a median value of 8 mm.Encephaloceles were identified in 14(77.8%)patients.No hydrocephalus was recognized.All CSF leaks were successfully repaired with a bath-plug technique.Follow-up ranged from 50 to 70 months.No surgical complications were encountered in any patient.Interpretation:Bath-plug technique is safe and reliable for the endoscopic management of CSF leaks in children.Meticulous peri-operative preparations are important for pediatric patients.

Treatment of traumatic cerebrospinal fluid rhinorrhea via extended extradural anterior skull base approach

To describe and assess the repair technique and perioperative management for cerebrospinal fluid(CSF)leak resulting from extensive anterior skull base fracture via extradural anterior skull base approach.;This was a retrospective review conducted at the Department of Neurosurgery of the Shanghai Tenth People's Hospital from January 2015 to April 2020.Patients with traumatic CSF rhinorrhea resulting from extensive anterior skull base fracture treated surgically via extended extradural anterior skull base approach were included in this study.The data of medical and radiological records,surgical approaches,repair techniques,peritoperative management,surgical outcome and postoperative follow-up were analyzed.Surgical repair techniques were tailored to the condition of associated injuries of the scalp,bony and dura injuries and associated intracranial lesions.Patients were followed up for the outcome of CSF leak and surgical complications.Data were presented as frequency and percent.;Thirty-five patients were included in this series.The patients'mean age was 33 years(range 11-71 years).Eight patients were treated surgically within 2 weeks;while the other 27 patients,with prolonged or recurrent CSF rhinorrhea,received the repair surgery at 17 days to 10 years after the initial trauma.The mean overall length of follow-up was 23 months(range 3-65 months).All the patients suffered from frontobasal multiple fractures.The basic repair tenet was to achieve watertight seal of the dura.The frontal pericranial flap alone was used in 20 patients,combined with temporalis muscle and/or its facia in 10 patients.Free fascia lata graft was used instead in the rest 5 patients.No CSF leak was found in all the patients at discharge.There was no surgical mortality in this series.Bilateral anosmia was the most common complication.At follow-up,no recurrent CSF leak or meningitis occurred.No patients developed mucoceles,epidural abscess or osteomyelitis.One patient ultimately required ventriculoperitoneal shunt because of progressive hydrocephalus.;Traumatic CSF rhinorrhea associated with extensive anterior skull base fractures often requires aggressive treatment via extended intracranial extradural approach.Vascularized tissue flaps are ideal grafts for cranial base reconstruction,either alone or in combination with temporalis muscle and its fascia---fascia lata sometimes can be opted as free autologous graft.The approach is usually reserved for patients with traumatic CSF rhinorrhea in complex frontobasal injuries.

Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa

Objective:To describe the procedure and results of an adapted closure and recon struction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube.Methods:Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique.Results:In addition to meticulous packing of potential conduits using soft tissue,hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue.Early results of a small patient cohort using this technique are encouraging and there were no wound infections.There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells,with no recurrence after appropriate implementation of the described protocol during revision surgery.Conclusion:Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.

Rapid resolution of subdural hematoma after targeted epidural blood patch treatment in patients with spontaneous intracranial hypotension

Background Subdural hematoma （SDH） is a common complication of spontaneous intracranial hypotension （SIH）.To date,the management of SDH caused by SIH remains controversial.In this paper,we reviewed the clinical course of SDH in patients with SIH,and discuss the underlying mechanism and attributing factors for rapid resolution of subdural hematomas after epidural blood patch （EBP） surgery.Methods We retrospectively reviewed a cohort of seventy-eight SIH patients diagnosed and treated with targeted EBP in our neurology center.Patients who received early CT/MRI follow-up after EBP operation were included.Results A series of four cases of SIH complicated with SDHs were evaluated.Early follow-up neuroimages of these patients revealed that SDHs could be partially or totally absorbed just two to four days after targeted epidural blood patch treatment.Conclusion Targeted epidural blood patch can result in rapid hematoma regression and good recovery in some patients with a combination of SDH and SIH.

Perigeniculate arachnoid cysts and CSF fistulae of the fallopian canal:Histopathologic correlates of a rare clinical entity

Cerebrospinal fluid(CSF)fistulae originating from the fallopian canal of the facial nerve is hypothesized to arise due to atypical patterns of subarachnoid space extension into the geniculate ganglion or more distal regions along the intratemporal course of the facial nerve,but its pathogenesis remains poorly understood.Although a rare etiology of CSF fistulae of the temporal bone,there are significant clinical ramifications due to the risk of recurrent meningitis,difficulty in identifying the anatomic location of the CSF leak,and technical challenges associated with surgical repair.We present three clinical cases of arachnoid cysts within the geniculate fossa with or without CSF fistulization and provide histopathologic correlates of this rare clinical phenomenon from a human temporal bone collection.The pediatric and adult patients presented suggest differential pathophysiologic mechanisms associated with CSF fistulae.Temporal bone histology reveals atypical patterns of subarachnoid space extension in the fallopian canal that may underlie arachnoid cyst formation and overt CSF leak from the geniculate region.