Objective: Fibrous 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 ha...Objective: Fibrous 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. Methods: A 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 Mc Cune-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. Conclusions: CFD, 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.展开更多
Pituitary adenoma coexisting with cerebrospinal fluid(CSF) rhinorrhea and carotid aneurysm is extremely rare. CSF rhinorrhea may cause pneumocephalus and intracranial infection. Rupture of the aneurysm may cause fatal...Pituitary adenoma coexisting with cerebrospinal fluid(CSF) rhinorrhea and carotid aneurysm is extremely rare. CSF rhinorrhea may cause pneumocephalus and intracranial infection. Rupture of the aneurysm may cause fatal consequence. The authors report such a rare case to draw more attentions. A 55-year-old man presented with sexual dysfunction for 2 years. The serum prolactin was tested as 1,600 ng/ml(normal range, 1.39–24.2). Enhanced cranial MR showed an evident lesion at the sellar area, invading the right cavernous sinus. Prolactinoma was diagnosed. He took bromocriptine for one year and received gamma knife therapy thereafter. Four months after the treatment of gamma knife, he got CSF rhinorrhea and nasal bleeding. The endoscopic transnasalsphenoidal approach was performed to resect the tumor and repair the dura defect.The CSF rhinorrhea stopped after the surgery, however his nasal bleeding continued. The digital subtraction angiography(DSA) showed an aneurysm at the right cavernous internal carotid. The endovascular coil embolization was performed to treat the aneurysm. The patient recovered well. The coexistence of CSF rhinorrhea and pituitary adenoma is a high risk factor for the rupture of cavernous internal carotid aneurysm. When treating patients with pituitary adenoma and CSF rhinorrhea, doctors should exclude the aneurysm. When nasal bleeding occurs, the hemorrhage of internal carotid should be considered, and appropriate measures should be taken immediately.展开更多
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 rhinorrh...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% Cl 0.306-0.843, P=0.009） and historical meningitis （RR=0.290, 95% Cl 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.展开更多
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 middl...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.展开更多
Cerebrospinal fluid fistulae occur when defects in dura, pla-arachnold or skull permit the cerebrospinal fluid escape from the subarachnoid space via anterior naris, nasopharynx or external acoustic meastus, Which is ...Cerebrospinal fluid fistulae occur when defects in dura, pla-arachnold or skull permit the cerebrospinal fluid escape from the subarachnoid space via anterior naris, nasopharynx or external acoustic meastus, Which is most commonly manifested as rhinorrhea or otorrhea,complicated by serious recurrent meningitis for months or years.This paper reports 20 cases of rhinorrhea and one of otorrhea, persisting longer than 3 months. All the cases were repaired successfully and there was no recurrence arter being followed up for 1 to 20 years.We compared various diagnostic methods and suggested a simple operative procedure.展开更多
INTRODUCTION Cerebrospinal fluid （CSF） rhinorrhea is a common condition managed by neurosurgeons. The accurate identification of the site of leak plays a key role in facilitating successful surgical repair. We repor...INTRODUCTION Cerebrospinal fluid （CSF） rhinorrhea is a common condition managed by neurosurgeons. The accurate identification of the site of leak plays a key role in facilitating successful surgical repair. We reported two surgery-proven cases of CSF rhinorrhea examined by magnetic resonance （MR） cisternography （Siemens, Berlin, Germany） and skull base coronal thin-section computed tomography （CT） scan （Siemens, Berlin, Germany） before surgical treatment.展开更多
基金the National Science and Technology Support Program of the 12th Five-Year of China(grant number:2012BAI12B03)Natural Science Foundation of Beijing(grant number:7112049)
文摘Objective: Fibrous 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. Methods: A 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 Mc Cune-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. Conclusions: CFD, 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.
基金Supported by the the National Science & Technology Pillar Program during the 12th Five-year Plan Period(No.2012BAI12B03)Beijing Talents Project(No.2012D003034000032)+2 种基金National Key Technology Research and Development Program of the Ministry of Science and Technology of China(No.2013BAI09B03)Beijing Institute for Brain Disorders project(No.BIBDPXM2013_014226_07_000084)the National Natural Science Funds for Distinguished 302 Young Scholars(No.81502390)
文摘Pituitary adenoma coexisting with cerebrospinal fluid(CSF) rhinorrhea and carotid aneurysm is extremely rare. CSF rhinorrhea may cause pneumocephalus and intracranial infection. Rupture of the aneurysm may cause fatal consequence. The authors report such a rare case to draw more attentions. A 55-year-old man presented with sexual dysfunction for 2 years. The serum prolactin was tested as 1,600 ng/ml(normal range, 1.39–24.2). Enhanced cranial MR showed an evident lesion at the sellar area, invading the right cavernous sinus. Prolactinoma was diagnosed. He took bromocriptine for one year and received gamma knife therapy thereafter. Four months after the treatment of gamma knife, he got CSF rhinorrhea and nasal bleeding. The endoscopic transnasalsphenoidal approach was performed to resect the tumor and repair the dura defect.The CSF rhinorrhea stopped after the surgery, however his nasal bleeding continued. The digital subtraction angiography(DSA) showed an aneurysm at the right cavernous internal carotid. The endovascular coil embolization was performed to treat the aneurysm. The patient recovered well. The coexistence of CSF rhinorrhea and pituitary adenoma is a high risk factor for the rupture of cavernous internal carotid aneurysm. When treating patients with pituitary adenoma and CSF rhinorrhea, doctors should exclude the aneurysm. When nasal bleeding occurs, the hemorrhage of internal carotid should be considered, and appropriate measures should be taken immediately.
文摘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% Cl 0.306-0.843, P=0.009） and historical meningitis （RR=0.290, 95% Cl 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.
文摘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.
文摘Cerebrospinal fluid fistulae occur when defects in dura, pla-arachnold or skull permit the cerebrospinal fluid escape from the subarachnoid space via anterior naris, nasopharynx or external acoustic meastus, Which is most commonly manifested as rhinorrhea or otorrhea,complicated by serious recurrent meningitis for months or years.This paper reports 20 cases of rhinorrhea and one of otorrhea, persisting longer than 3 months. All the cases were repaired successfully and there was no recurrence arter being followed up for 1 to 20 years.We compared various diagnostic methods and suggested a simple operative procedure.
文摘INTRODUCTION Cerebrospinal fluid （CSF） rhinorrhea is a common condition managed by neurosurgeons. The accurate identification of the site of leak plays a key role in facilitating successful surgical repair. We reported two surgery-proven cases of CSF rhinorrhea examined by magnetic resonance （MR） cisternography （Siemens, Berlin, Germany） and skull base coronal thin-section computed tomography （CT） scan （Siemens, Berlin, Germany） before surgical treatment.
文摘目的探讨基于主成分分析(principal component analysis,PCA)结合Logistic回归模型分析脑脊液可溶性Fas(soluble Fas,sFas)、Fas配体(soluble Fas ligand,sFasL)水平及压力参数对创伤性颅脑损伤患者术后继发脑积水的预测价值。方法选取2018-12/2021-12月由作者医院神经外科收治的260例创伤性颅脑损伤患者作为研究对象,对其临床资料进行回顾性分析,根据术后是否发生脑积水将患者分为继发脑积水组(n=48)和无继发脑积水组(n=212)。对患者的性别、年龄、手术前后格拉斯哥昏迷量表(Glasgow coma scale,GCS)、颅脑损伤部位、手术时间、手术前后脑室系统出血、术后颅内感染、术后大面积脑梗死、手术前后中脑导水管和环池结构、术后脑脊液压力参数、术后脑脊液sFas、sFasL水平等指标进行PCA。PCA后提取主成分作为自变量,以患者术后是否出现脑积水为因变量,应用Logistic回归分析探讨相关影响因素。结果单因素分析和PCA结果显示,脑组织损伤部位、手术前后GCS评分、脑室系统内出血、导水管和环池结构,术后颅内感染、术后大面积脑梗死、术后腰穿脑脊液置换术及术后脑脊液压力(cerebrospinal fluid pressure,CSFP)、ICP相关系数(regression of amplitude and pressure,RAP)和脑脊液sFas/sFasL水平均与患者术后继发脑积水有关(P<0.05)。PCA-Logistic回归模型显示,合并颅底损伤,手术前后GCS评分降低,脑室系统内出血,导水管和环池结构不清晰,术后合并颅内感染,大面积脑梗死,脑脊液sFas、sFasL水平升高,RAP升高和CSFP升高均是颅脑损伤患者术后继发脑水肿的独立危险因素,术后进行腰穿脑脊液置换是颅脑损伤患者术后继发脑积水的保护因素(P<0.05)。结论术后脑脊液sFas、sFasL水平和压力参数均是创伤性颅脑损伤患者术后继发脑积水的独立影响因素,对患者术后并发脑积水有一定的预测价值。
