Csf rhinorrhea occurring from defects in the lateral recess of the sphenoid sinus is rare. Cerebrospinal fluid rhinorrhea jama neurology jama network. It could be due to trauma, raised intracranial pressure icp. In this article i tried to collect, summarize and organize the updates on this topic from the english literature, and deliver it in a clinical approach manner with suggested algorithm and clarifying.
Cerebrospinal fluid csf location ventricular system subarachnoid space including cysternal system. Spontaneous csf leaks are associated with idiopathic intracranial. Cerebrospinal fluid in neurologic disorders, volume 146 1st. Spontaneous cerebrospinal fluid rhinorrhea associated with chronic renal failurecase report. The endoscopic transnasal repair with free grafts by the combined overlay and. Trauma is the most common cause, and nontraumatic cases spontaneous are considered rare.
Cerebrospinal fluid rhinorrhea after functional endoscopic sinus surgery the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Current approach to cerebrospinal fluid rhinorrhea diagnosis. Intracranial tumors have been regarded 1 as a common cause for nontraumatic rhinorrhea and the cribriform plate area in the anterior fossa as the most likely site of csf. The goal of this study is to make recommendations on intraoperative and postoperative management of csf fistulas across all causes. The usual symptom is watery, nasal drainage coming from either the left or right side of the nose. Objective to examine the methods of extracranial repair of traumatic defects in the cribriform plate and ethmoid roof resulting in persistent cerebrospinal fluid csf rhinorrhea in pediatric patients design retrospective case series setting a singleinstitution, tertiary care, pediatric hospital patients four children, ranging in age from 312 to 9 years, who sustained fractures in the.
Transnasal endoscopic repair of cerebrospinal fluid. The second part addresses the main purpose of the volume, describing csf from a research perspective in context with the most important. Feb 02, 2018 spontaneous cerebrospinal fluid csf rhinorrhea is a rare disease. Basing on location, the csf could leak through the nose csf rhinorrhea or ear passage csf otorhea. Measures of csf components such as glucose have been used in the past, but are neither sensitive nor specific. A cerebrospinal fluid csf rhinorrhoea occurs when there is a fistula between the dura and the skull base. Cerebrospinal fluid leak is a rare etiology of a common symptom, rhinorrhea. Current approach to cerebrospinal fluid rhinorrhea. Microscopic repair of csf rhinor rhea has been advocated by many authors5 71419 magni fication, stereoscopy i.
In around 90 percent of cases, the problem is caused by an injury to the head. Cerebrospinal fluid rhinorrhea definition of cerebrospinal. Trauma, both iatrogenic and noniatrogenic, contributes to 80%90% of csf fistulas. Disruption of the barriers between the sinonasal cavity and the anterior and middle cranial fossae is the underlying factor leading to the discharge of csf into the nasal cavity. Contemporary approach to the diagnosis and management of. Recent findings pooled analysis of case series reveals that free graft repairs are successful in closing most traumatic and iatrogenic csf leaks. Risk of meningitis with cerebrospinal fluid rhinorrhea anu. Successful management has been reported using a variety of repair techniques. Lee tj, huang cc, chuang cc, huang sf 2004 transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect. Cerebrospinal fluid csf rhinorrhea occurs due to communication between the. Ppt cerebrospinal fluid csf powerpoint presentation free. Csf rhinorrhoea refers to the drainage of cerebrospinal fluid through the nose.
Csf rhinorrhea may present spontaneously or following trauma and if untreated may lead to ascending meningitis and other complications. Intracranial tumors have been regarded1 as a common cause for nontraumatic rhinorrhea and the cribriform plate area in the. Observation in the hospital, head of bed elevation or complete bed rest for. Pdf contemporary approach to the diagnosis and management. Objective to examine the methods of extracranial repair of traumatic defects in the cribriform plate and ethmoid roof resulting in persistent cerebrospinal fluid csf rhinorrhea in pediatric patients.
Cerebrospinal fluid csf rhinorrhea clinical approach and therapeutic techniques are rapidly growing and the literature is almost daily enriched with new studies, techniques, and trials. Gk, rhis, nose, rhoia, flow a discharge of cerebrospinal fluid csf from the nose. Cerebrospinal fluid fistula as the presenting manifestation of pituitary adenoma. Cerebrospinal fluid rhinorrhoea med oral patol oral cir bucal 2007. Leak of cerebrospinal fluid csf can have a different sources trauma, iatrogenic or spontanaeous. Ozveren mf, kaplan m, topsakal c, bilge t, erol fs, celiker h et al. In general, the brain is a sterile compartment and is separated from the sinuses. The second part addresses the main purpose of the volume, describing csf from a research perspective in context with the most important diagnostic entities in neurology. Contemporary management of cerebrospinal fluid rhinorrhea. Endoscopic repair of cerebrospinal fluid rhinorrhoea. Synonyms for cerebrospinal fluid rhinorrhea in free thesaurus. Journal articles 15 diagnostic criteria for spontaneous spinal csf and intracranial hypotension schievink et al.
Cerebrospinal fluid csf rhinorrhea is a rare but potentially devastating condition that can lead to significant morbidity and mortality for the patient. Endoscopic endonasal repair of cerebrospinal fluid rhinorrhea by. Cerebrospinal fluid rhinorrhea and acquired anterior basal. Cerebrospinal fluid production approximately 70% of cerebrospinal fluid csf is produced by the choroid plexus of the lateral ventricles and the tela choroidea of the third and fourth ventricles. Pdf endoscopic management of cerebrospinal fluid rhinorrhea. If a doctor thinks you have an illness that affects your nervous system, she might take a sample for testing. May 08, 2020 cerebrospinal fluid csf rhinorrhea is a rare but potentially devastating condition that can lead to significant morbidity and mortality for the patient.
For centuries it was accepted that there was free communication between the brain and the nose. The annual risk of meningitis in unrepaired fistulas is widely quoted to be approximately 10% per annum. Cerebrospinal fluid rhinorrhea and acquired anterior basal encephalocoele in a patient with colloid cyst of the third ventricle kythasandra shivakumar deepak 1, chandrasekharan kesavadas 1, tirur raman kapilamoorthy 1, gireesh menon 2 1 departments of imaging sciences and interventional radiology, sree chitra tirunal institute for medical sciences and technology, trivandrum 695 011, india 2. Endoscopic management of cerebrospinal fluid rhinorrhea yadav. Anything which causes a tear in the dura and arachnoid mater, the membranes that enclose the brain and csf, and also makes a hole in the skull, could lead to the formation of a drainage channel between the brain and. The obliteration of the csf was achieved with fat free, mucoperichondrial or. A cerebrospinal fluid csf rhinorrhoea occurs when there is a fistula between the dura and the skull base and discharge of csf from the nose. A patient with cerebrospinal fluid rhinorrhoea may be unaware of the condition, or may experience symptoms of a clear, typically unilateral nasal discharge, which is watery and may taste salty. Because the brain produces roughly 17 ounces 500 milliliters of cerebrospinal fluid each day, a runny nose caused by csf rhinorrhea can be a seemingly endless problem. What are synonyms for cerebrospinal fluid rhinorrhea. The frontal sinuses may vary considerably in size and may.
Tension free closure is required for this technique, limiting repairs to large bony defects. It has also been noted to be characterized by unilateral discharge. Csf can then leak through the dural tear and drain from the nose. In contrast, multilayered, vascularized repairs are often required for large defects with highflow leaks that communicate with a cistern andor ventricles. It is produced by specialised ependymal cells in the choroid plexuses of the ventricles of the brain, and absorbed in the arachnoid granulations. Cerebrospinal fluid csf rhinorrhea, when left untreated, can lead to.
Cerebrospinal fluid csf is a clear, colorless body fluid found in the brain and spinal cord. Cerebrospinal fluid rhinorrhea from the lateral recess of. Cerebrospinal fluid rhinorrhea software fuzzyfluid v. The effectiveness of lumbar drainage in the conservative and surgical treatment of traumatic cerebrospinal fluid rhinorrhea. Cerebrospinal fluid rhinorrhea an overview sciencedirect. Pdf the surgical management of cerebrospinal fluid csf rhinorrhea has. A literature search was performed on pubmed, medline and cochrane central databases, independently by two of the authors, of all studies reporting the outcomes of csf rhinorrhoea repair, published until the 1st june 2014, using keywords cerebrospinal fluid leak, csf leak, csf fistula, csf leak or fistula repair, endoscopic sinus surgery or ess complications. Function protect the cns from mechanical insult as a cushion maintain the equilibrium of neuronal and glial remove the waste products of neuronal metabolism determine pulmonary ventilation and cbf according to its acidity. Cerebrospinal rhinorrhea definition of cerebrospinal.
The drainage will often worsen upon leaning forward or with strenuous activity. Cerebrospinal fluid rhinorrhoea occurs when the cerebrospinal fluid, or csf, that bathes the brain leaks through surrounding membranes and bone and emerges through the nose. Surgical management of cerebrospinal fluid rhinorrhea under scielo. Listing a study does not mean it has been evaluated by the u. Cerebrospinal fluid rhinorrhea synonyms, cerebrospinal fluid. Endoscopic endonasal tr article in pdf 1,4 kb citation manager access statistics reader comments email alert add to my list registration required free. The combination of a preexisting weakening of the meninges and sudden violence can also cause csf rhinorrhea. Csf rhinorrhea results due to a breakdown of the barrier separating the spinal fluid space from the nose and sinuses. Basal skull fractures can transverse the paranasal air sinuses of the frontal bone, resulting in a dural tear. Cerebrospinal fluid csf rhinorrhea involves a breakdown of all barriers that separate the subarachnoid space from the upper aerodigestive tract, namely, the mucosa of the nasal cavity or paranasal sinus, skull base i. What is the pathophysiology of cerebrospinal fluid csf. Of particular concern is that part of the skull base adjoining the paranasal sinuses fig. Ct scan through cribiform plate demonstrating defect after removal of an ethmoid sinusnasal mass. Cerebrospinal fluid csf rhinorrhea occurs due to communication between the intracranial subarachnoid space and the sinonasal mucosa.
Cerebrospinal fluid csf rhinorrhea, when left untreated, can lead to meningitis and other serious complications. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Pdf surgical management of cerebrospinal fluid rhinorrhea under. Surgical repair of cerebrospinal fluid leaks transnasal repair ofcsf leaks has gained popularity during the past decade.
Cerebrospinal fluid rhinorrhea is the result of transdural communication between the subarachnoid space and the skull base. Cerebrospinal fluid rhinorrhea and recurrent meningitis. Traumatic cerebrospinal fluid leaks johns hopkins medicine. Eighty percent of cerebrospinal fluid csf leaks occur following nonsurgical. The potential lethal consequences of incorrectly diagnosing and managing this condition make its discussion relevant. Cerebrospinal fluid csf rhinorrhea is sometimes difficult to diagnose and treat. Cerebrospinal fluid rhinorrhoea in cases where a confirmatory test is needed, the beta2 transferrin assay is the test of choice because of its high sensitivity and specificity 19. Sumaily i 2017 current approach to cerebrospinal fluid rhinorrhea diagnosis and management. Winner of the standing ovation award for best powerpoint templates from presentations magazine.
Cerebrospinal fluid is the liquid around your brain and spinal cord. Citardi and others published cerebrospinal fluid rhinorrhea find, read and cite all the research you need on researchgate. Tensionfree closure is required for this technique, limiting repairs to large bony defects. Cerebrospinal fluid csf rhinorrhea is common after noe fractures as a result of the compromise of the thin fovea ethmoidalis.
In the former two, the reason may be the acquired defect along base of skull for example from fractures or complication after sinus surgery. Ppt cerebrospinal fluid powerpoint presentation free to. Treatment traditionally has entailed an open craniotomy, although the paradigm has now evolved to encompass endoscopic procedures. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect.
Cerebrospinal fluid csf management market analytical overview, growth factors, demand and trends by 2026 the objectives of this study are to define, segment, and project the size of the cerebrospinal fluid csf management market based on company, product type, application and key regions. Spontaneous cerebrospinal fluid leakage is usually caused by. Cerebrospinal fluid csf rhinorrhea is a condition that results from an acquired communication between the central nervous system and external environment. Cerebrospinal fluid rhinorrhea can lead to serious infectious complications such as meningitis, hydrocephalus or pneumocephalus, or the presence of air or gas within the cranial cavity. Csf acts as a cushion or buffer, providing basic mechanical and. Spontaneous cerebrospinal fluid rhinorrhea associated with chronic renal failure.
Cerebrospinal fluid csf rhinorrhea involves a breakdown of. Anatomy related to cerebrospinal fluid rhinorrhea in cerebrospinal fluid rhinorrhea, the region of interest is the base of the skull from the frontal sinuses to the temporal bone. Cerebrospinal fluid rhinorrhea after functional endoscopic. All skullbase sites of leakage potentially lead to the nasal cavity. Cerebrospinal fluid rhinorrhea article about cerebrospinal. There is about 125ml of csf at any one time, and about 500 ml is generated every day.
Cerebrospinal fluid rhinorrhea is an uncommon but dangerous disease. Cerebrospinal fluid rhinorrhea software free download. Cerebrospinal fluid in neurologic disorders, volume 146. The incidence of csf rhinorrhea ranges from 40% to 50% in noe fracture series. Many lethal complications, such as bacterial meningitis and pneumoencephalus, may be the result of cerebrospinal fluid rhinorrhea.
Pdf contemporary management of cerebrospinal fluid. Ppt cerebrospinal fluid powerpoint presentation free. Cerebrospinal fluid csf rhinorrhea, when left untreated, can lead. Lack of free distribution of contrast in the csf space or very small amount of. Cerebrospinal fluid rhinorrhea synonyms, cerebrospinal. Ppt cerebrospinal fluid csf powerpoint presentation. Cerebrospinal fluid rhinorrhea brigham and womens hospital. Apr 11, 2017 casiano rr, jassir d 1999 endoscopic cerebrospinal fluid rhinorrhea repair. Cerebrospinal fluid fistula, commonly known as csf leak, occurs when there is an abnormal communication between the csf containing space around the brain subarachnoid space and either the sinuses or the ear. Spontaneous csf rhinorrhea4 spontaneouscsf rhinorrhea is subdivided into normal pressure and high pressure leaks. Extracranial repair of pediatric traumatic cerebrospinal. Cerebrospinal fluid csf rhinorrhea, the leakage of spinal fluid through the nose, was first described in the. Risk of meningitis with cerebrospinal fluid rhinorrhea. A transdural fistula may originate from the anterior, middle, or posterior cranial compartments.
Csf aim of its examination diagnostic treatment evaluation or follow. Spontaneous cerebrospinal fluid csf rhinorrhea is a rare disease. Cerebrospinal fluid in neurologic disorders, volume 146 provides a brief overview on the current use of csf in clinical routine, the physiology of csf, and its usefulness and potential as a biomarker. An analysis of patients treated for cerebrospinal fluid rhinorrhea in the united states from 2002 to 2010. Csf rhinorrhea or liquorrhoea commonly occurs following head trauma frontobasal skull. Trauma, both accidental and iatrogenic, causes the majority of leaks, and trauma involving skull base and facial fractures is.
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