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Pinan Liu - One of the best experts on this subject based on the ideXlab platform.
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Endoscopic transnasal surgery for treatment of Cerebrospinal Fluid Rhinorrhea
Tianjin Huanhu Hospital, 2019Co-Authors: Zhen Chen, Zhijun Yang, Jian Liu, Pinan LiuAbstract:Objective To explore the feasibility and curative effect of endoscopic transnasal surgery in the treatment of Cerebrospinal Fluid (CSF) Rhinorrhea. Methods and Results From November 2011 to June 2018, a total of 198 patients with CSF Rhinorrhea underwent endoscopic transnasal surgery in our hospital. There were 191 cases being repaired successfully in the first surgery, and the success rate of primary repair was 96.46% (191/198). Postoperative Rhinorrhea recurred in 7 cases (3.54%, 7/198), and they were repaired successfully in the second surgery. After operation, 14 cases (7.07% ) suffered from intracranial infection, and were cured by antibiotic therapy. One case (0.51%) with deep venous thrombosis of right lower limb and 2 cases (1.01%) with intermuscular venous thrombosis of lower limbs were treated by low molecular heparin anticoagulant therapy. One case (0.51% ) died of septic shock. All survival patients were followed up for (36.27 ± 15.36) months, and none of them relapsed. Conclusions Endoscopic transnasal surgery has a high success rate and less trauma in the repair of CSF Rhinorrhea. Postoperative intracranial infection should be prevented as the main postoperative complication. DOI: 10.3969/j.issn.1672-6731.2019.04.00
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primary spontaneous Cerebrospinal Fluid Rhinorrhea a symptom of idiopathic intracranial hypertension
Journal of Neurosurgery, 2011Co-Authors: Zhijun Yang, Chungcheng Wang, Bo Wang, Pinan LiuAbstract:Object The authors aim to identify the characteristics of primary spontaneous CSF Rhinorrhea and propose a hypothesis for its pathogenesis. Methods Between 2003 and 2009, 21 patients diagnosed with primary spontaneous CSF Rhinorrhea underwent surgery in the authors' hospital. The clinical aspects were retrospectively reviewed, and their characteristics were analyzed. Results There were 18 women and 3 men, whose ages ranged from 37 to 74 years (mean 53 years). Body mass index (BMI) ranged from 22 to 58.8 kg/m2 (mean 31.2 kg/m2). Eighteen patients (85.7%) were overweight, and 18 (85.7%) suffered from headache or tinnitus before Rhinorrhea. Radiological images revealed fully or partially empty sellae in 14 patients (66.7%). The preoperative intracranial pressure (ICP) ranged from 11 to 28 cm H2O (mean 17.6 cm H2O), while the postoperative ICP ranged from 21 to 32 cm H2O (mean 25.5 cm H2O, p < 0.01). An endoscopeassisted transnasal approach was chosen for the repair. Postoperatively, in 95.2% of patients a cu...
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surgical strategy for Cerebrospinal Fluid Rhinorrhea repair
Operative Neurosurgery, 2010Co-Authors: Pinan Liu, Bo WangAbstract:OBJECTIVE Cerebrospinal Fluid (CSF) Rhinorrhea is leakage of CSF from the nasal cavity caused by cranial base or meningeal defects. Surgical treatment of CSF Rhinorrhea is still problematic. We evaluated the clinical outcomes of 132 consecutive cases of CSF Rhinorrhea treated via transcranial or transnasal endoscopic approaches according to the patient's condition. The indications for the approaches are discussed. METHODS Of 132 patients with CSF Rhinorrhea, a transnasal endoscopic approach was used in 98 to repair cranial base defects in the ethmoid and sphenoid sinuses. A transcranial intradural approach was used in the remaining 34 patients for frontal sinus defects, multiple fractures of the cranial base, or combination nerve injury. RESULTS CSF Rhinorrhea resolved after initial surgery in 124 of 132 patients, giving a success rate of 94%. Of the 8 failures or recurrent cases, 4 were successfully repaired by repeat endoscopic surgery, 2 were cured by transcranial revision surgery, and 2 refused additional surgery (the condition subsequently resolved without treatment in these patients). Postoperative complications included intracranial infection (8 patients) and anosmia (1 patient). No neurological deficits were apparent over the 10-month mean follow-up period. CONCLUSION Transnasal endoscopic repair is a reliable method for CSF Rhinorrhea patients whose fistulae are located in the ethmoid and sphenoid sinuses. The transcranial procedure should be the treatment of choice for patients with frontal sinus fracture, multiple or complex anterior cranial base fractures, or nerve injury. A satisfactory surgical outcome depends on exact diagnosis, proper operative approach, and the surgeon's skill and experience.
L M Gustafson - One of the best experts on this subject based on the ideXlab platform.
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transnasal endoscopic repair of Cerebrospinal Fluid Rhinorrhea and skull base defects a review of twenty nine cases
Otolaryngology-Head and Neck Surgery, 1994Co-Authors: E E Dodson, Charles W. Gross, J L Swerdloff, L M GustafsonAbstract:The management of Cerebrospinal Fluid Rhinorrhea has historically plagued the neurosurgeon and the otolaryngologist-head and neck surgeon. Intracranial repair is still favored at many institutions, despite its inherent morbidity. Extracranial nonendoscopic techniques have been previously described but have not gained wide acceptance. More recently, several reports have been published describing a variety of endoscopic techniques in limited patient series used to manage Cerebrospinal Fluid Rhinorrhea. We present our series of 29 patients with Cerebrospinal Fluid Rhinorrhea, treated with endoscopic techniques between December 1989 and June 1993, with follow-up ranging from 3 to 43 months. This represents the largest reported series to date of patients treated with this technique. Our technique has evolved during this time period but centers around the use of free tissue grafts from various donor sites. The causes of the skull base defects in this series included neurosurgical procedures (9), functional endoscopic sinus surgery (8), and trauma (3). Defects occurred spontaneously in 9 cases. The fovea ethmoidalis and sphenoid sinus were the site in 11 and 12 cases, respectively, and the cribriform plate was involved in 6 cases. Cerebrospinal Fluid Rhinorrhea was documented by nasal endoscopy with or without intrathecal fluorescein, laboratory studies, computed tomography with or without contrast cisternography, and radioisotope cisternography in various combinations. Resolution of Cerebrospinal Fluid Rhinorrhea was achieved in 22 of 29 patients (75.9%) with one endoscopic procedure and 25 of 29 patients (86.2%) after a second attempt. Four patients required neurosurgical intervention for recurrent Cerebrospinal Fluid Rhinorrhea. Complications were minimal and were related primarily to the original pathology or procedure. Cerebrospinal Fluid Rhinorrhea can be managed safely and effectively with endoscopic techniques in a majority of cases, and the morbidity of open procedures can be avoided.
John A H Wass - One of the best experts on this subject based on the ideXlab platform.
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nonsurgical Cerebrospinal Fluid Rhinorrhea in invasive macroprolactinoma incidence radiological and clinicopathological features
The Journal of Clinical Endocrinology and Metabolism, 2007Co-Authors: Sgi Suliman, N Sullivan, G Thanabalasingham, Simon Cudlip, James V. Byrne, Olaf Ansorge, Ali Gurlek, John A H WassAbstract:Context: Macroprolactinomas (MPRLs) may result in nonsurgical (spontaneous or dopamine agonist induced) Cerebrospinal Fluid (CSF) Rhinorrhea; however, the incidence of and mechanisms underlying this phenomenon are poorly understood. Objective: The objective of the study was to determine the incidence of nonsurgical Rhinorrhea and identify biochemical, radiological, and histopathological factors associated with leakage. Design, Setting, and Participants: A retrospective review of MPRL patients (n = 114) was compared with patients with nonfunctioning pituitary adenoma (NFA) (n = 181) seen over a 19-yr period (1985–2004). Main Outcome Measures: Incidence of CSF Rhinorrhea, factors predictive of leakage, and differential expression of candidate markers of invasiveness were measured. Results: Nonsurgical CSF Rhinorrhea occurred in 8.7% of MPRLs (10 of 114) [2.6% spontaneous (three of 114), 6.1% dopamine agonist induced (seven of 114)], whereas no NFAs developed nonsurgical Rhinorrhea. There was a clear male pr...
Ali Gurlek - One of the best experts on this subject based on the ideXlab platform.
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nonsurgical Cerebrospinal Fluid Rhinorrhea in invasive macroprolactinoma incidence radiological and clinicopathological features
The Journal of Clinical Endocrinology and Metabolism, 2007Co-Authors: Sgi Suliman, N Sullivan, G Thanabalasingham, Simon Cudlip, James V. Byrne, Olaf Ansorge, Ali Gurlek, John A H WassAbstract:Context: Macroprolactinomas (MPRLs) may result in nonsurgical (spontaneous or dopamine agonist induced) Cerebrospinal Fluid (CSF) Rhinorrhea; however, the incidence of and mechanisms underlying this phenomenon are poorly understood. Objective: The objective of the study was to determine the incidence of nonsurgical Rhinorrhea and identify biochemical, radiological, and histopathological factors associated with leakage. Design, Setting, and Participants: A retrospective review of MPRL patients (n = 114) was compared with patients with nonfunctioning pituitary adenoma (NFA) (n = 181) seen over a 19-yr period (1985–2004). Main Outcome Measures: Incidence of CSF Rhinorrhea, factors predictive of leakage, and differential expression of candidate markers of invasiveness were measured. Results: Nonsurgical CSF Rhinorrhea occurred in 8.7% of MPRLs (10 of 114) [2.6% spontaneous (three of 114), 6.1% dopamine agonist induced (seven of 114)], whereas no NFAs developed nonsurgical Rhinorrhea. There was a clear male pr...
Charles W. Gross - One of the best experts on this subject based on the ideXlab platform.
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endoscopic management of Cerebrospinal Fluid Rhinorrhea
Laryngoscope, 2004Co-Authors: K. Christopher Mcmains, Charles W. Gross, Stilianos E KountakisAbstract:Purpose: Most anterior skull base defects causing Cerebrospinal Fluid (CSF) Rhinorrhea can be readily approached using endoscopic techniques when surgical repair is necessary. We present our data from endoscopic repair of CSF Rhinorrhea with long-term follow-up. Methods: Retrospective data analysis of patients that were diagnosed with anterior skull base CSF Rhinorrhea and underwent endoscopic repair at a tertiary institution. Data were analyzed to determine the etiology and location of CSF leaks. Diagnostic techniques, surgical techniques, and surgical outcomes were reviewed. Results: Ninety-two patients were diagnosed with CSF Rhinorrhea and underwent endoscopic repair over a 12-year period. Forty-eight were males, and 44 were females. The average age was 49 (range 6–81) years. Average follow-up was 25 months, with a range of 12 to 82 months. The etiology of CSF leak was prior endoscopic sinus surgery in 23 patients (25%), idiopathic in 19 (21%), neurosurgery in 17 (18%), trauma in 18 (20%), and the presence of meningocele/encephalocele in 11 patients (12%). The most common location of the defect was the sphenoid sinus (n = 36, 39%), followed by ethmoid roof (n-27, 29%), and cribriform plate (n = 24, 26%). Endoscopic repair was initially successful in 78 (85%) patients. Seven additional patients underwent successful revision endoscopic repair for an overall success rate of 92% (n = 85). Five (6%) large skull base defects were eventually repaired by neurosurgery using open intracranial techniques. No major complications were encountered. Conclusion: The intranasal endoscopic approach is an effective and safe technique in the surgical management of anterior skull base CSF Rhinorrhea. Long-term success rate in our patient population was 92%.
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transnasal endoscopic repair of Cerebrospinal Fluid Rhinorrhea and skull base defects a review of twenty nine cases
Otolaryngology-Head and Neck Surgery, 1994Co-Authors: E E Dodson, Charles W. Gross, J L Swerdloff, L M GustafsonAbstract:The management of Cerebrospinal Fluid Rhinorrhea has historically plagued the neurosurgeon and the otolaryngologist-head and neck surgeon. Intracranial repair is still favored at many institutions, despite its inherent morbidity. Extracranial nonendoscopic techniques have been previously described but have not gained wide acceptance. More recently, several reports have been published describing a variety of endoscopic techniques in limited patient series used to manage Cerebrospinal Fluid Rhinorrhea. We present our series of 29 patients with Cerebrospinal Fluid Rhinorrhea, treated with endoscopic techniques between December 1989 and June 1993, with follow-up ranging from 3 to 43 months. This represents the largest reported series to date of patients treated with this technique. Our technique has evolved during this time period but centers around the use of free tissue grafts from various donor sites. The causes of the skull base defects in this series included neurosurgical procedures (9), functional endoscopic sinus surgery (8), and trauma (3). Defects occurred spontaneously in 9 cases. The fovea ethmoidalis and sphenoid sinus were the site in 11 and 12 cases, respectively, and the cribriform plate was involved in 6 cases. Cerebrospinal Fluid Rhinorrhea was documented by nasal endoscopy with or without intrathecal fluorescein, laboratory studies, computed tomography with or without contrast cisternography, and radioisotope cisternography in various combinations. Resolution of Cerebrospinal Fluid Rhinorrhea was achieved in 22 of 29 patients (75.9%) with one endoscopic procedure and 25 of 29 patients (86.2%) after a second attempt. Four patients required neurosurgical intervention for recurrent Cerebrospinal Fluid Rhinorrhea. Complications were minimal and were related primarily to the original pathology or procedure. Cerebrospinal Fluid Rhinorrhea can be managed safely and effectively with endoscopic techniques in a majority of cases, and the morbidity of open procedures can be avoided.