Chronic Subdural Hematoma as a Complication of Cerebrospinal Fluid Leak During Revision Lumbar Spine Surgery: A Case Report and Review of the Literature.
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ABSTRACT:
SUBMITTER: Wawrose RA
PROVIDER: S-EPMC7749911 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:A 52-year-old woman underwent a right frontotemporal craniotomy for microsurgical clip obliteration of a ruptured right dorsal variant ophthalmic segment carotid aneurysm. During the craniotomy, a defect involving the orbital roof was inadvertently created. The patient was noted postoperatively to have fluid egressing from her OD. The fluid was analyzed and based on glucose and chloride levels was determined to be cerebrospinal fluid (CSF). CT scan of the head demonstrated the orbital roof defect created during surgery. After placement of a lumbar drain, fluid egress from the eye significantly decreased, further confirming the suspicion for CSF leak. Patient was found to have a conjunctival defect of the OD, approximately 2.5 cm × 1.5 cm, extending to the fornix from 9 to 12 o'clock. The conjunctival defect and fornix were repaired with an amniotic membrane graft and a temporary tarsorrhaphy with subsequent resolution of CSF egress. The case report is in compliance with the Health Insurance Portability and Accountability Act.
| S-EPMC4258181 | biostudies-literature
Project description:Revision lumbar spine surgeries are technically challenging with inconstant outcome results. This article discusses the preoperative, intraoperative, as well as postoperative management in these difficult patients. Successful intervention requires a detailed history and physical examination and carefully chosen diagnostic tests. Preoperative planning is paramount in these cases. The decision-making process should address the timing of the surgery, surgical approach, level of interbody fusion required, correction of sagittal imbalance, type of osteotomy, location of the osteotomy, and the end of the construct. Surgeons should be prepared to manage associated complications such as dural tear and massive blood loss. The use of autograft and/or biologic graft is necessary to help in achieving a successful fusion. Postoperative management includes prophylactic antibiotic, anticoagulation, nutritional support, and brace.
| S-EPMC3864481 | biostudies-other
Project description:Study Design Case report. Objective To report a case of remote cerebellar hemorrhage (RCH) without intraoperative dural tear after revision lumbar spine surgery. RCH is a rare postoperative complication following spine surgery. RCH has previously been reported only in cases with intraoperative dural tear or durotomy. Methods Case report and literature review. Results A 58-year-old woman underwent removal of L4-S1 posterior spinal instrumented fusion (PSIF) implants and L3-L4 decompressive laminectomy with PSIF. There was no intraoperative dural tear. After doing well initially, the patient developed new neurologic symptoms and was found to have RCH. Lumbar spine magnetic resonance imaging (MRI) demonstrated a large dural defect. After repair of the dura, the patient had dramatic improvement of her neurologic symptoms. At 1-year follow-up, the patient continued to have no neurologic sequelae. Conclusion This report demonstrates that RCH can occur without intraoperative dural tear. Although rare, any patient with new onset of declining neurologic symptoms following spine surgery should have a brain MRI and should have RCH on the differential diagnosis.
| S-EPMC4671890 | biostudies-other
Project description:IntroductionDysphagia is a common and severe symptom of traumatic brain injury (TBI) affecting up to 78% of patients. It is associated with pneumonia, increased morbidity, and mortality. Although subdural hematoma (SDH) accounts for over 50% of TBI, the occurrence of dysphagia in this subtype has not been investigated yet.MethodsAll patients with SDH admitted to the author's institution between the years 2007 and 2020 were included in the study. Patients with SDH and clinical suspicion for dysphagia received a clinical swallowing assessment by a speech and language pathologist (SLP). Furthermore, the severity of dysphagia was rated according to swallowing disorder scale. Functional outcome was evaluated by the Glasgow outcome scale (GOS).ResultsOut of 545 patients with SDH, 71 patients had dysphagia (13%). The prevalence of dysphagia was significantly lower in the surgical arm compared to the conservative arm (11.8 vs. 21.8%; OR 0.23; p = 0.02). Independent predictors for dysphagia were GCS <13 at admission (OR 4.17; p < 0.001), cardiovascular disease (OR 2.29; p = 0.002), and pneumonia (OR 2.88; p = 0.002), whereas the operation was a protective factor (OR 0.2; p < 0.001). In a subgroup analysis, right-sided SDH was an additional predictor for dysphagia (OR 2.7; p < 0.001). Overall, patients with dysphagia improved significantly under the SLP treatment from the initial diagnosis to hospital discharge (p < 0.01). However, a subgroup of patients with the most severe grade of dysphagia showed no significant improvement. Patients with dysphagia had significantly worse outcomes (GOS 1-3) compared to those without dysphagia (48.8 vs. 26.4%; p < 0.001).ConclusionDysphagia is a frequent symptom in SDH, and the early identification of dysphagia is crucial regarding the initiation of treatment and functional outcome. Surgery is effective in preventing dysphagia and should be considered in high-risked patients.
| S-EPMC8826688 | biostudies-literature
Project description:Introductionand Objectives: Leakage of cerebrospinal fluid (CSF) from the frontal sinus is a challenging condition facing the ENT surgeon. Repair of this condition has been changed nowadays due to the newer instruments and techniques of nasal endoscopy. This study aims to evaluate the outcome of frontal sinus CSF leak endoscopic repair.Patients and methodsTwenty-seven patients who had frontal sinus CSF leaks were included in this study. They were 9 females and 18 males. They underwent endoscopic repair of the leak site at the period of five years from 2015 to 2020. A retrospective evaluation of these patients includes reconstructive procedures, complications, and postoperative follow-up.ResultsThe frontal leaks were present in the frontal recess (8 patients, 29.6%), ethmoidal roof (5 patients, 18.5%), and the majority was in the posterior wall (14 patients, 51.9%); 11 in the medial side and 3 in the lateral side. All cases, 27 (100%) were treated successfully, no failed treatment was observed. Postoperative complications were minimal; two patients had elevated intracranial pressure (ICP), infection with fever were found in four patients (7.4%), and meningitis was observed in only two cases (7.4%), treated conservatively.ConclusionFor frontal sinus CSF leak repair, the endonasal endoscopic approach is the treatment of choice due to higher success rates and lower morbidity profile. A favorable result is possible with proper diagnosis, precise localization, and an appropriate strategy.
| S-EPMC8519771 | biostudies-literature
Project description:Cerebrospinal fluid (CSF) leak closure remains one of the most difficult surgeries for skull base surgeons, particularly with frontal sinus involvement. Technological advances in endoscopic surgery increasingly allow for less morbid approaches to the frontal sinus. We describe a series of patients who underwent endoscopic frontal sinus CSF leak repair utilizing a unilateral approach, to evaluate the utility and outcomes of this method. We performed a retrospective review of four cases in tertiary care centers. Participants included patients with CSF leak involving the frontal sinus. Main outcome measures included cessation of CSF leak and frontal sinus patency. Three patients were closed on the first surgical attempt; one with a communicating hydrocephalus required a revision procedure. Leak etiologies included prior craniotomy for frontal sinus mucopyocele, spontaneous meningoencephalocele, erosion due to mucormycosis, and prior endoscopic sinus surgery. The frontal sinus remained patent in three of four patients. No patients have evidence of a leak at a minimum of 1 year after surgery. The repair of frontal sinus CSF leaks is possible in specific cases with an endoscopic unilateral approach in leaks with multiple etiologies. Surgeons should consider this approach when selecting the appropriate procedure for repair of frontal sinus CSF leaks.
| S-EPMC3312112 | biostudies-other
Project description:A subdural hematoma (SDH) is a type of bleeding in which a collection of blood gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. Although most cases reported of subdural hematoma are due to traumatic brain injury, to the best of our knowledge this is a rare case of nontraumatic subdural hematoma. A 31 year-old-Male presented to the emergency department with a severe headache for 3 weeks, with the presence of oculomotor disorders. There is no history of major trauma, minor trauma or fights. Also, no history of hypertension, or Haematological diseases. Magnetic resonance imaging (MRI) showed bilateral subdural hematoma. The right-sided hematoma was treated conservatively and the Left-sided was treated by surgery. Follow-up for three months revealed no recurrence. Nontraumatic subdural hematoma is one of the challenging cases that neurosurgeons face. We presented a patient with idiopathic spontaneous subdural hematoma. Computed tomography (CT) is the first step for diagnosis and Magnetic resonance imaging (MRI) is considered an excellent imaging investigation to evaluate such patients. Symptomatic subdural hematomas require an emergent treatment by identifying and controlling sites of bleeding conservatively or by surgery. Subdural hematoma with no history of trauma should be treated emergently and evaluated strictly. Follow-up is essential in patients with neural symptoms. Massive symptomatic subdural hematoma (SDH) should be treated with surgery to control the bleeding.
| S-EPMC8528674 | biostudies-literature
Project description:Submucosal diathermy of the inferior turbinate (SMDIT) is a generally safe procedure to control inferior turbinate hypertrophy. We present a case of a cerebrospinal fluid (CSF) leak at the craniocervical junction after SMDIT done in another institution. A 27-year-old man presented 3 weeks after undergoing SMDIT with signs and symptoms of meningitis and postnasal rhinorrhea. Nasal endoscopy and imaging revealed a nasopharyngeal CSF fistula at the craniocervical junction. Transnasal endoscopic repair and reconstruction was performed with no recurrence on repeat imaging and clinical follow up. We describe the first reported case in the literature of an iatrogenic CSF fistula caused by SMDIT, an unusual and potentially fatal complication, and its surgical management.0None.
| S-EPMC6074370 | biostudies-other
Project description:Cerebrospinal fluid (CSF) leaks can occur when there is communication between the intracranial cavities and the external environment. They are a common and serious complication of numerous procedures in otolaryngology, and if not treated, persistent leaks can increase a patient's risk of developing life-threatening complications such as meningitis. As it is not uncommon for patients to exhibit increased secretions postoperatively, distinguishing normal secretions from those containing CSF can be difficult. Currently, there are no proven, available tests that allow a medical provider concerned about a CSF leak to inexpensively, rapidly, and noninvasively rule out the presence of a leak. The gold standard laboratory-based test requires that a sample be sent to a tertiary site for analysis, where days to weeks may pass before results return. To address this, our group recently developed a semiquantitative, barcode-style lateral-flow immunoassay (LFA) for the quantification of the beta-trace protein, which has been reported to be an indicator of the presence of CSF leaks. In the work presented here, we created a rapid diagnostic test kit composed of our LFA, a collection swab, dilution buffers, disposable pipettes, and instructions. Validation studies demonstrated excellent predictive capabilities of this kit in distinguishing between clinical specimens containing CSF and those that did not. Our diagnostic kit for CSF leak detection can be operated by an untrained user, does not require any external equipment, and can be performed in approximately 20 min, making it well suited for use at the point of care. This kit has the potential to transform patient outcomes.
| S-EPMC6980299 | biostudies-literature
Project description:Background Cerebrospinal fluid (CSF) leak is widely recognized as a challenging and commonly occurring postoperative complication of transsphenoidal surgery (TSS). The primary objective of this study is to benchmark the current prevalence of CSF leak after TSS in the adult population. Methods The authors followed the PRISMA guidelines. The PubMed, Embase, and Cochrane Library databases were searched for articles reporting CSF leak after TSS in the adult population. Meta-analysis was performed using the Untransformed Proportion metric in OpenMetaAnalyst. For two between-group comparisons a generalized linear mixed model was applied. Results We identified 2,408 articles through the database search, of which 70, published since 2015, were included in this systematic review. These studies yielded 24,979 patients who underwent a total of 25,034 transsphenoidal surgeries. The overall prevalence of postoperative CSF leak was 3.4% (95% confidence interval or CI 2.8-4.0%). The prevalence of CSF leak found in patients undergoing pituitary adenoma resection was 3.2% (95% CI 2.5-4.2%), whereas patients who underwent TSS for another indication had a CSF leak prevalence rate of 7.1% (95% CI 3.0-15.7%) (odds ratio [OR] 2.3, 95% CI 0.9-5.7). Patients with cavernous sinus invasion (OR 3.0, 95% CI 1.1-8.7) and intraoperative CSF leak (OR 5.9, 95% CI 3.8-9.0) have increased risk of postoperative CSF leak. Previous TSS and microscopic surgery are not significantly associated with postoperative CSF leak. Conclusion The overall recent prevalence of CSF leak after TSS in adults is 3.4%. Intraoperative CSF leak and cavernous sinus invasion appear to be significant risk factors for postoperative CSF leak.
| S-EPMC9272274 | biostudies-literature