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Purpose
The purpose of this study is to document the prevalence of MR findings suggestive of idiopathic intracranial hypertension (IIH) in patients undergoing endoscopic repair of spontaneous CSF rhinorrhea (SCSFR).
Methods
In a retrospective study, MR images of 117 consecutive patients who had undergone endoscopic repair of SCSFR were evaluated f...
Citations
... While most CSF rhinorrhea leaks are attributable to traumatic causes such as head injuries or surgical procedures, a small percentage, up to 5%, are associated with other factors such as hydrocephalus, structural anomalies, cerebral venous thrombosis, or unknown causes [1,2]. Primary spontaneous CSF leaks represent a unique subset of this condition, characterised by specific features including its target demographic and a high recurrence rate, of 2.9-46% after repair, compared to other types of CSF leak [3,4]. ...
... Additionally, several invasive procedures were performed to address the underlying causes of IIH and associated CSF leak, such as perioperative lumbar drains or Of a total of 792 patients who underwent surgical repair, 713 were successful within the first surgery and 79 had a recurrence. The average time of recurrence was 20.5 ± 13 months [1,4,6,11,12,15,31], indicating the need for long-term follow-up and effective management strategies (Tab. 4). ...
... Spontaneous CSF leak is a known complication of IIH, but its pathogenesis is still not fully understood. Several hypotheses have been put forward to account for how increased CSF pressure could lead to defects in the skull base, dura mater, arachnoid mater, or arachnoid villi [2][3][4][5]. However, these factors alone cannot explain why some patients develop a spontaneous CSF leak but others do not. ...
Introduction. Spontaneous CSF leak is a known complication of idiopathic intracranial hypertension (IIH). Patients with CSF rhinorrhea present a unique challenge within the IIH population, as the occurrence of a leak can mask the typical IIH symptoms and signs, complicating the diagnosis. Treatment of leaks in this population can also be challenging, with the risk of rhinorrhea recurrence if intracranial hypertension is not adequately treated. Objective. The aim of this narrative review was to examine current literature on the association between spontaneous CSF rhinorrhea leaks and IIH, focusing on key clinical features, diagnostic approaches, management strategies, and outcomes. Material and methods. A literature search was executed using the PubMed and Scopus databases. The search was confined to articles published between January 1985 and August 2023; extracted data was then analysed to form the foundation of the narrative review. Results. This search yielded 26 articles, comprising 943 patients. Average age was 46.8 ± 6.5 years, and average body mass index was 35.8 ± 4.8. Most of the patients were female (74.33%). Presenting symptoms were rhinorrhea, headaches and meningitis. The most common imaging findings were empty sella and encephalocele. The standard treatment approach was endoscopic endonasal approach for correction of CSF rhinorrhea leak, and shunt placement was also performed in 128 (13%) patients. Recurrences were observed in 10% of cases. Conclusions. The complex relationship between spontaneous CSF leaks and IIH is a challenge that benefits from multidisciplinary evaluation and management for successful treatment. Treatments such as endoscopic repair, acetazolamide, and VP/ /LP shunts reduce complications and recurrence. Personalised plans addressing elevated intracranial pressure are crucial for successful outcomes.
... Эхографическая картина воспалительного процесса характеризуется утолщением преимущественно переднего отдела ретробульбарной части нерва. Расширение диаметра поперечного сечения ЗН может быть связано с утолщением его паренхимы, расширением периневрального пространства и нарушением продукции/резорбции ликвора [4][5][6][7][8][9][10]. ...
Purpose: a comparative analysis of biometric parameters of the optic nerve obtained by different diagnostic ultrasound sensors.
Material and methods. We examined 20 healthy volunteers with emmetropia aged 20 to 40 years (40 eyes), average age 30.5 ± 5.4 years, who had no complaints or ophthalmic pathologies. Ultrasound scanning was performed on a multifunctional Voluson E8 (GE) scanner (11–18 MHz linear sensor), ophthalmic ultrasound device Ellex Eyecubed (a conventional 10 MHz transducer) and an ophthalmic scanner Absolu «Quantel Medical» (a 20 MHz transducer). All examinations were carried out by one operator who used the same scanning technique and measured the optic nerve sheath diameter (ONSD) and optic nerve diameter (OND) without sheaths in both eyes. Six consequent measurements of the ONSD and the OND parameters were performed to ascertain the reproducibility of the examinations and evaluate the variation coefficient.
Results. The analysis revealed no statistically significant differences in the ONSD and in the OND obtained with 11–18 MHz, 10 MHz and 20 MHz transducers in the B-mode (р > 0.05). The minimum variation coefficient of the optic nerve thickness parameters was registered using a high-frequency 20 MHz transducer on the ophthalmic scanner. The biometry obtained with a high frequency 20 MHz transducer could be considered as the most reproducible.
Conclusion. A high frequency 20 MHz transducer can be recommended for optimal visualization and precise evaluation of biometric parameters of the retrobulbar part of the optic nerve. Transducers of multifunctional scanners with the frequency range from 11 to 20 MHz can be used for measurements of the optic nerve sheath diameter.
... In addition, she showed typical clinical signs of IIH, i.e., headaches and balance problems. In a study by Rupa et al. the majority of patients with spontaneous CSF rhinorrhea showed MRI features of IIH, e.g., empty sella, flattened posterior globe, enlarged Meckel's cave [21]. It is reasonable to check for signs of IIH in patients with spontaneous CSF rhinorrhea with typical patient characteristics and clinical signs and initiate treatment to prevent recurrence postoperatively [1]. ...
Purpose
Precise preoperative localization of anterior skull base defects is important to plan surgical access, increase the success rate and reduce complications. A stable closure of the defect is vital to prevent recurrence of cerebrospinal fluid (CSF) rhinorrhea. The purpose of this retrospective case series was to evaluate the reliability of a new high-resolution gadolinium-enhanced compressed-sensing SPACE technique (CS T1 SPACE) for magnetic resonance (MR) cisternography to detect cerebrospinal fluid leaks of the anterior skull base and to assess the long-term success rate of the gasket-seal technique for closure of skull base defects.
Method
All patients with spontaneous or postoperative cerebrospinal fluid rhinorrhea and defects of the anterior skull base presenting to the Departments of Otorhinolaryngology and Neurosurgery between 2019 and 2020, receiving a computed tomography (CT) cisternography and MR cisternography (on a 3T whole-body MR scanner using a 64-channel head and neck coil) with CS T1 SPACE sequence and closure of the defect with the gasket-seal technique, were enrolled in the study. For the cisternography, iodinated contrast agent (15 ml Solutrast 250 M®), saline (4 mL) mixed with a 0.5 mL of gadoteridol was injected into the lumbar subarachnoid space.
Results
A total of four patients were included in the study and MR cisternography with CS T1 SPACE sequence was able to precisely localize CSF leaks in all patients. The imaging results correlated with intraoperative findings. All defects could be successfully closed with the gasket-seal technique. The mean follow-up was 35.25 months (range 33–37 months).
Conclusion
MR cisternography with CS T1 SPACE sequence could be a promising technique for precise localization of CSF leaks and the gasket-seal technique resulted in good closure of the CSF fistula in this case series.
BACKGROUND AND OBJECTIVES
Intrasellar arachnoid diverticulae can often be identified on preoperative imaging in patients undergoing endoscopic transsphenoidal surgery. The objective of this study was to characterize arachnoid diverticulae both qualitatively and quantitatively in a large institutional cohort of patients with pituitary tumors and to evaluate its association with intraoperative cerebrospinal fluid (CSF) leak.
METHODS
Preoperative imaging studies of 530 patients who underwent primary endoscopic transsphenoidal resection of pituitary tumors were examined both quantitatively and qualitatively for the presence of an intrasellar arachnoid diverticulum. A matched cohort analysis was performed to compare patients with a “significant” (>50% sellar depth) diverticulum with those with nonsignificant/no diverticulum. Morphologically, diverticulae were separately classified as Type 1 (ventral CSF cleft with no tumor/gland tissue between sellar face and infundibulum) or Type 2 (central CSF cleft with tumor/gland tissue between sellar face and infundibulum).
RESULTS
Arachnoid diverticulae were noted in 40.2% of cases, and diverticulum depth was linearly correlated with tumor size and body mass index. A significant diverticulum was identified in 66 cases (12.5%) and was significantly associated with the functional tumor subtype ( P = .005) and intraoperative CSF leak ( P < .001). Type 1 clefts were associated with nonfunctional pathology ( P = .034) and the presence of suprasellar extension ( P = .035) and tended to be deeper than Type 2 clefts ( P < .001), with a higher incidence of intraoperative CSF leak ( P = .093). On logistic regression analysis, only the presence of a significant diverticulum was independently associated with intraoperative CSF leak (odds ratio 4.545; 95% CI 2.418-8.544; P < .001).
CONCLUSION
The presence of an intrasellar arachnoid diverticulum should alert the surgeon to an elevated risk of intraoperative CSF leak during transsphenoidal surgery for pituitary tumors. A relatively limited surgical exposure tailored to the craniocaudal extent of the sellar pathology should be considered in these patients.
