Direct communication between the lateral ventricle and the frontal sinus as the cause of CSF rhinorrhea in aqueductal stenosis

1981 ◽  
Vol 57 (1-2) ◽  
pp. 95-98 ◽  
Author(s):  
J. M. Cabezudo ◽  
J. Vaquero ◽  
R. García-de-Sola ◽  
E. Areitio ◽  
R. Martinez
Keyword(s):  
Frontal Sinus ◽  
Lateral Ventricle ◽  
Aqueductal Stenosis ◽  
Csf Rhinorrhea ◽  
Direct Communication

Aqueductal Stenosis Leading to Herniation of the Frontal Horn of the Lateral Ventricle into the Frontal Sinus

1997 ◽  
Vol 21 (5) ◽  
pp. 837-839 ◽  
Author(s):  
Andrei I. Holodny ◽  
Nikita V. Arutiunov ◽  
Valeri N. Kornienko ◽  
Reynaldo Gonzales ◽  
Ceslovas Vaicys ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Lateral Ventricle ◽  
Aqueductal Stenosis ◽  
Frontal Horn

Spontaneous indirect CSF rhinorrhea following excision of a giant choroid plexus papilloma of lateral ventricle

2014 ◽  
Vol 62 (6) ◽  
pp. 700
Author(s):  
Laxminadh Sivaraju ◽  
NarayanamAnantha Sai Kiran ◽  
Ravi Dadlani ◽  
AlangarS Hegde
Keyword(s):  
Choroid Plexus ◽  
Lateral Ventricle ◽  
Choroid Plexus Papilloma ◽  
Csf Rhinorrhea ◽  
Plexus Papilloma

A giant intracranial mucocele associated with an orbitoethmoidal osteoma

2000 ◽  
Vol 92 (4) ◽  
pp. 697-701 ◽  
Author(s):  
Yoshikazu Nakajima ◽  
Toshiki Yoshimine ◽  
Makoto Ogawa ◽  
Mayako Takanashi ◽  
Kana Nakamuta ◽  
...  
Keyword(s):  
Cyst Wall ◽  
Lateral Ventricle ◽  
Rare Case ◽  
Dural Defect ◽  
Convulsive Disorder ◽  
Direct Communication ◽  
Content Type ◽  
Ethmoidal Sinus ◽  
Olfactory Groove ◽  
Fine Print

✓ The authors present a rare case of a giant intracranial mucocele associated with an orbitoethmoidal osteoma in a patient suffering from a generalized convulsive disorder. The broad pedicle of the osteoma had penetrated the cribriform plate and extended intracranially to form a nodular mass in the olfactory groove. The intracranial portion of the osteoma was surrounded by a mucocele. Both the cyst wall and multilayered intracystic septations of the mucocele were indented by layers of the osteoma. Although the extracranial portion adhered to the mucosa of the ethmoidal sinus, there were no signs of sinus obstruction. No direct communication other than the osteoma was identified between the mucocele and the ethmoidal mucosa. The large cerebral defect, which the mucocele occupied, communicated directly with the lateral ventricle without any intervening membranous structures. A frontal craniotomy is recommended for exposure of the lesion and plastic repair of the dural defect.

Recurrent meningitis associated with frontal sinus tuber encephalocele in a patient with tuberous sclerosis

2011 ◽  
Vol 8 (1) ◽  
pp. 103-106 ◽  
Author(s):  
Samer K. Elbabaa ◽  
Angela D. Riggs ◽  
Ali G. Saad
Keyword(s):  
Tuberous Sclerosis ◽  
Frontal Sinus ◽  
Posterior Wall ◽  
Bony Defect ◽  
Recurrent Meningitis ◽  
Csf Rhinorrhea ◽  
Lumbar Drain ◽  
Sinus Wall ◽  
Sinus Mucosa

Tuberous sclerosis complex (TSC) is a genetic neurocutaneous disorder that commonly affects the CNS. The most commonly associated brain tumors include cortical tubers, subependymal nodules, and subependymal giant cell astrocytomas (SEGAs). The authors report an unusual case of recurrent meningitis due to a tuber-containing encephalocele via the posterior wall of the frontal sinus. An 11-year-old girl presented with a history of TSC and previous SEGA resection via interhemispheric approach. She presented twice within 4 months with classic bacterial meningitis. Cerebrospinal fluid cultures revealed Streptococcus pneumoniae. Computed tomography and MR imaging of the brain showed a right frontal sinus encephalocele via a posterior frontal sinus wall defect. Both episodes of meningitis were treated successfully with standard regimens of intravenous antibiotics. The neurosurgical service was consulted to discuss surgical options. Via a bicoronal incision, a right basal frontal craniotomy was performed. A large frontal encephalocele was encountered in the frontal sinus. The encephalocele was herniating through a bony defect of the posterior sinus wall. The encephalocele was ligated and resected followed by removing frontal sinus mucosa and complete cranialization of frontal sinus. Repair of the sinus floor was conducted with fat and pericranial grafts followed by CSF diversion via lumbar drain. Histopathology of the resected encephalocele showed a TSC tuber covered with respiratory (frontal sinus) mucosa. Tuber cells were diffusely positive for GFAP. The patient underwent follow-up for 2 years without evidence of recurrent meningitis or CSF rhinorrhea. This report demonstrates that frontal tubers of TSC can protrude into the frontal sinus as acquired encephaloceles and present with recurrent meningitis. To the authors' knowledge, recurrent meningitis is not known to coincide with TSC. Careful clinical and radiographic follow-up for frontal tubers in patients with TSC is recommended.

scholarly journals Purely endoscopic pterional extradural approach: A novel technique for repair of cerebrospinal fluid rhinorrhea

2016 ◽  
Vol 07 (02) ◽  
pp. 310-313 ◽  
Author(s):  
Ajit Kumar Sinha ◽  
Sumit Goyal
Keyword(s):  
Cerebrospinal Fluid ◽  
Neurological Deficit ◽  
Frontal Sinus ◽  
Intraoperative Complications ◽  
Posterior Wall ◽  
Csf Leak ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Novel Technique ◽  
Extradural Approach

ABSTRACT Study Design: Retrospective descriptive study of an innovative surgical technique. Objective: To assess the feasibility and success of repair of transfrontal sinus cerebrospinal fluid (CSF) rhinorrhea through pterional transcranial extradural approach using endoscope. Summary of Background Data: Repair of CSF rhinorrhea has seen advancement with the evolution of endoscopic transnasal techniques. However, leaks from defect in the posterior wall of frontal sinus still remain a challenge for the skull base surgeons and requires conventional craniotomy more often. We describe a novel technique to repair these leaks by purely endoscopic pterional extradural (PEPE) approach thereby avoiding complications associated with conventional craniotomy and endoscopic transnasal approaches. Materials and Methods: Thirty-five patients with traumatic CSF rhinorrhea from the posterior wall of frontal sinus underwent repair with the present technique. They were followed up for 6–18 months and were evaluated for feasibility of procedure, recurrence of leak, and occurrence of the fresh neurological deficit. Results: Thirty-five patients underwent CSF rhinorrhea repair using the above technique. The procedure was accomplished in all patients without any intraoperative complications. There was no requirement of blood transfusion in any case. All patients had a cessation of CSF leak in the postoperative period, and there was no recurrence. There was no evidence of frontal lobe retraction injury in any of these patients, and no fresh neurological deficit was observed. Conclusion: This PEPE approach to repair CSF leak through the posterior wall of the frontal sinus is a novel technique in which we can avoid disadvantages associated with both conventional craniotomy as well as transnasal endoscopic approaches.

Surgical Strategy for Cerebrospinal Fluid Rhinorrhea Repair

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons281-ons286 ◽  
Author(s):  
Pinan Liu ◽  
Shengtian Wu ◽  
Zhi Li ◽  
Bo Wang
Keyword(s):  
Cerebrospinal Fluid ◽  
Nerve Injury ◽  
Frontal Sinus ◽  
Cranial Base ◽  
Neurological Deficits ◽  
Csf Rhinorrhea ◽  
Initial Surgery ◽  
Additional Surgery ◽  
Anterior Cranial Base ◽  
Sphenoid Sinuses

Abstract 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.

Endonasal Endoscopic Management of Frontal Sinus Cerebrospinal Fluid Leak

2017 ◽  
Vol 31 (6) ◽  
pp. 406-411 ◽  
Author(s):  
Javaneh Jahanshahi ◽  
Mehdi Zeinalizadeh ◽  
Hasan Reza Mohammadi ◽  
Seyed Mousa Sadrehosseini
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Frontal Sinus ◽  
Surgical Approaches ◽  
Endoscopic Management ◽  
Graft Material ◽  
Endoscopic Repair ◽  
Skull Base Reconstruction ◽  
Csf Rhinorrhea

Background A frontal sinus leak is uncommon and is seen in ∼15% of cases of patients with cerebrospinal fluid (CSF) rhinorrhea. Now, endonasal endoscopic techniques have been reported to reconstruct skull base defects in the frontal sinus with a favorable outcome. Objective To review our experience in the repair of frontal sinus CSF leaks through an endonasal endoscopic approach. Methods Twenty-four patients with a frontal sinus leak who underwent endonasal endoscopic repair entered the study. Clinical presentation, location, frontal sinusotomy, graft material, follow-up, and frontal sinus status were evaluated. Results Among >100 cases of surgically repaired CST rhinorrhea, the frontal sinus was the site of the leak in 24 patients (mean age, 28.9 years; mean follow-up, 22 months). The etiology consisted of spontaneous leak and traumatic leak; whereas patients with skull base reconstruction after removal of tumor were excluded. Surgical approaches included Draf IIb, Draf III, Draf IIa in 20, 3, and 1 patients, respectively. Tree autografts as two-layer inlay fat–muscle and onlay fascia lata were used in the majority of patients. A success rate was achieved in 95.83% of the patients. Conclusion Endonasal endoscopic repair of a frontal sinus leak was a successful procedure, with a low failure rate and minimal morbidity.

scholarly journals 351 Anterior Ethmoid Artery Septal Flap for Endoscopic Reconstruction of Frontal Sinus CSF Leak

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Adegboyega ◽  
H A Elhassan ◽  
J Zocchi ◽  
A Lambertoni ◽  
G Bozkurt ◽  
...  
Keyword(s):  
Skull Base ◽  
Frontal Sinus ◽  
Middle Turbinate ◽  
Posterior Wall ◽  
Csf Leak ◽  
Csf Rhinorrhea ◽  
Endoscopic Closure ◽  
Nasal Floor ◽  
Anterior Ethmoid Artery ◽  
Csf Leaks

Abstract Introduction Anterior skull base cerebrospinal fluid (CSF) leaks are managed successfully with endonasal surgery. Endoscopic closure of CSF leaks from posterior table of the frontal sinus remains challenging. Vascularized Hadad-Bassagasteguy flap (HBF) reconstruction of the skull base has increased CSF closure rates but does not extend to frontal sinus. We describe our technique using septal flap pedicled by anterior ethmoid artery (AEA) for repairing frontal defects. Method Retrospective review of cases of frontal CSF leak repair using the AEA flap reconstruction. Flap design: an anterior vertical septal mucosa incision at posterior border of the frontal sinusotomy is made and extended to nasal floor. Posterior vertical incision is made 1 cm posterior to the projection of the axilla of the middle turbinate on the septum and extended to nasal floor. A horizontal incision along the nasal floor joins the two incisions. The flap is raised and rotated into the frontal sinus over the posterior table reconstructed defect. Results Three patients identified. Two males, one female, aged 11, 33 and 56. Patient histories included recurrent bacterial meningitis following head trauma, recurrent sinusitis and fronto-ethmoidal osteoma, with intraoperative CSF leak and CSF rhinorrhea due to meningoencephalocele. The three posterior wall defects were successfully repaired endoscopically with multilayer reconstruction and the AEA septal flap. Conclusions The anterior ethmoid artery septal flap can be successfully utilised for frontal CSF leak repair. Flap is conveniently located for frontal sinus defects. When the septum is intact it provides an excellent final layer as part of multilayer reconstruction.

Endoscopic repair of frontal sinus cerebrospinal fluid leaks

2005 ◽  
Vol 119 (9) ◽  
pp. 709-713 ◽  
Author(s):  
B A Woodworth ◽  
R J Schlosser ◽  
J N Palmer
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
Outflow Tract ◽  
Endoscopic Approach ◽  
Surgical Trauma ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Frontal Recess ◽  
Csf Leaks

Objective: To describe endoscopic management of frontal sinus cerebrospinal fluid (CSF) leaks.Study design: Retrospective.Methods: We reviewed all frontal sinus CSF leaks treated using an endoscopic approach at ourinstitutions from 1998 to 2003. CSF leaks originated immediately adjacent to or within the frontal recess or frontal sinus proper for inclusion in the study. Data collected included demographics, presenting signs and symptoms, site and size of skull-base defect, surgical approach, repair technique, and clinical follow up.Results: Seven frontal sinus CSF leaks in six patients were repaired endoscopically. Average age of presentation was 45 years (range 25–65 years). Aetiology was idiopathic (three), congenital (one), accidental trauma (one), and surgical trauma (two). All patients presented with CSF rhinorrhea; two patients presented with meningitis. Four defects originated in the frontal recess, while two others involved the posterior table and frontal sinus outflow tract. Four patients had associated encephaloceles. We performed endoscopic repair in all six patients withone patient requiring an adjuvant osteoplastic flap without obliteration. All repairs were successful at the first attempt with a mean follow up of 13 months. All frontal sinuses remained patent on both post-operative endoscopic and radiographic exam.Conclusions: Endoscopic repair of frontal sinus CSF leaks and encephaloceles can be an effective method if meticulous attention is directed toward preservation of the frontal sinus outflow tract, thus avoiding an osteoplastic flap and obliteration. The major limiting factor for an endoscopic approach is extreme extension superiorly or laterally within the posterior table beyond the reach of current instrumentation.

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