Objective: To determine the incidence of cerebrospinal fluid (CSF) leak after Hadad[1]Bassagasteguy Flap (HBF) reconstruction after endoscopic endonasal transsphenoidal surgery for skull base pathologies from 2016 to 2020 at the University of the East Ramon Magsaysay Memorial Medical Center. Methods: Design: Case Series. Setting: Tertiary Private Training Hospital. Participants: Charts of 35 patients who underwent endoscopic endonasal transsphenoidal surgery with reconstruction using Hadad-Bassagasteguy flap between January 2016 to February 2020 were reviewed and data on demographics, date of procedure, mass size, final diagnosis, presence of preoperative, intraoperative and postoperative CSF leak, placement of lumbar drain and course in the wards were collected. Results: There were 23 women and 12 men with ages ranging from 21 to 71 years. Four patients (11.4%) had postoperative CSF leak after reconstruction with HBF. Two of these four patients had episodes of nose blowing and sneezing weeks after surgery, prior to the development of the CSF leak. The other two patients experienced CSF leak 3 days postoperatively. Conclusion HBF has been a workhorse for reconstruction of skull base defects after transsphenoidal surgery, and based on our experience remains to be so, making it possible for expanded approaches and a wide variety of pathologies to be operated on via the endonasal route
Cerebrospinal Fluid Leak ;

OBJECTIVE: To present a case of a non-traumatic cerebrospinal fluid (CSF) rhinorrhea from a midline sphenoid sinus roof that presented as a persistent postnasal drip and was previously managed as allergic rhinitis for 43 years.

METHODS:

            Design:           Case Report

            Setting:           Tertiary Private University Hospital

            Participant:     One

RESULTS: A 58-year-old obese and hypertensive man presented with persistent post nasal drip and intermittent clear watery rhinorrhea. He had been managed as a case of allergic rhinitis for 43 years and was maintained on nasal steroid sprays without relief. Nasal endoscopy revealed pulsating clear watery discharge from the sphenoid ostium. On trans-sphenoidal surgery, a midline sphenoid sinus roof defect was sealed using a Hadad-Bassagasteguy flap.

CONCLUSION: CSF rhinorrhea is uncommon and may mimic more common diseases such as allergic rhinitis. Because misdiagnosis can then lead to life threatening complications, physicians should be vigilant when seeing patients with clear watery rhinorrhea to be able to arrive at a proper diagnosis and provide prompt treatment.

Intranasal meningoencephalocoele is a rare clinical entity especially in the adult population. It is usually a congenital anomaly but can occur as a result of traumatic head injury or increased intracranial hypertension. We report the case of 25-year-old Malay man who presented with persistent headache of one-year duration that was associated with bilateral nasal blockage and intermittent right nasal discharge. He was also treated for meningitis and previously had two episodes of closed head injuries. Investigations showed that he had an intranasal transethmoidal meningoenchepalocoele. This was successfully treated with an endoscopic excision and fistula repaired using cartilage graft and tissue glue.
Meningitis ; Fistula ; Cerebrospinal Fluid Leak

Cerebrospinal Fluid Leak ; pathology ; Humans ; Intracranial Hypertension

A variety of complications in endoscopic third ventriculostomy have been reported, including neurovascular injury, hemodynamic alterations, endocrinologic abnormalities, electrolyte imbalances, cerebrospinal fluid leakage, fever and infection. Even though most complications are transient, the overall rate of permanent morbidity is 2.38% and the overall mortality rate is 0.28%. To avoid these serious complications, we should keep in mind potential complications and how to prevent them. Proper decisions with regard to surgical indication, choice of endoscopic entry and trajectory, careful endoscopic procedures with anatomic orientation, bleeding control and tight closure are emphasized for the prevention of complications.
Cerebrospinal Fluid Leak ; Fever ; Hemodynamics ; Hemorrhage ; Mortality ; Neuroendoscopy ; Ventriculostomy*

About one-third of patients with transsphenoidal basal encephaloceles have associated congenital anomalies, including cleft palate. Moreover, they are often plagued by symptomatic exacerbations in the form of upper respiratory obstructions, cerebrospinal fluid leaks, meningitis, etc., with few patients being asymptomatic. We herein present a rare asymptomatic case of transsphenoidal basal encephalocele in an 18-month-old child with cleft palate and highlight a modified version of two-flap palatoplasty.
Cerebrospinal Fluid Leak ; Child ; Cleft Palate ; Encephalocele* ; Humans ; Infant ; Meningitis

We herein present a case of a 29-year-old man with clear rhinorrhea, which persisted for 8 years following a myringotomy. After cotton pledgets were placed in several different regions of the nasal cavity, cisternography using Tc-99m DTPA was performed to measure the radioactivity of each pledget. Cisternography showed subtle uptake in the nasal cavity. However, intense uptake was detected in the pledget placed in the right eustachian tube orifice, where the pledget:serum count ratio was 10.3:1. The patient underwent duroplasty and cranioplasty, and the rhinorrhea resolved.
Adult ; Cerebrospinal Fluid Leak ; Cerebrospinal Fluid Rhinorrhea ; Cerebrospinal Fluid ; Eustachian Tube ; Humans ; Nasal Cavity ; Pentetic Acid ; Radioactivity ; Radionuclide Imaging

Cerebrospinal fluid (CSF) leaks are one of the common complications after traumatic brain injuries (TBI). The risks of CSF leaks can be detrimental to the outcomes of the patients. Early diagnosis and proper management is imperative for it is strongly associated with a better long-term prognosis of the patients. Diagnostic tools for CSF leaks are still under debate. Nevertheless, many reports of successful treatments for CSF leaks have been published with introduction of various repair techniques for leakage sites even though it is surgically challenging. Hereby, we review about the pathophysiology, manifestations as well as the update of the clinical diagnosis and current management of CSF leaks.
Brain Injuries ; Cerebrospinal Fluid Leak* ; Cerebrospinal Fluid* ; Diagnosis ; Early Diagnosis ; Humans ; Meningitis ; Prognosis

BACKGROUND: One of the most frequent complications after endoscopic endonasal approach (EEA) for resection of pituitary tumors is cerebrospinal fluid (CSF) leaks. With the introduction of the pedicled nasoseptal flap, the reconstruction of the skull base has improved significantly resulting in a decrease in the occurrence of persistent CSF leaks. We present our experience utilizing the pedicled nasoseptal flap technique after EEA for reconstruction of the skull base in cases where CSF leak was detected. METHODS: Data for patients undergoing EEA for pituitary tumors was retrospectively reviewed. These included demographic, clinical, operative, radiographic, and pathological information. Incidence of post-operative complications and CSF leaks were recorded. Descriptive statistical analysis was performed. RESULTS: Between 2008 and 2015, 67 patients and 69 hospital admissions with pituitary tumors underwent a nasoseptal flap to reconstruct a skull base defect at Johns Hopkins Hospital. The mean age at surgery was 54.5±14.2 years. Fifty-two percent of patients were male. Forty-six percent of patients were white, 33% African-American, and 12% belonged to other racial groups. There was an intraoperative CSF leak in 39% of patients. Seventy percent of patients with an intraoperative CSF leak had a nasoseptal flap reconstruction of the skull base. There were zero postoperative CSF leaks. CONCLUSION: With the introduction of the pedicled nasoseptal flap for reconstruction of the skull base after EEA for resection of pituitary adenomas, the incidence of postoperative CSF leaks has decreased significantly. In this retrospective analysis, we demonstrate the effectiveness of the use of nasoseptal flap in repairing CSF leak after EEA.
Adenoma ; Cerebrospinal Fluid Leak ; Cerebrospinal Fluid ; Humans ; Incidence ; Male ; Neurosurgery ; Pituitary Neoplasms ; Retrospective Studies ; Skull Base

BACKGROUND AND OBJECTIVES: Endoscopic repair of cerebrospinal fluid (CSF) leak can avoid morbidity of open approaches and has shown a favorable success rate. Free mucosal graft is a good method, and multi-layered repair is more favorable. The inferior turbinate has been commonly utilized for the free mucosal graft, but we newly designed it as a bone-periosteal-mucosal composite graft for multilayered reconstruction. SUBJECTS AND METHOD: Four subjects with a skull base defect were treated with this method. The inferior turbinate was partially resected including the conchal bone and was trimmed according to defect size. Both bony parts and periosteum were preserved on the basolateral side of the mucosa as a composite graft. The graft was applied to the defect site using an overlay technique. RESULTS: All cases were successfully repaired without any complications. Three of them had a defect size greater than 10–12 mm, and the graft stably repaired the CSF leakage. CONCLUSIONS: Endoscopic repair of CSF leakage using inferior turbinate composite graft is a simple and easy method and would be favorable for defect sizes greater than 10 mm.
Cerebrospinal Fluid Leak* ; Cerebrospinal Fluid* ; Methods ; Mucous Membrane ; Periosteum ; Skull Base ; Transplants* ; Turbinates*