OBJECTIVETo review the clinical characteristics of spontaneous intracranial hypotension (SIH) with cerebrospinal fluid (CSF) leakage.

METHODSClinical data of 42 SIH patients with cerebrospinal leakage, whose diagnosis met the criteria of the International Headache Classification, were retrospectively reviewed. The patients were divided into short (n=27) and long (n=15) course groups. The clinical data and imaging features were compared between two groups.

RESULTSThirty-nine patients (92.9%) had orthostatic headache. Compared with the short course group, the frequency of headache were significantly lower in patients with long disease duration (80% vs 100%, P =0.040); the ratio of high CSF opening pressure (>=60.0 mm H2O), the average CSF opening pressure, and the frequencies of subdural hematoma were higher in long course group than those in short course group [60.0% vs 20.8%, (64.7±42.1) vs (40.0±33.8)mm H2O, and 50.0% vs 11.6%; P=0.019, 0.038 and 0.018, respectively]. Forty-two patients underwent CT myelography;definite focal CSF leakage sites were found in all patients and multiple sites of CSF leakage in 38 patients.

CONCLUSIONAll SIH do not necessarily show the typical clinical manifestations, and cranial MRI and CT myelography are helpful in the diagnosis. Because of higher risk of subdural hemorrhage, patients with long disease duration require active intervention.

Adolescent ; Adult ; Aged ; Cerebrospinal Fluid Otorrhea ; complications ; Cerebrospinal Fluid Rhinorrhea ; complications ; Female ; Humans ; Intracranial Hypotension ; diagnosis ; etiology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVE: To analyze the factors of intracranial infection after transnasal endoscopic crannialbase approach. METHOD: Retrospective analysis of 346 patients of ransnasal endoscopic crannialbase approach, logistic regression analysis of the factors was carried out. RESULT: The total number of cases of postoperative infections were 19 cases in 346 patients, the infection rate was 5.49%. The cerebrospinal fluid rhinorrhea , the restitution of skull base, the history of crannialbase approach, the history of radiotherapy and diabetes were infection fators after transnasal endoscopic diabetes (P < 0.05), while sex,age,operative approach,the use of artificial material,longer application of antibiotics before or after operation,and the history of chemotherapy had no obvious effects (P > 0.05). CONCLUSION Intracranial infection after transnasal endoscopic the use of artificial material was affected by many factors. Much attention should be paid for the intracranial infection prevention.
Cerebrospinal Fluid Rhinorrhea ; etiology ; Endoscopy ; Humans ; Postoperative Complications ; Retrospective Studies ; Skull Base ; surgery

Pituitary adenoma with cerebrospinal fluid rhinorrhea is rare clinically. In this paper, through the analysis of a pituitary adenoma patient with initial symptom of cerebrospinal fluid rhinorrhea, we look forward to provide evidence for clinical diagnosis, so that we can avoid misdiagnosis.
Adenoma ; complications ; diagnosis ; Cerebrospinal Fluid Rhinorrhea ; etiology ; Humans ; Pituitary Neoplasms ; complications ; diagnosis

Adult ; Cerebrospinal Fluid Rhinorrhea ; surgery ; Endoscopy ; adverse effects ; Female ; Humans ; Mucormycosis ; etiology

OBJECTIVETo explore the postoperative complication and its preventive measure of cervical open-door expansive laminoplasty with lateral mass screw fixation in treating cervical canal stenosis.

METHODSFrom February 2008 to July 2011, 33 patients with cervical canal stenosis underwent cervical open-door expansive laminoplasty with lateral mass screw fixation. JOA score was used to evaluate clinical effects before and after operation. Of them, complications occurred in 6 cases, male in 2 cases and female in 4 cases. The reason of complications were analyzed.

RESULTSAll the patients were followed up from 6 months to 2 years with an average of 10.3 months. The improvement rate of JOA was 78.8% and incidence rate of complication was 18.2% (6 cases). There were 2 cases of axiality symptoms, 1 case of lateral mass screw pulled-out, 2 cases of cerebrospinal fluid leakage with wound dehiscence, 1 case of nerve root parlysis. These complications correlated with operative design, manipulation,improved degree of cervical curvature,postoperative management and cooperation of patient.

CONCLUSIONAs an effective treatment, cervical open-door expansive laminoplasty with lateral mass screw fixation has lower incidence of axiality pain. Preoperative examination ,postoperative management ,meticulous surgical skill are very important to avoid complications.

Bone Screws ; Cerebrospinal Fluid Rhinorrhea ; etiology ; Cervical Vertebrae ; surgery ; Female ; Humans ; Laminectomy ; adverse effects ; methods ; Male ; Postoperative Complications ; etiology ; prevention & control ; Spinal Stenosis ; surgery

An unusual case of spontaneous cerebrospinal fluid (CSF) rhinorrhea with a pneumocephalus is described in a middle-aged woman who presented with a watery nasal discharge for 1 week and headache, vomiting, and fever for 1 day. The neurological examination revealed meningeal signs and bilateral papilledema. The CSF picture suggested pyogenic meningitis, and computed tomography of the brain revealed pneumocephalus. Diagnostic nasal endoscopy showed outpouching of the dura from the left olfactory cleft with a CSF leak and granular nasal mucosa. The defect was repaired surgically, and a biopsy of that area revealed granulomatous changes suggestive of tuberculosis. The patient recovered completely with standard four-drug antitubercular therapy. To our knowledge spontaneous CSF rhinorrhea with pneumocephalus occurring secondary to nasal tuberculosis has not been previously reported.
Antitubercular Agents/therapeutic use ; Biopsy ; Cerebrospinal Fluid Rhinorrhea/diagnosis/*etiology/therapy ; Endoscopy ; Female ; Humans ; Middle Aged ; Nose Diseases/*complications/diagnosis/microbiology/therapy ; Otorhinolaryngologic Surgical Procedures ; Pneumocephalus/diagnosis/*etiology/therapy ; Tomography, X-Ray Computed ; Treatment Outcome ; Tuberculosis/*complications/diagnosis/microbiology/therapy

Spontaneous intracranial hypotension (SIH) is caused by single or multiple cerebrospinal fluid (CSF) leaks in the spine with the prototypical symptom of postural headache. One of the characteristic MRI features in SIH is intracranial venous engorgement. This report presents a case of SIH with engorgement of the bilateral superior ophthalmic veins (SOVs) which resume their normal diameters by the third day of successful epidural blood patches (EBPs). We define this phenomenon as the "reversal of the SOV" sign.
Aged ; *Blood Patch, Epidural ; Cerebrospinal Fluid Rhinorrhea/*complications ; Diagnosis, Differential ; Humans ; Intracranial Hypotension/*diagnosis/etiology/*therapy ; *Magnetic Resonance Imaging ; Male ; Orbit/*blood supply

OBJECTIVETo explore an effective method for further improving the surgical results of treatment of olfactory groove meningiomas.

METHODSSixty seven cases of olfactory groove meningiomas were treated by microneurosurgery, among which fifty seven were de novo cases, eight were recurrent tumors and the other two re-recurrent cases. Modified Derome approach was used in 12 cases, bilateral subfrontal approach in 28 cases, modified pterional approach in 21 cases and unilateral subfrontal approach in six cases. Tumors were resected microsurgically with radical removal of invaded dura, bone, and paranasal sinus mucosa. Reconstruction was performed in patients with skull base defect.

RESULTSSimpson grade I removal was accomplished in 59 cases, grade II in seven cases and grade IV in one case. Among 57 patients with de novo tumor, Simpson I resection was accomplished in 54 cases. Postoperative rhinorrhea and intracranial infection occurred in one case and was cured after temporal lumbar CSF drainage and antibiotic therapy. Two patients (2.9%) died within one month after operation, i.e.one aged patient of heart failure and the other of severe hypothalamus complication. Forty seven patients (72.3%) were followed up from one to ten years with an average of five years and four months. With the exception of two cases died, among the alive 45 patients, there were only three patients with tumor recurrence, which had undergone Simpson II or IV tumor resection. No recurrence was found in cases with Simpson I tumor removal. Previous blurred vision was not improved in three patients, hemiparalysis in two patients, and the other patients recovered well, resuming previous jobs or being able to take care themselves.

CONCLUSIONSTotal tumor removal (Simpson I) should be the surgical goal for treatment of olfactory groove meningiomas, especially for de novo cases. An appropriate approach is fundamental in the effort to remove an OGM totally. Appropriate anterior skull base reconstruction with vascularized material is important and mandatory.

Adult ; Aged ; Cerebrospinal Fluid Rhinorrhea ; etiology ; Dura Mater ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Meningeal Neoplasms ; diagnosis ; pathology ; surgery ; Meningioma ; diagnosis ; pathology ; surgery ; Microsurgery ; adverse effects ; methods ; Middle Aged ; Neoplasm Recurrence, Local ; Paranasal Sinuses ; pathology ; surgery ; Reconstructive Surgical Procedures ; Skull Base ; pathology ; surgery

Cerebrospinal Fluid Rhinorrhea ; diagnosis ; etiology ; Chondrosarcoma ; surgery ; Endoscopy ; Enterococcus ; pathogenicity ; Humans ; Male ; Meningitis ; diagnosis ; microbiology ; Middle Aged ; Skull Base ; pathology ; surgery

Aged ; Cerebrospinal Fluid Rhinorrhea ; etiology ; prevention & control ; therapy ; Female ; Humans ; Male ; Nose Neoplasms ; radiotherapy ; Paranasal Sinus Neoplasms ; radiotherapy ; Young Adult