Objective: To investigate the related factors and treatments of delayed cerebrospinal fluid rhinorrhea (CFR) after invasive pituitary adenoma (IPA) surgery. Methods: One hundred and forty-two patients with IPA treated in Tianjin Huanhu Hospital from January 2014 to January 2019 were analyzed retrospectively, including 62 males and 80 females, aging from 38 to 67 years. The clinical data of patients before and after operation were collected. All patients with postoperative CFR underwent endoscopic CFR repair. During the operation, residual or recurrent pituitary adenomas were resected, the dura around the leak was enlarged and the necrotic tissue was removed. For those who still had fluid leakage after repair, the necrotic tissue was cleaned up, the leakage was filled and reinforced under endoscopy. Endoscopic rhinorrhea repair was performed if necessary. The cerebrospinal fluid leak was repaired with multi-layer materials. The related risk factors of delayed CFR after operation were analyzed. SPSS 19.0 software was used for statistical analysis. Results: Among the 142 patients in this group, 64 cases underwent total tumor resection and 78 cases underwent non-total tumor resection. They were followed up for 6 to 72 months. Thirty-one cases had delayed CFR, with an incidence of 21.83%, and occurred between 1 and 5 years postoperatively, with an average of 2.4 years. All 31 patients with delayed CFR underwent endoscopic CFR repair. The nasal endoscopy was rechecked at 2 weeks, 1 month, 3 months and 6 months after operation. Twenty-eight patients were repaired successfully after 1 operation, while 2 patients after 2 operations and 1 patient after 3 operations. These patients were followed up for 6 to 60 months, and no CFR occurred again. Univariate analysis showed that the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and operator experience were the risk factors of delayed CFR (all P<0.05). Multivariate analysis showed that the degree of tumor resection and recurrence were the highest independent risk factors for postoperative CFR, and tumor size, texture, postoperative radiotherapy and operator experience were the independent risk factors in this study. Conclusions: Delayed CFR after IPA is related to the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and the operator experience. It is necessary to completely remove the tumor under endoscope, to expand resection of the dura and necrotic tissue around the leak, to repair the defect with multi-layer materials, to follow-up closely and to repair timely after operation.
Adenoma/surgery* ; Adult ; Aged ; Cerebrospinal Fluid Leak ; Cerebrospinal Fluid Rhinorrhea/surgery* ; Female ; Humans ; Male ; Middle Aged ; Pituitary Neoplasms/surgery* ; Retrospective Studies

Adult ; Cerebrospinal Fluid Rhinorrhea ; diagnosis ; surgery ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Skull Base ; pathology ; surgery ; Tomography, X-Ray Computed ; methods

OBJECTIVE: Although many treatment modalities have been introduced for trigeminal neuralgia (TN), the long-term clinical results remain unsatisfactory. It has been particularly challenging to determine an appropriate treatment strategy for patients who have responded poorly to initial therapies. We analyzed the surgical outcomes in TN patients who failed prior treatments. METHODS: We performed a retrospective analysis of 37 patients with recurrent or persistent TN symptoms who underwent surgery at our hospital between January 2010 and December 2014. Patients with follow-up data of at least one year were included. The prior treatment modalities of the 37 patients included microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and percutaneous procedures such as radiofrequency rhizotomy (RFR), balloon compression, and glycerol rhizotomy (GR). The mean follow-up period was 69.9 months (range : 16–173). The mean interval between the prior treatment and second surgery was 26 months (range : 7–123). We evaluated the surgical outcomes using the Barrow Neurological Institute (BNI) pain intensity scale. RESULTS: Among the 37 recurrent or persistent TN patients, 22 underwent MVD with partial sensory rhizotomy (PSR), 8 received MVD alone, and 7 had PSR alone. Monitoring of the surgical treatment outcomes via the BNI pain intensity scale revealed 8 (21.6%) patients with a score of I, 13 (35.1%) scoring II, 13 (35.1%) scoring III, and 3 (8.2%) scoring IV at the end of the follow-up period. Overall, 91.8% of patients had good surgical outcomes. With regard to postoperative complications, 1 patient had transient cerebrospinal fluid rhinorrhea (2.7%), another had a subdural hematoma (2.7%), and facial sensory changes were noted in 8 (21.1%) patients after surgery. CONCLUSION: Surgical interventions, such as MVD and PSR, are safe and very effective treatment modalities in TN patients who failed initial or prior treatments. We presume that the combination of MVD with PSR enabled us to obtain good short- and long-term surgical outcomes. Therefore, aggressive surgical treatment should be considered in patients with recurrent TN despite failure of various treatment modalities.
Cerebrospinal Fluid Rhinorrhea ; Follow-Up Studies ; Glycerol ; Hematoma, Subdural ; Humans ; Microvascular Decompression Surgery ; Postoperative Complications ; Radiosurgery ; Retrospective Studies ; Rhizotomy ; Trigeminal Neuralgia*

OBJECTIVE: To Summarize and analyze the clinical characteristics and treatment of patients with spontaneous cerebrospinal fluid rhinorrhea, and to explore the related factors of recurrence. METHOD: Retrospective- ly analyze the clinical data of 58 patients of spontaneous cerebrospinal fluid rhinorrhea from July 2002 to July 2012, combined with its clinical characteristics, and statistically analyze the related recurrence factors. RESULT: Fifty-eight cases were accepted the nasal endoscopic repairment of cerebrospinal fluid rhinorrheak, follow-up 3 years, 20 cases (34.5%) recurred, 1 case recurred in half a year after operation. In the first year, there were 10 cases recurred. In the second year there were 9 cases recurred, and 1 case recurred in the third year. Through multiariable analysis it was found that higher BMI, empty sella and skull base bone defect were the independent risk factors influencing the recurrence of spontaneous cerebrospinal fluid rhinorrhea (P < 0.05). CONCLUSION The recurrence rate of spontaneous cerebrospinal fluid rhinorrhea is high, needing long-term follow-up. Higher BMI, empty sella, skull base bone defect are independent risk factors of recurrence of the disease, and the treatment should be individualized.
Cerebrospinal Fluid Rhinorrhea ; pathology ; surgery ; Empty Sella Syndrome ; pathology ; Endoscopy ; adverse effects ; Humans ; Nose ; Recurrence ; Retrospective Studies ; Risk Factors ; Skull Base ; pathology

OBJECTIVE: To investigate the therapeutic effects of the image navigation system in nasal endoscopic surgery in treatment of basicranial tumor. METHOD: Retrospective analysis was carried out in 17 patients with basicranial tumor who underwent nasal endoscopic resection via image navigation system. The accuracy of image navigation system, operation procedure time, curative effect and complications were analyzed and summarized to evaluate the effect. RESULT: The image navigation system provided an accurate anatomical localization 0.5-2.0 mm localization error (mean 1.2 mm). The operation procedure time was 1.5-3.0 h. Postoperative complications occurred in 3 of 17 patients including cerebrospinal fluid rhinorrhea and injury of sieve plate. Two patients recrudesce within half a year. CONCLUSION The image navigation system in combination with a nasal endoscope is helpful in the resection of basicranial tumor with minimal trauma, increasing the curative effect and avoiding complications.
Cerebrospinal Fluid Rhinorrhea ; Endoscopy ; Humans ; Nasal Surgical Procedures ; methods ; Neoplasm Recurrence, Local ; Neoplasms ; surgery ; Nose ; Postoperative Complications ; Retrospective Studies ; Skull Base ; surgery ; Surgery, Computer-Assisted ; methods

Cerebrospinal Fluid Rhinorrhea ; surgery ; Endoscopy ; Humans

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

OBJECTIVE: To summarize the clinical experience of endoscopic repair for cerebrospinal fluid (CSF) rhinorrhea in our department in the last 4 years. METHOD: Clinical data of 16 patients with CSF rhinorrhea who underwent nasal endoscopic repair was analyzed retrospectively. The effect of etiology, image data, location of CSF leaks and surgical techniques on treatment were discussed. RESULT: Among the 16 patients, 10 were diagnosed with spontaneous CSF rhinorrhea, 2 were diagnosed with traumatic CSF rhinorrhea, 3 were diagnosed with CSF rhinorrhea after catching cold and 1 was diagnosed with meningo-encephalocele in with CSF rhinorrhea. The leak was located by CT scan in 11 cases, by MRI in 7 cases. The common locations of the defect were the frontal sinus (3 cases), cribriform roof (3 cases), sphenoid sinus (6 cases) and the nasal cavity top (4 cases). All the cases were successfully cured after the first nasal endoscopic repair with autologous materials. None of patients had a reoccurrence during 10 to 42 months follow-up time. CONCLUSION The application of CT and MRC before surgery which could make an accurate diagnosis of the location and the size of the defect. The correct selection of repair materials, processing planting bed around the leakage and complete contacting leakage with graft bed are the key points to the successful surgery of CSF rhinorrhea.
Adolescent ; Adult ; Cerebrospinal Fluid Rhinorrhea ; surgery ; Child ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Failure ; Treatment Outcome ; Young Adult

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

Spontaneous cerebrospinal fluid rhinorrhoea is a rare clinical entity. The accurate localisation of the leakage site is essential for surgical planning. Imaging techniques such as high-resolution computed tomography (CT), CT cisternography and magnetic resonance cisternography in variable combinations are performed for this purpose. This pictorial essay aims to present the spectrum of imaging findings in cases of spontaneous cerebrospinal fluid rhinorrhoea, which may be useful for radiologists in the determination of the site of cerebrospinal fluid leakage.
Adult ; Cerebrospinal Fluid Rhinorrhea ; diagnostic imaging ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Posture ; Tomography, X-Ray Computed