2,430 results match your criteria Cerebrospinal Fluid Leak Imaging


Spontaneous, Intrasphenoidal Rupture of Ecchordosis Physaliphora with Pneumocephalus Captured During Serial Imaging and Clinical Follow-up: Pathoanatomic Features and Management.

World Neurosurg 2020 May 31. Epub 2020 May 31.

Department of Radiology, NYU Langone Health, New York, New York. Electronic address:

Background: Ecchordosis physaliphora (EP) is a congenital, uniformly asymptomatic, hamartomatous lesion of the primitive notochord. Herein we report, to our knowledge, the first credible case report of unprovoked intra-sphenoidal rupture resulting in recurrent pneumocephalus and cerebrospinal fluid (CSF) leak, definitively captured over serial imaging during clinical and radiologic surveillance.

Case Description: A 68-year old woman with Marfan syndrome presented to the Emergency Department with the worst headache of life. Read More

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http://dx.doi.org/10.1016/j.wneu.2020.05.220DOI Listing

Spontaneous Intracranial Hypotension May Be an Under-recognized Cause of Endolymphatic Hydrops.

Otol Neurotol 2020 May 28. Epub 2020 May 28.

Department of Otolaryngology.

Objective: We describe three rare cases of spontaneous intracranial hypotension (SIH) presenting with symptoms of endolymphatic hydrops (EH) and perform a literature review to bring attention to a rare link between SIH and EH.

Patient: A 59-year-old female presented with postural headache, aural fullness, vertigo, hearing loss, and abnormal electrocochleography after being diagnosed with SIH by magnetic resonance imaging. The site of cerebrospinal fluid leak was identified in this individual. Read More

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http://dx.doi.org/10.1097/MAO.0000000000002665DOI Listing

Incidence of Unrecognized Incidental Durotomy during Surgery for Malignant Spinal Tumor.

Spine Surg Relat Res 2020 1;4(2):159-163. Epub 2019 Nov 1.

Department of Orthopaedic Surgery and Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.

Introduction: Cerebral spinal fluid leak from durotomy is a well-known risk with spinal surgeries. The aim of this study is to identify the incidence of unrecognized incidental durotomy during posterior surgery for spinal metastases and its risk factors.

Methods: Participants comprised 75 patients who underwent posterior spine surgery for spinal metastases between January 2012 and December 2016. Read More

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http://dx.doi.org/10.22603/ssrr.2019-0081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217675PMC
November 2019

Intrathecal blood injection: a case report of a rare complication of an epidural blood patch.

BMC Neurol 2020 May 13;20(1):187. Epub 2020 May 13.

Department of Neurology, Neuroscience Institute, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA.

Background: Intrathecal injection is a rare complication of spinal anesthesia and an underreported complication of epidural blood patches. Although there are other reported cases of intrathecal blood injection, these cases lack confirmatory imaging and others report injection of mixed blood with other agents.

Case Presentation: We present a case report of post-laminectomy cerebrospinal fluid leak who underwent epidural blood patch placement. Read More

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http://dx.doi.org/10.1186/s12883-020-01763-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222553PMC

Utility of heavily T2-weighted MR myelography as the first step in CSF leak detection and the planning of epidural blood patches.

J Clin Neurosci 2020 May 8. Epub 2020 May 8.

Department of Radiology, Seoul National University Bundang Hospital, Republic of Korea.

Heavily T2-weighted MR myelography (HT2W-MRM) is emerging as an alternative approach for detection and follow up of CSF leaks. We aimed to assess epidural blood patch (EBP) treatment outcome when using HT2W-MRM as the primary modality for detecting CSF leak and planning EBP placement in routine clinical practice. Since 2018, patients at our institute suspected of having CSF leak, routinely HT2W-MRM instead of CT myelography to determine presence of the leak and identify the EBP target site. Read More

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http://dx.doi.org/10.1016/j.jocn.2020.05.010DOI Listing

Cervical Intradural Disc Herniation: Case Report and Operative Video.

Cureus 2020 Apr 4;12(4):e7537. Epub 2020 Apr 4.

Neurological Surgery, Baylor College of Medicine, Houston, USA.

Cervical intradural disc herniation (CIDH) is a rare presentation of an intradural disc herniation. We present a case of CIDH with associated surgical video depicting an anterior surgical approach to treatment. Patient presentation, relevant radiographic imaging, surgical exposure and technique, and cerebrospinal fluid leak complication and prevention are discussed. Read More

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http://dx.doi.org/10.7759/cureus.7537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198083PMC

Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture.

BMC Neurol 2020 Apr 29;20(1):162. Epub 2020 Apr 29.

Department of Anesthesia, Stanford University, Palo Alto, CA, USA.

Background: Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak.

Methods: This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated between January 2016 and September 2019. Read More

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http://dx.doi.org/10.1186/s12883-020-01740-1DOI Listing

Value of the Petromeatal Angle in Predicting Outcome of Translabyrinthine Resection of Vestibular Schwannomas.

Oper Neurosurg (Hagerstown) 2020 Apr 29. Epub 2020 Apr 29.

Tampa General Hospital, University of South Florida Morsani College of Medicine, Tampa, Florida.

Background: Factors associated with extent of tumor resection (EOR) and facial nerve outcomes include tumor size, anterior extension of the tumor, patient age, and surgical approach.

Objective: To check whether preoperative measurement of the petromeatal (PMA), petroclival (PCA), and petrous-petrous (PPA) angles can help in predicting EOR, facial nerve outcome, and cerebrospinal fluid (CSF) leak occurrence in patients undergoing vestibular schwannoma (VS) surgery via the translabyrinthine approach (TLA).

Methods: A total of 75 patients were included in this retrospective study. Read More

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http://dx.doi.org/10.1093/ons/opaa109DOI Listing

Temporal Bone Encephaloceles: Utility of Preoperative Imaging.

Otolaryngol Head Neck Surg 2020 Apr 28:194599820918566. Epub 2020 Apr 28.

Department of Otolaryngology and Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA.

Objective: To determine the diagnostic efficacy and clinical value of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) among patients with suspected temporal bone encephaloceles (TBE).

Study Design: Retrospective chart review from 2006 to 2018.

Setting: Tertiary referral center. Read More

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http://dx.doi.org/10.1177/0194599820918566DOI Listing

Application of the Three Points and Three Lines Method to Accurately Open the Sellar Floor in Microscopic Transsphenoidal Surgery of Pituitary Adenomas.

World Neurosurg 2020 Apr 24. Epub 2020 Apr 24.

Department of Neurosurgery, The Affiliated Hospital of Putian University, Putian, P.R. China. Electronic address:

Objective: In this study, the sellar floor morphology of patients with pituitary adenoma is analyzed and a simple yet reliable method is identified to determine the location of bone window opening.

Methods: Clinical information of 144 consecutively admitted patients was retrospectively analyzed. Enhanced magnetic resonance imaging of the midsagittal plane was selected as the reference for classifying the sellar floor. Read More

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http://dx.doi.org/10.1016/j.wneu.2020.04.110DOI Listing
April 2020
2.417 Impact Factor

Spontaneous intracranial hypotension: key features for a frequently misdiagnosed disorder.

Neurol Sci 2020 Apr 27. Epub 2020 Apr 27.

School of Medicine and Health Sciences, Tecnologico de Monterrey Campus Guadalajara, Zapopan, Mexico.

Spontaneous intracranial hypotension (SIH) is a rare neurological condition caused by low cerebrospinal fluid (CSF) volume, most commonly due to a CSF leak. The most common presenting symptom is an orthostatic headache, but some patients may present with atypical neurological manifestations such as cranial nerve palsies, an altered mental status, and movement disorders, which complicate the clinical diagnosis. Therefore, the diagnosis is based on the combination of clinical signs and symptoms, neuroimaging, and/or a low cerebrospinal fluid pressure. Read More

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http://dx.doi.org/10.1007/s10072-020-04368-8DOI Listing

Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report.

BMC Neurol 2020 Apr 23;20(1):151. Epub 2020 Apr 23.

Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan.

Background: Intracranial hypotension is a disorder characterized by low cerebrospinal fluid (CSF) pressure typically caused by loss of CSF. Although some mechanisms account for the CSF leakage have been elucidated, spinal canal stenosis has never been reported as a pathological cause of intracranial hypotension. C1-C2 sign is a characteristic imaging feature, which indicates CSF collection between the spinous processes of C1 and C2, occasionally observed on magnetic resonance imaging (MRI) in patients with intracranial hypotension. Read More

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http://dx.doi.org/10.1186/s12883-020-01697-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181568PMC

Developing a Spinal CSF Leak Program in a Multihospital Network.

Curr Probl Diagn Radiol 2020 Apr 9. Epub 2020 Apr 9.

Department of Neurosurgery, The Permanente Medical Group, Kaiser Permanente Medical Center, Redwood City, CA.

Objective: Spontaneous spinal cerebrospinal fluid (CSF) leaks are rare and challenging to diagnose and treat. Patients may present to a variety of physicians, and many patients are often referred to a specialized center with a dedicated spinal CSF leak program and expertise in this condition. To our knowledge, there are no reported publications on how to create such a program. Read More

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http://dx.doi.org/10.1067/j.cpradiol.2020.03.004DOI Listing

Association Between Klippel-Trenaunay Syndrome and Spontaneous Intracranial Hypotension: A Report of 4 Patients.

World Neurosurg 2020 Apr 2;138:398-403. Epub 2020 Apr 2.

Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.

Background: Klippel-Trenaunay syndrome (KTS) is associated with a wide variety of vascular and neurologic abnormalities, including venolymphatic malformations. A recent report postulated that patients with KTS may also be predisposed to spontaneous intracranial hypotension. We reviewed brain magnetic resonance imaging from 67 patients with KTS and unexpectedly noted findings of cerebrospinal fluid (CSF) hypotension in 4 of them. Read More

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http://dx.doi.org/10.1016/j.wneu.2020.03.148DOI Listing

Expanded transnasal approaches to the skull base in the Middle East: Where do we stand?

Ann Saudi Med 2020 Mar-Apr;40(2):94-104. Epub 2020 Apr 2.

From the Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: Endoscopic transnasal surgery has gained rapid global acceptance over the last two decades. The growing literature and understanding of anterior skull base endoscopic anatomy, in addition to new dedicated endoscopic instruments and tools, have helped to expand the use of the transnasal route in skull base surgery.

Objective: Report our early experience in expanded endoscopic transnasal surgery (EETS) and approach to skull base neoplasms. Read More

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http://dx.doi.org/10.5144/0256-4947.2020.94DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118227PMC
April 2020
0.705 Impact Factor

Salvage Free Tissue Transfer for Clival Osteoradionecrosis After Repeat Proton Beam Therapy.

World Neurosurg 2020 Mar 27;138:485-490. Epub 2020 Mar 27.

Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA.

Background: Craniocervical junction chordoma treated with surgery and Proton Beam Therapy evolved with Osteonecrosis and CSF leak. As the vascularization of the head was compromised, we harvested an Anterolateral thigh musculofascial flap to seal the leak.

Case Description: A 56-year-old man presented with a history of chronic headaches and dysarthria with tongue deviation to the right. Read More

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http://dx.doi.org/10.1016/j.wneu.2020.03.108DOI Listing

Spontaneous Intracranial Hypotension: Case Study and Review of the Literature.

Cureus 2020 Feb 17;12(2):e7018. Epub 2020 Feb 17.

Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, USA.

Spontaneous intracranial hypotension (SIH) is a pathology characterized by orthostatic headaches, diffuse pachymeningeal enhancement on magnetic resonance imaging (MRI), and low to normal cerebrospinal fluid (CSF) pressures. We present the case of a 46-year-old male with refractory postural headaches, found to have a diffuse CSF leak throughout the cervicothoracic (C1-T12) spine. His neurological status declined rapidly to a Glasgow Coma Scale (GCS) of eight, necessitating bilateral subdural drain placement. Read More

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http://dx.doi.org/10.7759/cureus.7018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081740PMC
February 2020

Transpalpebral Approach for Microsurgical Removal of Tuberculum Sellae Meningiomas.

Asian J Neurosurg 2020 Jan-Mar;15(1):98-106. Epub 2020 Feb 25.

Department of Neurosurgery, Russian Medical Academy for Continuing Postgraduate Education, Ministry of Health of Russia, Moscow, Russia.

Background: The evolution of skull base approaches associated with individualization of surgical corridor and minimizing the collateral damage. Achieving the radical removal of tumor and preserving the neurological status of the patient is possible, both with the traditional approaches and keyhole approaches. Our work presents experience using the transpalpebral approach (TPA) for microsurgical removal of tuberculum sellae meningioma (TSM). Read More

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http://dx.doi.org/10.4103/ajns.AJNS_186_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057880PMC
February 2020

Dural venous sinus thrombosis after cerebellopontine angle surgery: Should it be treated?

J Clin Neurosci 2020 May 12;75:157-162. Epub 2020 Mar 12.

Neurosurgery Department, Auckland City Hospital, Auckland, New Zealand. Electronic address:

Introduction: Dural venous sinus thrombosis is an uncommon, but significant sequela that may occur after resection of a cerebellopontine angle lesion. The natural history and management of this pathology has not been sufficiently studied.

Methods: All operative cases for cerebellopontine angle lesions performed in our local institution dating from 1 January 2005 to 30 June 2018 were retrospectively reviewed to identify patients who developed new post-operative dural venous sinus thrombosis. Read More

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http://dx.doi.org/10.1016/j.jocn.2019.12.036DOI Listing

Endoscopic endonasal resection of congenital trans-sphenoidal meningoencephalocele with extension to the epipharynx in early childhood: a case report.

Afr Health Sci 2019 Sep;19(3):2764-2767

Department of Neurosurgery, Faculty of Medicine, Medical University-Plovdiv, Bulgaria.

Background: The clinical presentation of sphenoid sinus meningoencephaloceles (MEC) may have insidious onset and evolution. Contemporary treatment incorporates endoscopic resection via the endonasal route.

Case Description: We present a case of 3 year old girl who had been complaining of permanent nasal discharge, impeded nasal breathing and difficulty with feeding since she was 5 months old. Read More

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http://dx.doi.org/10.4314/ahs.v19i3.52DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040274PMC
September 2019

A large case series of temporal bone fractures at a UK major trauma centre with an evidence-based management protocol.

J Laryngol Otol 2020 Mar 3;134(3):205-212. Epub 2020 Mar 3.

Department of ENT, Royal London Hospital, Barts Health NHS Trust, UK.

Objective: To review the management of temporal bone fractures at a major trauma centre and introduce an evidence-based protocol.

Methods: A review of reports of head computed tomography performed for trauma from January 2012 to July 2018 was conducted. Recorded data fields included: mode of trauma, patient age, associated intracranial injury, mortality, temporal bone fracture pattern, symptoms and intervention. Read More

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http://dx.doi.org/10.1017/S0022215120000419DOI Listing

Imaging of the Spontaneous Low Cerebrospinal Fluid Pressure Headache: A Review.

Can Assoc Radiol J 2020 May 24;71(2):174-185. Epub 2020 Jan 24.

Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.

Spontaneous intracranial hypotension (SIH) is a significant cause of chronic, postural headaches. Spontaneous intracranial hypotension is generally believed to be associated with cerebrospinal fluid (CSF) leaks, and these leaks can be posttraumatic, iatrogenic, or idiopathic in origin. An integral part of the management of patients with this condition consists of localizing and stopping the leaks. Read More

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http://dx.doi.org/10.1177/0846537119888395DOI Listing

Transclival Approach for Resection of a Pontine Cavernous Malformation: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2020 Feb 11. Epub 2020 Feb 11.

Department of Neurosurgery, NYU Langone Health, New York, New York.

Cerebral cavernous malformations are common vascular anomalies consisting of a cluster of capillaries without intervening brain tissue.1 A variety of approaches for resection have been undertaken,2 and a handful of case reports have described the endoscopic, endonasal, transclival approach.3 We present a case of a 51-yr-old woman with lupus and hepatitis B-associated cirrhosis who presented with diplopia, dysphagia, and ataxia. Read More

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http://dx.doi.org/10.1093/ons/opaa025DOI Listing
February 2020

Pituitary Apoplexy Case Series: Outcomes After Endoscopic Endonasal Transsphenoidal Surgery at a Single Tertiary Center.

World Neurosurg 2020 May 4;137:e366-e372. Epub 2020 Feb 4.

Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA; USC Pituitary Center, Keck School of Medicine of University of Southern California, Los Angeles, California, USA. Electronic address:

Background: The management of pituitary apoplexy, caused by acute hemorrhage and/or infarction of a pituitary adenoma, is debated.

Objective: To analyze clinical characteristics of patients undergoing endoscopic endonasal approaches (EEAs) for pituitary apoplexy.

Methods: A retrospective review of patients at our institution from 2012 to 2018 undergoing EEA for pituitary apoplexy diagnosed clinically and with imaging/pathologic findings. Read More

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http://dx.doi.org/10.1016/j.wneu.2020.01.204DOI Listing

Approaching the Sella through the Nonpneumatized Sphenoid in Pediatric Patients.

J Neurol Surg B Skull Base 2020 Feb 18;81(1):56-61. Epub 2019 Feb 18.

University of California, San Diego School of Medicine, La Jolla, California, United States.

 The purpose of this study is to specifically assess pediatric patients with nonpneumatized sphenoid sinuses who have undergone transsphenoidal resections of skull base tumors and assess the complications and outcomes.  Data was collected by a retrospective chart review done on children ages 7 and under who underwent endoscopic tumor resection and had a partially or completely nonpneumatized sphenoid sinus on preoperative computed tomography imaging. Surgical data collected included surgical corridor, gross total versus subtotal resection, repair method, use of septal flap, intraoperative and postoperative cerebrospinal fluid leak, and estimated blood loss. Read More

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http://dx.doi.org/10.1055/s-0039-1679895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996996PMC
February 2020

Endoscopic anatomy of the sellar barrier: From the anatomical model to the operating room.

Clin Anat 2020 Apr 20;33(3):468-474. Epub 2020 Jan 20.

Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.

Background: The sellar barrier concept reflects the association between the components of the roof of the pituitary fossa and the risk of intraoperative cerebrospinal fluid (CSF) leak in the surgery of pituitary adenomas. We based our concept in previous reports on the microsurgical anatomy of the pituitary fossa's superior wall. However, proof of the usefulness of this concept in endoscopic approaches is yet missing. Read More

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http://dx.doi.org/10.1002/ca.23566DOI Listing

Clinical Reasoning: An underrecognized etiology of new daily persistent headache.

Neurology 2020 01;94(1):e114-e120

From the Department of Neurology, Headache Division, Mayo Clinic, Rochester, MN.

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http://dx.doi.org/10.1212/WNL.0000000000008707DOI Listing
January 2020

Correlation of spontaneous and traumatic anterior skull base CSF leak flow rates with fluid pattern on early, delayed, and subtraction volumetric extended echo train T2-weighted MRI.

J Neurosurg 2019 Dec 27:1-9. Epub 2019 Dec 27.

3Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.

Objective: CSF leakage is a potentially fatal condition that may result when a skull base dural defect permits CSF communication between the cranial vault and sinonasal cavities. Flow rate is an important property of CSF leaks that can contribute to surgical decision-making and predispose patients to complications and inferior outcomes. Noninvasive preoperative prediction of the leak rate is challenging with traditional diagnostic tools. Read More

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http://dx.doi.org/10.3171/2019.10.JNS192500DOI Listing
December 2019

Diagnosis of a Cerebrospinal Fluid-Venous Fistula Associated with a Venous Malformation Using Digital Subtraction and Computed Tomography Myelography.

World Neurosurg 2020 Mar 21;135:262-266. Epub 2019 Dec 21.

Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.

Background: Spontaneous cerebrospinal fluid (CSF) leaks can be an intractable cause of orthostatic headaches but have several treatable causes. CSF-venous fistulas are an increasingly recognized cause of rapid CSF leaks. Although CSF-venous fistulas have been previously reported in the literature, their imaging appearance, associated anomalies, and treatment are incompletely understood. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.12.075DOI Listing

Ecchordosis physaliphora: a cautionary tale.

J Laryngol Otol 2020 Jan 20;134(1):46-51. Epub 2019 Dec 20.

Department of Otolaryngology, Pisa University Hospital, Italy.

Background: Ecchordosis physaliphora is a congenital, benign lesion originating from notochordal remnants along the craniospinal axis, most frequently located at the level of the clivus and sacrum. Sometimes ecchordosis physaliphora is difficult to recognise and treat, with a total of twenty-six cases described in the literature.

Methods: This study reports on three cases of previously undiagnosed ecchordosis physaliphora presenting with cerebrospinal fluid rhinorrhoea and meningitis. Read More

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http://dx.doi.org/10.1017/S0022215119002512DOI Listing
January 2020

Spontaneous Tension Pneumocephalus.

Acta Med Port 2019 Dec 2;32(12):788. Epub 2019 Dec 2.

Serviço de Medicina IV. Hospital Prof. Doutor Fernando Fonseca. Amadora. Portugal.

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http://dx.doi.org/10.20344/amp.11591DOI Listing
December 2019

Multiple Iterations of Magnetic Resonance-Guided Laser Interstitial Thermal Ablation of Brain Metastases: Single Surgeon's Experience and Review of the Literature.

Oper Neurosurg (Hagerstown) 2019 Dec 12. Epub 2019 Dec 12.

Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida.

Background: Prior treatment with magnetic resonance-guided, laser-induced thermal therapy (LITT) is widely assumed not to be a contraindication for further treatment of brain lesions, including further iterations of LITT. However, the safety and efficacy of repeat LITT treatments have never been formally investigated.

Objective: To evaluate treatment with multiple iterations of LITT. Read More

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http://dx.doi.org/10.1093/ons/opz375DOI Listing
December 2019

Cerebral Venous Sinus Thrombosis After Translabyrinthine Vestibular Schwannoma-A Prospective Study and Suggested Management Paradigm.

Otol Neurotol 2020 Feb;41(2):e273-e279

Department of Otolaryngology, Head and Neck Surgery.

Objective: To prospectively evaluate the incidence, risk factors and natural history of postoperative cerebral venous sinus thrombosis (pCVST) in translabyrinthine vestibular schwannoma microsurgical resection and propose a potential management paradigm.

Study Design: Prospective, single cohort, multicenter study.

Setting: State-wide academic tertiary referral centers. Read More

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http://dx.doi.org/10.1097/MAO.0000000000002508DOI Listing
February 2020

Impact of obesity and obstructive sleep apnea in lateral skull base cerebrospinal fluid leak repair.

Laryngoscope 2019 Nov 27. Epub 2019 Nov 27.

Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A.

Objective: To investigate the prevalence and impact of obstructive sleep apnea (OSA) and obesity in lateral skull base cerebrospinal fluid leak repair (LSBR) of various etiologies.

Methods: Retrospective case review at a tertiary skull base center was conducted of consecutive adults undergoing LSBR via transmastoid, middle cranial fossa, or combined approach between 2013-2018. The following data were collected: demographics, comorbidities, radiology and intraoperative findings, and surgical outcomes including complications and need for revision surgery or shunt placement. Read More

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http://dx.doi.org/10.1002/lary.28421DOI Listing
November 2019
5 Reads

Obstruction of Ventriculoperitoneal Shunt After Myelography-Report of a Unique Case and Its Treatment.

World Neurosurg 2020 Feb 20;134:443-447. Epub 2019 Nov 20.

Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Electronic address:

Background: Myelography, frequently supplanted by noninvasive, efficient magnetic resonance imaging, remains a useful technique when evaluating the spinal canal in nerve root avulsion, radiation therapy treatment planning, cerebrospinal fluid (CSF) loculation, and CSF leak. Myelography is achieved through a lumbar puncture and instillation of nonionic, water-soluble intrathecal iohexol (Omnipaque, GE Healthcare, Marlborough, Massachusetts, USA) contrast. The aim of the study was to highlight a possible complication of obstruction of a shunt valve due to an increased viscosity of the CSF after intrathecal Omnipaque contrast administration during myelography. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.11.067DOI Listing
February 2020

Radial Forearm Free Tissue Transfer to Clival Defect.

J Neurol Surg B Skull Base 2019 Dec 31;80(Suppl 4):S380-S381. Epub 2019 Oct 31.

Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.

 Reconstruction of craniocervical junction (CCJ) defects after endoscopic endonasal skull base surgery (ESBS) remains challenging, despite advancements in vascularized intranasal and regional flaps. Microvascular free tissue transfers have revolutionized reconstruction in open skull base surgery but have been utilized rarely in ESBS. We describe the use of a radial forearm free flap (RFFF) for reconstruction of a recalcitrant CCJ defect after resection of a clival chordoma. Read More

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http://dx.doi.org/10.1055/s-0039-1700890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864404PMC
December 2019

Comparison of Spontaneous Temporal Bone Cerebrospinal Fluid Leaks From the Middle and Posterior Fossa.

Otol Neurotol 2020 Feb;41(2):e232-e237

Department of Otolaryngology.

Objectives: To compare patients surgically managed for spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone arising from the middle cranial fossa (MCF) and posterior cranial fossa (PCF) and to describe the surgical management of posterior fossa CSF leaks.

Study Design: Retrospective case review.

Setting: Academic tertiary center. Read More

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http://dx.doi.org/10.1097/MAO.0000000000002473DOI Listing
February 2020

Peri-operative Lumbar Drains for Trans-Sphenoidal resection of Pituitary Adenomas.

J Pak Med Assoc 2019 Nov;69(11):1752-1754

The Aga Khan University Hospital, Karachi, Pakistan.

Trans-sphenoidal approach for resection of pituitary adenomas is a safe and common neurosurgical procedure. It can be done both through microscopic or endoscopic methods, and both methods can be facilitated by a perioperative lumbar drain insertion, that in theory improves tumour resection and reduces risk of post-operative cerebrospinal fluid leak. Herein we have reviewed the literature to find out the evidence in support of perioperative lumbar drain insertion for trans-sphenoidal resections. Read More

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November 2019

Alteration of the lysophosphatidic acid and its precursor lysophosphatidylcholine levels in spinal cord stenosis: A study using a rat cauda equina compression model.

Sci Rep 2019 11 12;9(1):16578. Epub 2019 Nov 12.

Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, Japan.

Cauda equina compression (CEC) is a major cause of neurogenic claudication and progresses to neuropathic pain (NP). A lipid mediator, lysophosphatidic acid (LPA), is known to induce NP via the LPA receptor. To know a possible mechanism of LPA production in neurogenic claudication, we determined the levels of LPA, lysophosphatidylcholine (LPC) and LPA-producing enzyme autotaxin (ATX), in the cerebrospinal fluid (CSF) and spinal cord (SC) using a CEC as a possible model of neurogenic claudication. Read More

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http://dx.doi.org/10.1038/s41598-019-52999-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6851136PMC
November 2019

Streptococcus Oralis meningitis from right sphenoid Meningoencephalocele and cerebrospinal fluid leak.

BMC Infect Dis 2019 Nov 11;19(1):960. Epub 2019 Nov 11.

Department of Internal Medicine, Zucker School of Medicine at Hofstra Northwell, Lenox Hill Hospital New York, New York, USA.

Background: Streptococcus oralis belongs to the Streptococcus mitis group and is part of the normal flora of the nasal and oropharynx (Koneman et al., The Gram-positive cocci part II: streptococci, enterococci and the 'Streptococcus-like' bacteria. Color atlas and textbook of diagnostic microbiology, 1997). Read More

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http://dx.doi.org/10.1186/s12879-019-4472-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849159PMC
November 2019

CSF volume provocation maneuvers during lumbar puncture as a possible predictive tool for diagnosing spontaneous intracranial hypotension.

Clin Neurol Neurosurg 2019 Nov 7;186:105552. Epub 2019 Oct 7.

Department of Radiology, Duke University Medical Center, Durham, NC, USA.

Objectives: Spontaneous intracranial hypotension (SIH) is a pathologic state of low CSF volume caused by a CSF to venous fistula or CSF leak. It is diagnosed based on symptoms, imaging, and CSF pressure but is often a diagnostic challenge because no single test is highly sensitive. Physician-induced changes in CSF volume may result in changes in patient symptoms, as has been shown with idiopathic intracranial hypertension (IIH). Read More

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http://dx.doi.org/10.1016/j.clineuro.2019.105552DOI Listing
November 2019
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Outcome of Endoscopic Endonasal Surgery in Pediatric Craniopharyngiomas.

World Neurosurg 2020 Feb 17;134:e277-e288. Epub 2019 Oct 17.

Division of Pediatric Neurosurgery, Department of Neurosurgery, Bellaria Hospital, Bologna, Italy.

Background: In the last years, few reports have shown the feasibility of the endoscopic endonasal approach (EEA) for craniopharyngiomas in pediatric patients. For these tumors, recent studies have suggested less aggressive surgery, favoring the preservation of the patient's quality of life.

Objective: The aim of this study was to assess the outcome of the EEA in a large series with specific attention on the long-term functional sequelae. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.10.039DOI Listing
February 2020

Pseudohypoxic Brain Swelling: Report of 2 Cases and Introduction of the Lentiform Rim Sign as Potential MRI Marker.

World Neurosurg 2020 Jan 10;133:221-226. Epub 2019 Oct 10.

Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: A rare but important complication related to otherwise uneventful brain and spine surgery is becoming more recognized and more frequently reported in the medical literature. This has been variably labeled as pseudohypoxic brain swelling or postoperative hypotension-associated venous congestion. This poorly understood condition occurs in the setting of surgical intervention and is thought to be related to cerebrospinal fluid leak or evacuation, decreased intracranial pressure, and subsequent development of deep venous congestion affecting the basal ganglia, thalami, and cerebellum. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.10.018DOI Listing
January 2020
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Investigation of Skull-Based Cerebrospinal Fluid Leak Repair: A Single-Institution Comprehensive Study of 116 Cases Over 10 Years.

World Neurosurg 2020 Mar 8;135:e1-e11. Epub 2019 Oct 8.

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Background: Cerebrospinal fluid (CSF) leaks have been historically difficult to diagnose and treat because their cause can widely vary. There are insufficient diagnostic predictors and no clinically accepted standards for their treatment. This large institutional study reports on the diagnosis, management, and outcomes of patients presenting with CSF leak over 10 years and aims to identify potential comorbidities and risk factors for primary and recurrent leaks. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S18788750193257
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http://dx.doi.org/10.1016/j.wneu.2019.09.133DOI Listing
March 2020
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Synchondral Fracture of the Posterior "Hemiarch" of Pediatric Atlas with Cerebrospinal Fluid Fistula following a Penetrating Neck Injury.

Pediatr Neurosurg 2019 10;54(6):424-427. Epub 2019 Oct 10.

Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Introduction: As such, the incidence of spinal fractures in young children is less than that of adults due to an increased pliability of the immature bones. The presence of unfused synchondroses in these children predisposes them to an infrequent pattern of fractures that traverse through ossification centers. Such synchondral injuries are uncommonly reported in the C1 and C2 vertebrae. Read More

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http://dx.doi.org/10.1159/000503109DOI Listing
April 2020
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Headache due to spontaneous spinal cerebrospinal fluid leak secondary to cerebrospinal fluid-venous fistula: Case series.

Cephalalgia 2019 Dec 9;39(14):1847-1854. Epub 2019 Oct 9.

Mayo Clinic, Headache Division, Department of Neurology, Rochester, Minnesota, USA.

Objective: Cerebrospinal fluid-venous fistula is an uncommon cause of spontaneous spinal cerebrospinal fluid leak (SSCSFL). We aim to describe the clinical presentation, imaging evaluation, treatment and outcome of SSCSFL secondary to cerebrospinal fluid-venous fistula.

Methods: A retrospective review was undertaken of SSCSFL cases secondary to cerebrospinal fluid-venous fistula confirmed radiologically or intraoperatively, seen at our institution from January 1994 to March 2019. Read More

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http://dx.doi.org/10.1177/0333102419881673DOI Listing
December 2019

Possible Skull Base Erosion After Prolonged Frontal Sinus Stenting.

Ear Nose Throat J 2019 Sep 29:145561319878951. Epub 2019 Sep 29.

Department of Otolaryngology-Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, NV, USA.

Frontal sinus stenting is widely used with the goal of maintaining nasofrontal duct patency after sinus surgery. The general recommendation is to leave stents in place for 6 months; however, prolonged stenting up to 6 years has been reported with no complication. We present the first reported case of frontal sinus posterior table and skull base erosion following prolonged frontal sinus stenting. Read More

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http://dx.doi.org/10.1177/0145561319878951DOI Listing
September 2019
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Conservative Management for Late Presenting Dural Tears After Spine Surgery: An Institutional Experience and Literature Review.

World Neurosurg 2020 Feb 19;134:e82-e92. Epub 2019 Sep 19.

Department of Spine Service, Indian Spinal Injuries Center, Vasant Kunj, New Delhi, India.

Background: Symptoms and evidence of cerebrospinal fluid (CSF) leak after an uneventful intraoperative and immediate postoperative course are a rare entity in spine surgery. The literature is sparse on the description of such late presenting dural tears (LPDTs). They may need further admissions, wound management, and additional surgical procedures that add to the morbidity of the patient. Read More

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http://dx.doi.org/10.1016/j.wneu.2019.09.067DOI Listing
February 2020
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Bioabsorbable Steroid Eluting Stents in the Treatment of Recurrent Rathke's Cleft Cyst.

J Neurol Surg B Skull Base 2019 Oct 6;80(5):505-510. Epub 2018 Dec 6.

Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, United States.

 Bioabsorbable steroid eluting stents may prevent the stenosis of ostia after sinus surgery. We describe a technique utilizing this technology to prevent the reformation of Rathke's cleft cysts (RCC) after transnasal transsphenoidal surgical drainage.  This study is based on retrospective review. Read More

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http://dx.doi.org/10.1055/s-0038-1675558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748848PMC
October 2019
1 Read