2,592 results match your criteria Cerebrospinal Fluid Leak Imaging

Cerebellar tonsillar descent: A diagnostic dilemma between Chiari malformation type 1 and spinal cerebrospinal fluid leak.

Heliyon 2021 Apr 19;7(4):e06795. Epub 2021 Apr 19.

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

Cerebellar tonsillar descent can be seen on head magnetic resonance imaging in both Chiari malformation type 1 and spinal cerebrospinal fluid leak creating the potential for misdiagnosis. We report five cases of spinal cerebrospinal fluid leak at Stanford University initially misdiagnosed and treated as Chiari malformation type 1 based on cerebellar tonsillar descent demonstrated on imaging. All five cases had sustained relief at the 6-month follow up visit from epidural blood patches for the treatment of spinal cerebrospinal leak after unsuccessful suboccipital decompression surgeries. Read More

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Radiological findings in spontaneous cerebrospinal fluid leaks of the temporal bone.

J Laryngol Otol 2021 May 10:1-7. Epub 2021 May 10.

Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Australia.

Background And Objective: Spontaneous cerebrospinal fluid leak of the temporal bone is an emerging clinical entity for which prompt and accurate diagnosis is difficult given the subtle signs and symptoms that patients present with. This study sought to describe the key temporal bone abnormalities in patients with spontaneous cerebrospinal fluid leak.

Methods: A retrospective cohort study was conducted of adult patients with biochemically confirmed spontaneous cerebrospinal fluid leak. Read More

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ACR Appropriateness Criteria® Head Trauma: 2021 Update.

J Am Coll Radiol 2021 May;18(5S):S13-S36

Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.

Head trauma (ie, head injury) is a significant public health concern and is a leading cause of morbidity and mortality in children and young adults. Neuroimaging plays an important role in the management of head and brain injury, which can be separated into acute (0-7 days), subacute (<3 months), then chronic (>3 months) phases. Over 75% of acute head trauma is classified as mild, of which over 75% have a normal Glasgow Coma Scale score of 15, therefore clinical practice guidelines universally recommend selective CT scanning in this patient population, which is often based on clinical decision rules. Read More

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Superficial Siderosis: A Clinical Review.

Neeraj Kumar

Ann Neurol 2021 Apr 15. Epub 2021 Apr 15.

Department of Neurology, Mayo Clinic, Rochester, MN.

Superficial siderosis of the central nervous system results from subpial hemosiderin deposition due to chronic low-grade bleeding into the subarachnoid space. The confluent and marginal subpial hemosiderin is best appreciated on iron-sensitive magnetic resonance imaging sequences. With widespread use of magnetic resonance imaging, the disorder is increasingly being recognized, including in asymptomatic individuals. Read More

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Sensorineural Hearing Loss Caused by Labyrinthine Erosion Due to a Cerebrospinal Fluid Diverticulum.

Otol Neurotol 2021 Apr 14. Epub 2021 Apr 14.

Division of Otolaryngology-Head and Neck Surgery, The George Washington University, Washington DC.

Objective: To present a case of progressive sensorineural hearing loss (SNHL) caused by labyrinthine erosion secondary to expanding geniculate ganglion cerebrospinal fluid (CSF) diverticulum extending along the path of the facial nerve.

Patient: Thirteen-year-old man with no past medical history or risk factors presented with unilateral progressive SNHL and no other otologic or neurologic symptoms.

Interventions: Audiological data as well as imaging studies including a magnetic resonance imaging (MRI) of the brain and internal auditory canal and a temporal bone computed tomography (CT) are presented. Read More

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Deployment of a bioabsorbable plate as the rigid buttress for skull base repair after endoscopic pituitary surgery.

Gland Surg 2021 Mar;10(3):1010-1017

Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China.

Background: Bioresorbable alloplastic implants have become desirable as a rigid buttress for reconstructing skull base defects. This study aimed to describe the use of a biodegradable plate (PolyMax RAPID) in skull base repair of endoscopic endonasal pituitary surgery and to investigate the clinical outcome and safety of this novel method.

Methods: Between January 2019 and January 2020, 22 patients with pituitary adenomas who underwent endoscopic skull base repair with a Polymax RAPID plate were included. Read More

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Spontaneous Congenital Perilabyrinthine Cerebrospinal Fluid Fistulas.

Ann Otol Rhinol Laryngol 2021 Apr 9:34894211007242. Epub 2021 Apr 9.

Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.

Objectives: To report a recalcitrant spontaneous cerebrospinal fluid (CSF) fistula arising from multiple, anatomically-linked lateral skull base defects, and to review the available literature to determine optimal techniques for operative repair of congenital CSF fistulae.

Methods: A patient with recurrent episodes of otologic meningitis was found to have a patent tympanomeningeal fissure, also known as a Hyrtl's fissure, and internal auditory canal (IAC) diverticulum that communicated with the jugular bulb. A systematic review of the literature characterized all reports of spontaneous congenital perilabyrinthine CSF leaks, and all cases of Hyrtl's fissures. Read More

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Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function.

Endocrine 2021 Apr 6. Epub 2021 Apr 6.

Department of Endocrinology & Metabolism, Royal Preston Hospital, The Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

Background: Non-functioning pituitary macroadenomas (NFPAs) with visual field defects are ideally managed by transsphenoidal tumour resection to improve vision, and long-term postsurgical follow up is necessary to monitor for tumour recurrence. Regular updates from global data are necessary for developing optimal management strategies of these tumours.

Methods: Pre- and postoperative visual and endocrine profile, imaging characteristics and details of surgical interventions among patients with NFPAs managed between 2008 and 2019 in a UK regional centre were assessed. Read More

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The role of reoperation after recurrence of Cushing's disease.

Best Pract Res Clin Endocrinol Metab 2021 Feb 6:101489. Epub 2021 Feb 6.

USC Pituitary Center, Department of Neurosurgery, Keck School of Medicine of University of Southern California, 1300 N. State Street, Suite 3300, Los Angeles, CA, 90033, USA; Department of Medicine, Division of Endocrinology and Diabetes, Keck School of Medicine of University of Southern California, 1333 San Pablo Street, BMT-B11, Los Angeles, CA, 90033, USA. Electronic address:

Surgical failure or recurrence of Cushing's disease can be treated with medical therapy, radiotherapy, adrenalectomy, and/or repeat transsphenoidal surgery, all of which have their respective benefits and drawbacks. Redo transsphenoidal surgery has been shown to achieve at least short-term remission in about 40-80% of patients and is associated with low rates of morbidity and near-zero mortality, albeit higher rates of postoperative hypopituitarism, diabetes insipidus, and cerebrospinal fluid leak than initial resection. Despite this, recurrence may ensue in 50% of patients. Read More

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February 2021

Spontaneous Spinal Cerebrospinal Fluid Leak: Review and Management Algorithm.

World Neurosurg 2021 Mar 30;150:133-139. Epub 2021 Mar 30.

Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. Electronic address:

Spontaneous spinal cerebrospinal fluid (CSF) leak is a condition that commonly presents with debilitating positional headaches. Often, the cause of the leak is located in the spine. Although often cured with conservative management, including epidural blood patching, a subset of patients are refractory to this initial management. Read More

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CT of Skull Base Fractures: Classification Systems, Complications, and Management.

Radiographics 2021 May-Jun;41(3):762-782. Epub 2021 Apr 2.

From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., K.C., D.G., R.E.M.), R. Adams Cowley Shock Trauma Center (D.D., B.A., A.J.N.), Department of Neurosurgery (B.A.), Division of Plastic Surgery (A.J.N.), and Department of Otorhinolaryngology-Head and Neck Surgery (D.J.E.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass (O.S.); and Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD (K.C.).

As advances in prehospital and early hospital care improve survival of the head-injured patient, radiologists are increasingly charged with understanding the myriad skull base fracture management implications conferred by CT. Successfully parlaying knowledge of skull base anatomy and fracture patterns into precise actionable clinical recommendations is a challenging task. The authors aim to provide a pragmatic overview of CT for skull base fractures within the broader context of diagnostic and treatment planning algorithms. Read More

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[Analysis of correlation between the pneumatization degree of paranasal sinuses and skull base and spontaneous cerebrospinal fluid rhinorrhea].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021 Mar;35(3):252-255

Department of Rhinology,the First Affiliated Hospital of Zhengzhou University,450052,Zhengzhou,China.

To investigate the relationship between the pneumatization degree of paranasal sinuses and skull base and the incidence of spontaneous cerebrospinal fluid rhinorrhea (SCSFR). Date of 107 patients with SCSFR were reviewed retrospectively. Using CT scans, investigator evaluated the pneumatization degree of paranasal sinuses and skull base, and compared classifications of various imaging characteristics between SCSFR group(case group) and nasal septum deviation group(control group), including frontal cells, Onodi cell, lateral recess of sphenoid sinus (LRSS), pneumatization of anterior clinoid process and pneumatization of posterior clinoid process. Read More

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Meningitis in the Setting of Frontoethmoidal and Temporal Meningoencephaloceles.

Neurohospitalist 2021 Apr 10;11(2):183-184. Epub 2020 Sep 10.

Department of Neurology, NYU Langone Medical Center, New York, NY, USA.

This is a patient with multiple meningoencephaloceles which resulted in bacterial meningitis and subsequent status epilepticus. We identify impressive imaging findings demonstrating herniation of the meninges from nasal and bitemporal skull base defects possibly as a result of intracranial hypertension. Read More

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Prolactinoma extension as a contributing factor in dopamine agonist-induced CSF rhinorrhea: a systematic review of the literature.

Br J Neurosurg 2021 Mar 30:1-6. Epub 2021 Mar 30.

Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

Background: Dopamine agonist-induced cerebrospinal fluid (CSF) rhinorrhea is an uncommon treatment-related complication arising in 6.1% of prolactinoma patients treated with dopamine agonists. Locally invasive prolactinomas may create CSF fistulae through formation of dural and osseous skull base defects. Read More

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The Endonasal Endoscopic Management of Cerebrospinal Fluid Rhinorrhea.

Cureus 2021 Feb 20;13(2):e13457. Epub 2021 Feb 20.

Otolaryngology - Head and Neck Surgery, King Fahad Specialist Hospital, Dammam, SAU.

Introduction Cerebrospinal fluid (CSF) rhinorrhea is the result of a bony defect at the skull base with disruption of the arachnoid, dura mater, and sinonasal mucosa that leads to an active CSF leak and flow of clear fluid from the nose. The endoscopic repair of CSF leaks and skull defects have been used by an increasing number of surgeons and is the standard of care for repairing CSF leaks. Materials and methods We conducted a retrospective study of all cases of CSF leaks managed via the endonasal endoscopic approach from 2010 to 2020 at a tertiary referral hospital of King Fahad Specialist Hospital, Dammam (KFSH-D). Read More

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February 2021

CSF rhinorrhoea post COVID-19 swab: A case report and review of literature.

J Clin Neurosci 2021 Apr 14;86:6-9. Epub 2021 Jan 14.

Department of Neurosurgery, Liverpool Hospital, Sydney, NSW, Australia.

We report the case of a 59 year old male who presented with 2 months of persistent rhinorrhoea from left nostril post a nasal swab done for coryzal symptoms at the peak of the COVID-19 pandemic. Beta-2-transferrin confirmed it to be a CSF leak and imaging showed a left middle cranial fossa encephalocele herniating into the sphenoid sinus as the site of the leak post swab. The leak was treated endoscopically. Read More

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Cranial fat dissemination following fat grafting for lumbar dural tear: First case report in the literature.

Int J Surg Case Rep 2021 Apr 22;81:105809. Epub 2021 Mar 22.

Department of Neurosurgery, Monash Medical Centre, Clayton, VIC, 3168, Australia. Electronic address:

Introduction And Importance: Dural tear and cerebrospinal fluid (CSF) leak is among the most common complications in lumbar spine surgery. Although primary dural suturing is the preferred method for repair, this is not always achievable specially with ventrolateral tears. Autologous fat grafting is one of the oldest and effective methods for dural repair which can also be used along with other methods of repair. Read More

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Atypical presentations of idiopathic intracranial hypertension.

Taiwan J Ophthalmol 2021 Jan-Mar;11(1):25-38. Epub 2020 Dec 2.

Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States.

Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that results in isolated raised intracranial pressure. Classic symptoms and signs of IIH include headache, papilledema, diplopia from sixth nerve palsy and divergence insufficiency, and pulsatile tinnitus. Atypical presentations include: (1) highly asymmetric or even unilateral papilledema, and IIH without papilledema; (2) ocular motor disturbances from third nerve palsy, fourth nerve palsy, internuclear ophthalmoplegia, diffuse ophthalmoplegia, and skew deviation; (3) olfactory dysfunction; (4) trigeminal nerve dysfunction; (5) facial nerve dysfunction; (6) hearing loss and vestibular dysfunction; (7) lower cranial nerve dysfunction including deviated uvula, torticollis, and tongue weakness; (8) spontaneous skull base cerebrospinal fluid leak; and (9) seizures. Read More

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December 2020

[Bilateral Chronic Subdural Hematomas].

No Shinkei Geka 2021 Mar;49(2):238-243

Department of Radiology, Saitama Medical Center, Saitama Medical University.

Chronic subdural hematomas(SDHs)do not infrequently present isodensity on CT. They should not be overlooked, particularly if bilateral. Therefore, checking for an abnormal mass effect and visualizing the cortical sulci in higher slices should be routine. Read More

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Prediction of Postoperative Risk of Raised Intracranial Pressure After Spontaneous Skull Base Cerebrospinal Fluid Leak Repair.

J Neuroophthalmol 2021 Mar 12. Epub 2021 Mar 12.

Departments of Ophthalmology (BB, BSC, BBB, NJN, VB); Pathology (SB); Epidemiology (BBB); Neurology (BBB, NJN, VB); Neurological Surgery (NJN); Radiology and Imaging Sciences (AMS); and Otolaryngology- Head and Neck Surgery (JML), Emory University School of Medicine, Atlanta, Georgia.

Background: A relationship between idiopathic intracranial hypertension and spontaneous skull base cerebrospinal fluid (CSF) leaks has been proposed, by which CSF leak decreases intracranial pressure (ICP) and masks the symptoms and signs of elevated ICP. These patients are at risk of developing papilledema, symptoms of elevated ICP, or a recurrent CSF leak after CSF leak repair. The objective of this study was to assess whether radiographic signs of raised ICP on preoperative magnetic resonance or computed venography (MRI or CTV) are predictors of postoperative papilledema, recurrence of CSF leak, or need for CSF shunt surgery. Read More

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Spontaneous Cerebrospinal Fluid Rhinorrhea from a Prolactin-Secreting Pituitary Macroadenoma.

Cureus 2021 Feb 3;13(2):e13111. Epub 2021 Feb 3.

Neurosurgery, University of Utah, Salt Lake City, USA.

Cerebrospinal fluid (CSF) rhinorrhea is a rare complication of macroprolactinomas that, in the vast majority of cases, is subsequent to either medical or surgical intervention. Here, we present the successful management of a rare case of spontaneous, noniatrogenic CSF rhinorrhea in a patient with an untreated macroprolactinoma. A 27-year-old man with no significant medical history presented with six months of persistent CSF rhinorrhea, which was confirmed by testing for beta-2-transferrin. Read More

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February 2021

Epidural blood patch for the treatment of liquor hypotension after intrathecal chemotherapy in a 10-year-old: case report.

Braz J Anesthesiol 2021 Feb 19. Epub 2021 Feb 19.

Centro Hospitalar Universitário de São João, Department of Anaesthesiology, Porto, Portugal.

Background And Objectives: An epidural blood patch is used to treat postdural puncture and liquor hypotension headache. We report the use of an epidural blood patch in a critical pediatric patient.

Case Report: A 10-year-old girl with acute leukemia developed venous cerebral thrombosis with hemorrhagic transformation one month after intrathecal chemotherapy. Read More

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February 2021

A Rare Complication of Pituitary Adenoma Surgery in a Patient with Multiple Endocrine Neoplasia 1 Syndrome with Two Novel Genetic Mutations.

Asian J Neurosurg 2020 Oct-Dec;15(4):1020-1023. Epub 2020 Dec 21.

Department of Endocrinology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

Pituitary adenoma surgeries are common in neurosurgical setup. Majority are tackled by a transsphenoidal route either by endoscopic or microscopic aid. Complications such as cerebrospinal fluid (CSF) leak, meningitis, diabetes insipidus, hematoma, and loss of vision are known, but midbrain infarct is rarely reported. Read More

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December 2020

Remote medulla ablongata ventral acute subarachnoid hemorrhage following cervical spinal surgery: A case report.

Int J Surg Case Rep 2021 Mar 22;80:105675. Epub 2021 Feb 22.

Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, 130021, PR China. Electronic address:

Introduction: The incidence of remote intracranial hemorrhage (RICH) in patients during spinal surgery is rare and the detailed mechanism remains unclear.

Presentation Of Case: A 55-year-old man had undergone cervical discectomy and fusion at C5-6 and C6-7 due to herniated disc and secondary spinal canal stenosis. He had severe headache 20 h postoperatively and his drain output increased from 100 to 350 mL in the second 10 h after surgery. Read More

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Tension pneumocephalus following an implant removal from spine.

BMJ Case Rep 2021 Feb 24;14(2). Epub 2021 Feb 24.

Orthopaedics, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Pneumocephalus is commonly seen after skull and maxillofacial fractures. It can also occur following cerebrospinal fluid leak after skull base surgery and epidural catheter placement. We report a rare case report of a 20-year-old man who developed tension pneumocephalus following implant removal from the spine. Read More

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February 2021

Petrous Apex Cephaloceles: Radiology Features and Surgical Management of a Rare Entity.

Otol Neurotol 2021 Feb 23. Epub 2021 Feb 23.

Rush Medical College Department of Radiology Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois Ohio State University College of Medicine, Columbus, Ohio Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois.

Objective: To characterize the radiologic findings of petrous apex cephalocele (PAC) in a patient cohort, and report the surgical management for three symptomatic PAC patients and cerebrospinal fluid (CSF) leak via the middle cranial fossa approach.

Study Design: Retrospective case series.

Setting: Academic center. Read More

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February 2021

Compressive cervicothoracic pseudomeningocele as a rare manifestation of idiopathic intrathecal hypotension after past trauma: a review.

Eur Spine J 2021 Feb 23. Epub 2021 Feb 23.

Department of Spine Surgery, Orthopedics and Neurosurgery, Hôpital Fribourgeois, Fribourg, Switzerland.

Purpose: Spontaneous intracranial or intrathecal hypotension (SIH) is an underdiagnosed phenomenon predominantly presenting with low cerebrospinal fluid (CSF) pressure and postural headache in the setting of CSF leak. Extrathecal CSF collections causing compression of the spinal cord or nerve roots present an even rarer subset of this disease. We aim to describe this pathology in a comprehensive manner while illustrating with a case of our own. Read More

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February 2021

Arachnoiditis, a complication of epidural blood patch for the treatment of low-pressure headache: A case report and systematic review.

Headache 2021 Feb 13;61(2):244-252. Epub 2021 Feb 13.

Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.

Objective: To report a case of arachnoiditis as a complication of epidural blood patch procedures and to systematically review the diagnostic workup, clinical outcomes, and treatment modalities reported in the literature.

Background: Epidural blood patching is an effective treatment for low-pressure headache secondary to spontaneous cerebrospinal fluid leak or iatrogenic post-dural puncture. Spontaneous intracranial hypotension is believed to be a rare headache disorder, but recently has been diagnosed at higher frequencies, making it an important differential diagnosis for intractable headaches. Read More

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February 2021

Cochlear implantation in children with Mondini dysplasia: our experience.

J Laryngol Otol 2021 Feb 11;135(2):125-129. Epub 2021 Feb 11.

Asian Speech and Hearing Clinic, Ahmedabad, India.

Objective: This study details the intra-operative complications, and compares auditory scales post-implantation of either profoundly deaf young children with radiologically normal inner ears (group A) or children with Mondini dysplasia (group B).

Methods: A retrospective survey was carried out of 338 patients with severe to profound sensorineural hearing loss who underwent cochlear implant surgery from February 2015 to May 2017. Patients were divided into 2 groups of 27 patients each. Read More

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February 2021

Plasma Ablation-Assisted Endoscopic Endonasal Transpterygoid Approach to Sphenoid Lateral Recess Cerebrospinal Fluid Leaks: Technique and Outcome.

World Neurosurg 2021 May 3;149:e636-e645. Epub 2021 Feb 3.

Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Management of sphenoid lateral recess (SLR) cerebrospinal fluid (CSF) leaks present a challenge because of the location and requiring complete visualization of the defect for a successful repair. The endoscopic endonasal transpterygoid approach (EETPA) is considered the gold standard in addressing these defects. We lay out our experience in implementing this approach with plasma ablation. Read More

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