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cerebrospinal_fluid_leakage

Cerebrospinal fluid leakage

A cerebrospinal fluid leak (CSFL) is a medical condition when the cerebrospinal fluid of a person leaks out of the dura mater.

There is a incomplete sealing of the dura mater and is a major complication of intradural procedures.

Classification

CSF leaks have been traditionally classified as traumatic or non-traumatic.

Non-traumatic CSF leak may be spontaneous in the absence of obvious cause, such as skull base abnormalities or bone erosion related to tumors or hydrocephalus 1) 2) 3).

Etiology

This can be caused by several reasons, including spontaneous cerebrospinal fluid leak, post-surgical lumbar puncture (iatrogenic), physical trauma, etc.

It is a common complication of surgery involving the lumbar spine.

While high CSF pressure can make reclining unbearable, low CSF pressure due to a leak is often relieved somewhat by maintaining a supine position.

Posttraumatic cerebrospinal fluid leakage.

Spontaneous cerebrospinal fluid leak or nontraumatic.

see

Cerebrospinal fluid otorrhea.

Cerebrospinal fluid rhinorrhea.

see

Pediatric cerebrospinal fluid leakage

see

Spinal cerebrospinal fluid leakage

Cerebrospinal fluid leak after vestibular schwannoma surgery.

Cerebrospinal fluid leak after endoscopic skull base surgery.

Diagnosis

Beta 2 transferrin, is almost exclusively found in the cerebrospinal fluid. It is not found in blood, mucus or tears, thus making it a specific marker of cerebrospinal fluid, applied as an assay in cases where cerebrospinal fluid leakage is suspected.


(111)In-DTPA RIC images were taken at 0, 1, 3, 6, and 24-h after radioisotope injection following the current protocol. Regions of interest (ROI) were selected on 3-h images to include brain, spine, bladder or the whole body. The accumulative radioactivity counts were calculated for quantitative analysis. Final diagnoses of SCH were established based on the diagnostic criteria recently proposed by Schievink and colleagues.

Thirty-five patients were focused on. Twenty-one (60.0%) patients were diagnosed as having SCH according to the Schievink criteria. On the 3-h images, direct cerebrospinal fluid leakage sign was detected in nine of 21 SCH patients (42.9%), as well as three patients with suspected iatrogenic leakage. Compared to non-SCH patients, SCH patients showed higher bladder accumulation at 3-h images (P = 0.0002), and higher brain clearance between the 6- and 24-h images (P < 0.0001). In particular, the 24-h brain clearance was more conclusive for the diagnosis than 24-h whole cistern clearance. The combination of direct sign and 24-h brain accumulation resulted in 100% of accuracy in the 32 patients in whom iatrogenic leakage was not observed. 1- and 6-h images did not provide any additional information in any patients.

A new simple ROI setting method, in which only the 3-h whole body and 24-h brain images were necessary, was sufficient to diagnose SCH 4).

Treatment

To avoid cerebrospinal fluid leaks and related possible complications, the dura mater should be meticulously closed after craniotomy procedures. Several techniques for duraplasty and different material for watertight closure have been described.

A plastic dummy with a balloon was developed to test the efficacy of the watertight closure of the dura. The technical notes to reproduce the method have been described.

The described model represents a new, simple, effective and affordable device to be used for neurosurgical training in the procedures of duraplasty and to test the efficacy of watertight closures 5).

see Cerebrospinal fluid leakage treatment

1)
Ommaya AK. Cerebrospinal Fluid Rhinorrhea. Neurology. 1964;14:106–113.
2)
Clark D, Bullock P, Hui T, et al. Benign intracranial hypertension: a cause of CSF rhinorrhoea. J Neurol Neurosurg Psych. 1994;57:847–849.
3)
Yang Z, Wang B, Wang C, et al. Primary spontaneous cerebrospinal fluid rhinorrhea: a symptom of idiopathic intracranial hypertension? J Neurosurg. 2011;115:165–170.
4)
Hoshino H, Higuchi T, Achmad A, Taketomi-Takahashi A, Fujimaki H, Tsushima Y. A new approach for simple radioisotope cisternography examination in cerebrospinal fluid leakage detection. Ann Nucl Med. 2016 Jan;30(1):40-8. PubMed PMID: 26466604.
5)
Matula C, Kjærsgaard L, Di Ieva A. Watertight dural closure in brain surgery: a simple model for training. J Neurol Surg A Cent Eur Neurosurg. 2014 May;75(3):241-5. doi: 10.1055/s-0033-1342928. PubMed PMID: 23681920.
cerebrospinal_fluid_leakage.txt · Last modified: 2017/07/22 19:37 by administrador