Neumoencéfalo recurrente post quirúrgico, a raíz de dos casos / Post-surgical late pneumoencephalus, based on two cases

El neumoencéfalo es una patología que comúnmente se presenta después de cirugía neuroquirúrgica y ocasionalmente endonasal. Estos se suelen manejar de manera conservadora, sin embargo, se pueden asociar a distintas etiologías las cuales los hacen recurrir. En este reporte presentamos dos casos de neumoencéfalo tardío post quirúrgico asociado a fístulas de LCR de bajo flujo, donde se discute su clínica, etiología y manejo posterior.

Pneumocephalus is a pathology that commonly occurs after endonasal surgery, these are usually managed conservatively, however they can be associated with different etiologies which make them recur. In this report we present two cases of post-surgical late pneumocephalus associated with low-flow CSF fistulae, where its symptoms, etiology, and subsequent management are discussed.

Extraordinarily Long-Term Posttraumatic Cerebrospinal Fluid Fistula

Most posttraumatic cerebrospinal fluid (CSF) leakage is noticed by the patients with the first symptom, rhinorrhea. A 38-year-old woman presented with frequent clear continuous rhinorrhea and otorrhea for 5 years after basilar skull fracture. After this, meningitis was developed with subsequent CSF fistula. Her clinical symptom was improved by medical treatment. The dural defect and CSF leakage were not detected by computerized tomography (CT) cisternography. We report a rare case of persistent posttraumatic CSF fistula that continued for five years.

Usefulness of Intrathecal Gadolinium Enhanced Magnetic Resonance Cisternography in Cerebrospinal Fluid Fistula: Case Report

Accurate localization of cerebrospinal fluid(CSF) fistulae makes the planning of surgery easier, increases the chances of successful dural repair and eliminates negative exploration. The authors report our early experience with intrathecal use of gadolinium DTPA(Gd-DTPA) magnetic resonance(MR) cisternography for evaluation of CSF leakage and localization. By means of lumbar puncture, a single dose of 1ml of gadolinium DTPA mixed with 4ml NaCl 5% was injected. The images were interpreted by comparing those before and after injection. Three patients showed leakage of contrast material through the cribriform plate into the ethmoid or sphenoid air cells. No leakage was observed in one patient. The study results show the relatively safety and feasibility of low-dose Gd-DTPA MR cisternography in confirming the presence and determining the focus of active CSF leaks.

Diagnosis of Congenital Otogenic CSF Fistula Combined with Recurrent Meningitis in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otogenic cerebrospinal fluid (CSF)fistula referrs to the abnormal communication between the CSF and the middle ear space due to defects in the inner ear, and is one of the causes of recurrent meningitis. MATERIALS AND METHODS: We report on five children with congenital otogenic CSF fistula, presented by recurrent meningitis and confirmed by surgical exploration. We also propose diagnostic steps for detecting otogenic fistula in the children based on our experiences and paper review. RESULTS: We used the metrizamide CT in the diagnostic procedure for most cases, although not all. The temporal bone CT was an useful initial diagnostic step for clinically suspicious cases. CONCLUSION: No one test or combination of specific tests were found to accurately predict the presence or absence of CSF fistula. It is thought that the only way to diagnose the CSF fistula is by surgical exploration. If the CSF fistula was suspected, aggressive diagnostic evaluation was needed in order to prevent recurrence.