Research in Cerebrospinal Fluid Leak (Rhinorrhea and Otorrhea): A Bibliometric Analysis From 1945 to 2018.

Objective In this study, we aimed to analyze research activity on cerebrospinal fluid (CSF) leaks in general and CSF rhinorrhea and otorrhea in particular and to identify the main topic clusters in these areas. Methods We identified all relevant documents, using the medical subject heading (MeSH) term "Cerebrospinal Fluid Leak", that are indexed in the MEDLINE database between 1945 and 2018. We performed a descriptive bibliometric analysis and analyses of networks and research clusters in order to identify the main topic areas of research. Results From 1945 to 2018, a total of 4,130 records were published with the term CSF leak, including 2,821 documents (68.1%) with the term CSF rhinorrhea and 1,040 documents (25.8%) with CSF otorrhea. The number of documents published increased from 10 in 1945-49 to 642 in 2010-14. Articles represented the dominant document type (86.8% of the documents analyzed), while case reports were the main type of study (37.4%). In terms of geographical distribution, researchers from the USA led in the number of signatures (39.1%), followed by those from the UK (7.5%). The most active areas of research in the field were "Postoperative Complications," "Tomography, X-Ray Computed," and "Magnetic Resonance Imaging." The terms "Adults," "Young Adult," and "Middle-Aged" were most common in CSF rhinorrhea research; and the terms "Infant," "Child, Preschool," "Child," and "Adolescent" were more common in CSF otorrhea. Conclusions Based on our findings, articles and case reports related to "Surgery" and "Postoperative Complications" associated with the diagnosis are the main topics of study, highlighting the importance of this document type in advancing knowledge in the field.

Top-cited articles in cerebrospinal fluid leak (rhinorrhea and otorrhea) (1945-2018).

INTRODUCTION: As scientific knowledge has grown in biomedicine, it has also become necessary to develop tools to manage and understand the body of evidence. In that sense, bibliometrics has become a consolidated discipline for analyzing scientific activity, enabling the characterization of a particular field or area of knowledge by means of the quantification of the bibliographic characteristics of scientific publications. OBJECTIVE: The objective of this study was to determine the most frequently cited articles in the field of cerebrospinal fluid rhinorrhea and otorrhea. METHODS: The searches took place on the Clarivate Analytics Web of Science platform, which includes the MEDLINE database. The study period was limited to 1945-2018. RESULTS: The 101 most cited articles in the field of cerebrospinal fluid leak were published in 36 journals, and the most important specialties contributing to the literature were neurosurgery and otorhinolaryngology. Of the 101 top-cited articles, 70% were published from 1990 to 2018, with two distinct periods of high scientific productivity: 1990-1999 and 2000-2009. In the first period, the main topic of research interest was endoscopic sinus surgery for cerebrospinal fluid fistulas, whereas from 2000 to 2009, documents focused more on surgical aspects of extended skull base approaches. The articles received 73-767 citations. The top article over the whole study period was "A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap" by Hadad et al., which was published 2006 in Laryngoscope. Its publication represented an inflection point in the literature on cerebrospinal fluid leak and endoscopic skull base surgery, and it gave rise to numerous other research publications. CONCLUSION: Different surgical innovations in the field of cerebrospinal fluid leak sparked two different periods of intense scientific activity. Otorhinolaryngology and neurosurgery were the dominant specialties. The most frequent topic studied was endoscopic surgery; others included clinical and diagnostic features, neurinoma surgery, and cerebrospinal fluid leak related to temporal bone fractures.

Cirugía endoscópica endonasal en adenomas hipofisarios: resultados quirúrgicos en una serie de 86 pacientes consecutivos / Endonasal endoscopic surgery in pituitary adenomas: Surgical results in a series of 86 consecutive patients

Introducción: El abordaje endoscópico endonasal se ha convertido en la técnica quirúrgica de elección para el tratamiento de los adenomas hipofisarios. Objetivos: El objetivo de este trabajo es presentar los resultados obtenidos en nuestro hospital en cirugía puramente endoscópica de los adenomas hipofisarios. Métodos: Hemos realizado un estudio prospectivo, recogiendo a los pacientes intervenidos de adenoma hipofisario mediante un abordaje endonasal puramente endoscópico, desde febrero de 2011 hasta agosto de 2016, obteniendo una muestra total de 86 pacientes. Todos los pacientes fueron intervenidos conjuntamente por un ORL y un neurocirujano con la técnica de four hands-two nostrils. El seguimiento medio postoperatorio fue de 32 meses. Todos los pacientes fueron evaluados según criterios clínicos, radiológicos y endocrinológicos. Resultados: En nuestra serie un 53% eran mujeres y un 47% hombres; el rango de edad variaba desde los 14 hasta los 84 años, siendo la media de 54 años. El síntoma inicial más habitual fue el déficit visual (42%), seguido por la hiperfunción hormonal (21%), siendo la acromegalia el síndrome clínico observado con más frecuencia. Los tumores más frecuentes fueron los no funcionantes (73%), y de entre los adenomas funcionantes el más frecuente fue el productor de GH (65%). En cuanto a tamaño tumoral, un 76% eran macroadenomas, un 11% microadenomas y un 13% gigantes. Un 63% presentaban extensión supraselar y un 37% invasión de seno cavernoso (grado de Knosp ≥3). Se consiguió una exéresis total en un 77% de los casos. Tras la intervención se consiguió en un 91% mejoría visual y hasta en un 73% remisión de la hiperfunción endocrina. En cuanto a las complicaciones, la más frecuente fue la insuficiencia de al menos un eje de la hipófisis anterior (9%), sin presentar casos de fístula de LCR posquirúrgica. Conclusiones: Nuestros resultados, en términos de calidad quirúrgica, se asemejan a las series publicadas y avalan la eficacia y seguridad del abordaje endoscópico endonasal como técnica de elección en el manejo quirúrgico de la glándula hipofisaria. Sin embargo, es necesario un estudio con mayor número de casos para obtener resultados con significación clínica

Introduction: The endoscopic endonasal approach has become the gold standard for the surgical treatment of pituitary adenomas. Objectives: The aim of this study is to present the results obtained in our hospital in purely endoscopic surgery of pituitary adenomas. Methods: From February 2011 to August 2016, we conducted a prospective study on a series of 86 patients with pituitary adenoma, all of whom underwent surgery with a purely endoscopic endonasal approach. The ‘four hands-two nostrils’ technique was performed in all cases by a surgical team composed of an ENT surgeon and a neurosurgeon. Mean follow-up was 32 months. All patients were evaluated according to clinical, radiological and endocrinological criteria. Results: In our series, 53% were women and 47% men. The age ranged from 14 to 84 years of age, with a mean of 54 years of age. The most common initial symptom was visual deficit (42%), followed by hormonal hyperfunction (21%), with acromegaly being the most common clinical syndrome. The most common tumours were non-functioning tumours (73%), while GH-secreting tumours (65%) were the most common functioning adenoma. Regarding tumour size, 76% were macroadenomas, 11% microadenomas and 13% giant adenomas. Approximately 63% of the adenomas exhibited suprasellar extension and 37% involved invasion of the cavernous sinus (Knosp grade ≥3). Total excision was achieved in 77% of the cases. After the intervention, visual improvement was achieved in 91% and remission of endocrine hyperfunction in up to a 73% of cases. The most common complication was anterior pituitary insufficiency of at least one axis (9%). There were no cases of postoperative cerebrospinal fluid fistula. Conclusions: In terms of surgical quality, our results are similar to those of published series, and demonstrate the efficacy and safety of the endoscopic endonasal approach as the surgical treatment of choice for pituitary adenomas. However, further studies with a higher sample size are necessary to obtain clinically significant results

[Endonasal endoscopic surgery in pituitary adenomas: Surgical results in a series of 86 consecutive patients]. / Cirugía endoscópica endonasal en adenomas hipofisarios: resultados quirúrgicos en una serie de 86 pacientes consecutivos.

INTRODUCTION: The endoscopic endonasal approach has become the gold standard for the surgical treatment of pituitary adenomas. OBJECTIVES: The aim of this study is to present the results obtained in our hospital in purely endoscopic surgery of pituitary adenomas. METHODS: From February 2011 to August 2016, we conducted a prospective study on a series of 86 patients with pituitary adenoma, all of whom underwent surgery with a purely endoscopic endonasal approach. The 'four hands-two nostrils' technique was performed in all cases by a surgical team composed of an ENT surgeon and a neurosurgeon. Mean follow-up was 32 months. All patients were evaluated according to clinical, radiological and endocrinological criteria. RESULTS: In our series, 53% were women and 47% men. The age ranged from 14 to 84 years of age, with a mean of 54 years of age. The most common initial symptom was visual deficit (42%), followed by hormonal hyperfunction (21%), with acromegaly being the most common clinical syndrome. The most common tumours were non-functioning tumours (73%), while GH-secreting tumours (65%) were the most common functioning adenoma. Regarding tumour size, 76% were macroadenomas, 11% microadenomas and 13% giant adenomas. Approximately 63% of the adenomas exhibited suprasellar extension and 37% involved invasion of the cavernous sinus (Knosp grade ≥3). Total excision was achieved in 77% of the cases. After the intervention, visual improvement was achieved in 91% and remission of endocrine hyperfunction in up to a 73% of cases. The most common complication was anterior pituitary insufficiency of at least one axis (9%). There were no cases of postoperative cerebrospinal fluid fistula. CONCLUSIONS: In terms of surgical quality, our results are similar to those of published series, and demonstrate the efficacy and safety of the endoscopic endonasal approach as the surgical treatment of choice for pituitary adenomas. However, further studies with a higher sample size are necessary to obtain clinically significant results.

Estudio endoscópico endonasal 3D de la anatomía de la base de cráneo / Three-dimensional endoscopic endonasal study of skull base anatomy

INTRODUCCIÓN: El entrenamiento en la disección de los senos paranasales y la base de cráneo es esencial para el conocimiento anatómico y la correcta aplicación de las técnicas quirúrgicas. La visualización tridimensional de la anatomía endoscópica de la base de cráneo mejora la orientación espacial y permite la percepción de profundidad. OBJETIVO: Mostrar la anatomía endoscópica de la base de cráneo basándose en la técnica tridimensional. MÉTODOS: Realizamos disección endoscópica endonasal en especímenes cadavéricos fijados con formol y con la técnica de Thiel, ambos con inyección intravascular de colorantes. Los abordajes fueron realizados con endoscopios convencionales 2D. Posteriormente aplicamos la técnica 3D anaglífica para ilustrar las figuras en 3D. RESULTADOS: Se ilustran las más importantes estructuras y referencias anatómicas de la región selar desde la perspectiva endonasal endoscópica en 3D. CONCLUSIÓN: La base del cráneo está compuesta por complejas estructuras óseas y neurovasculares. La experiencia con la disección en cadáver es crucial para comprender la anatomía y desarrollar habilidades quirúrgicas. La visualización 3D representa una útil herramienta para comprender la anatomía de la base de cráneo

INTRODUCTION: Training in dissection of the paranasal sinuses and the skull base is essential for anatomical understanding and correct surgical techniques. Three-dimensional (3D) visualisation of endoscopic skull base anatomy increases spatial orientation and allows depthperception. OBJECTIVE: To show endoscopic skull base anatomy based on the 3D technique. METHODS: We performed endoscopic dissection in cadaveric specimens fixed with formalin and with the Thiel technique, both prepared using intravascular injection of coloured material. Endonasal approaches were performed with conventional 2D endoscopes. Then we applied the 3D anaglyph technique to illustrate the pictures in 3D. RESULTS: The mostimportant anatomical structures and landmarks of the sellar region underendonasal endoscopic vision are illustrated in 3D images. CONCLUSION: The skull base consists of complex bony and neurovascular structures. Experience with cadaver dissection is essential to understand complex anatomy and developsurgical skills. A 3D view constitutes a useful tool for understanding skull base anatomy

[Three-dimensional endoscopic endonasal study of skull base anatomy]. / Estudio endoscópico endonasal 3D de la anatomía de la base de cráneo.

INTRODUCTION: Training in dissection of the paranasal sinuses and the skull base is essential for anatomical understanding and correct surgical techniques. Three-dimensional (3D) visualisation of endoscopic skull base anatomy increases spatial orientation and allows depth perception. OBJECTIVE: To show endoscopic skull base anatomy based on the 3D technique. METHODS: We performed endoscopic dissection in cadaveric specimens fixed with formalin and with the Thiel technique, both prepared using intravascular injection of coloured material. Endonasal approaches were performed with conventional 2D endoscopes. Then we applied the 3D anaglyph technique to illustrate the pictures in 3D. RESULTS: The most important anatomical structures and landmarks of the sellar region under endonasal endoscopic vision are illustrated in 3D images. CONCLUSION: The skull base consists of complex bony and neurovascular structures. Experience with cadaver dissection is essential to understand complex anatomy and develop surgical skills. A 3D view constitutes a useful tool for understanding skull base anatomy.

Manifestación laríngea de linfoma no Hodgkin de células B / Laryngeal manifestation of B-cell non-Hodgkin lymphoma

Los linfomas laríngeos primarios son raros, representando menos del 1% de ellos. Los linfomas no Hodgkin (LNH) extranodales aparecen generalmente en lugares donde hay tejido linfoide como el intestino delgado o la parótida, siendo muy raros en órganos con poca o ausente cantidad de este tejido como la laringe. Cuando se encuentran en estadios avanzados, su debut laríngeo ha sido poco documentado. Presentamos el caso de un LNH linfocítico de células pequeñas en estadio IV E con primera manifestación clínica a nivel laríngeo, así como su manejo y seguimiento evolutivo(AU)

Laryngeal lymphomas are rare, involving less than 1% of all laryngeal tumours. Extranodal non-Hodgkin lymphomas generally appear in places where lymphoid tissue exists, such as the small bowel or parotid; they are very unusual in organs with little or no presence of lymphoid tissue, such as the larynx. When advanced stages are established, initial lymphoma manifestation at the laryngeal level has rarely been documented. We present a case of a small cell lymphocytic lymphoma at stage IV/E with initial laryngeal symptoms and indicate its management and follow up(AU)

Cordoma extraóseo de nasofaringe en edad pediátrica / Extraosseous chordoma of nasopharynx in paediatric age

Los cordomas intracraneales son tumores relativamente raros localmente agresivos, que probablemente se originan de remanentes embrionarios de la notocorda. La localización primaria más frecuente es el sacro, seguida en orden de frecuencia por el clivus. Cuando los cordomas de base de cráneo tienen una localización extraósea (sin destrucción lítica del hueso) mimetizan cualquier otra lesión de nasofaringe. Presentamos el caso de un cordoma extraóseo primario en edad pediátrica que se origina en la nasofaringe, con la intención de mejorar el diagnóstico y tratamiento postoperatorio de este raro tumor(AU)

Intracranial chordomas are relatively rare locally aggressive tumours that probably originate from embryonic remnants of the notochord. They typically arise from the sacrum and secondly in the skull base/clivus region. When skull base chordomas occur at an extraosseous location (without lytic bone destruction), they may mimic other lesions of the nasopharynx. We present a case of primarily extraosseous chordoma in paediatric age, involving the nasopharynx, to improve preoperative diagnosis and postoperative management of this rare tumour(AU)

Laryngeal manifestation of B-cell non-Hodgkin lymphoma.

Laryngeal lymphomas are rare, involving less than 1% of all laryngeal tumours. Extranodal non-Hodgkin lymphomas generally appear in places where lymphoid tissue exists, such as the small bowel or parotid; they are very unusual in organs with little or no presence of lymphoid tissue, such as the larynx. When advanced stages are established, initial lymphoma manifestation at the laryngeal level has rarely been documented. We present a case of a small cell lymphocytic lymphoma at stage IV/E with initial laryngeal symptoms and indicate its management and follow up.

Extraosseous chordoma of nasopharynx in paediatric age.

Intracranial chordomas are relatively rare locally aggressive tumours that probably originate from embryonic remnants of the notochord. They typically arise from the sacrum and secondly in the skull base/clivus region. When skull base chordomas occur at an extraosseous location (without lytic bone destruction), they may mimic other lesions of the nasopharynx. We present a case of primarily extraosseous chordoma in paediatric age, involving the nasopharynx, to improve preoperative diagnosis and postoperative management of this rare tumour.

Papilomas invertidos nasosinusales. Revisión de 10 años / Sinunasal inverted papilloma. A 10 year review

Objetivos. Analizar nuestra experiencia en el diagnostico y tratamiento del papiloma invertido (PI), especialmente en relación a recientes cambios y estrategias en los abordajes quirúrgicos. Material y método. Se realizó un estudio retrospectivo durante 10 años en pacientes diagnosticados de PI consecutivamente seleccionados. El tiempo medio de seguimiento fue de 36 meses. Resultados. 15 casos diagnosticados por estudio anatomopatológico predominantemente hombres, y en estadio T2 según la clasificación Krouse. La localización primaria más común fue el seno etmoidal y maxilar. La tasa de recidiva del total de pacientes fue de 40%, con predominio de los pacientes sometidos a abordaje mixto (abierto y endoscópico). Conclusiones. La modalidad de tratamiento depende de la localización y extensión de la enfermedad. Se recomienda un seguimiento anual endoscópico para valorar los resultados del tratamiento y, de por vida debido a posibles recurrencias tardías(AU)

Aim. To analyze our experience in the diagnostic and treatment of inverted papilloma (IP), especially based on recent changes and strategies through surgical approach. Material and method. This is a retrospective chart study over a 10-year period in patients with IP consecutively selected. The mean follow-up period was 36 month. Material and method. This is a retrospective chart study over a 10-year period in patients with IP consecutively selected. The mean follow-up period was 36 month. Results. 15 cases diagnosed by anatomopathological study predominantly males, and T2 stage according to Krouseìs classification system. Most common primary localization of the tumor was ethmoid and maxillary sinus. The recurrence rate was 40%, predominantly in patients with combined approach (external and endoscopic). Results. 15 cases diagnosed by anatomopathological study predominantly males, and T2 stage according to Krouseìs classification system. Most common primary localization of the tumor was ethmoid and maxillary sinus. The recurrence rate was 40%, predominantly in patients with combined approach (external and endoscopic). Conclusions. To analyze our experience in the diagnostic and treatment of inverted papilloma (IP), especially based on recent changes and strategies through surgical approach. The treatment modality is related to the location and extent of the disease. Annual endoscopic follow-up observation is recommended for the preliminary report on the treatment results of this condition and, lifelong follow-up for possible late recurrences. Conclusions. The treatment modality is related to the location and extent of the disease. Annual endoscopic follow-up observation is recommended for the preliminary report on the treatment results of this condition and, lifelong follow-up for possible late recurrences(AU)

[Aneurysmal bone cyst of the ethmoid: apropos of a case and review of the medical literature]. / Quiste óseo aneurismático de etmoides: a propósito de un caso y revisión de la literatura médica.

This is a case report of aneurysmal bone cyst of the ethmoid. It is a benign process but with high capacity of local damage. Because of its resemblance with other expansive pathologies of the nasal cavity, it needs to be taken into account to ensure proper diagnosis and treatment.

Quiste óseo aneurismático de etmoides: a propósito de un caso y revisión de la literatura médica / Aneurysmal bone cyst of the ethmoid: apropos of a case and review of the medical literature

Presentamos el caso de un quiste óseo aneurismático etmoidal. Se trata de un proceso benigno pero con alta capacidad de destrucción local. Dada su semejanza con otros procesos expansivos de las fosas nasales, es necesario tenerlo en cuenta para el diagnóstico y el tratamiento correctos. Realizamos una revisión de la bibliografía al respecto

This is a case report of aneurysmal bone cyst of the ethmoid. It is a benign process but with high capacity of local damage. Because of its resemblance with other expansive pathologies of the nasal cavity, it needs to be taken into account to ensure proper diagnosis and treatment