Idiopathic sphenoid sinus CSF rhinorrhoea.

Cerebrospinal fluid (CSF) rhinorrhoea results from a direct communication between the CSF-containing subarachnoid space and the mucosa-lined space of the nasal cavity and paranasal sinuses. We present a case of 40-year-old woman, presenting with clear, watery discharge through the right nostril spontaneously. The CT cisternography confirmed the diagnosis of sphenoid sinus CSF rhinorrhoea, with no intracranial pathology. The patient was managed by transnasal endoscopic procedure, wherein bath plug technique was followed using temporalis fascia and overlay grafting with fascia lata and fibrin glue. The patient has been symptom free for the last year.

Clinical and critical care concerns of cranio-facial trauma: A retrospective study in a tertiary care institute.

BACKGROUND AND OBJECTIVES: Maxillofacial trauma is commonly associated with other injuries, predominantly head injuries. The predictors of outcome in such concomitant injuries have been studied the least. The present study aims at the evaluation of types of injury, management and outcome of patients sustaining maxillofacial trauma and concomitant cranial injuries. MATERIALS AND METHODS: A retrospective study was carried out in the department of anesthesiology and intensive care. A case series of 129 patients was evaluated who were admitted in ICU (Intensive Care Unit) with maxillofacial trauma and head injuries. The data was then compiled systematically and analyzed using SPSS windows and value of P < 0.05 was considered significant and P < 0.001 as highly significant. RESULTS: Among the 129 patients, majority of them had roadside accidents (RSA > 90%) and male gender predominance with male to female ratio of 5: 1. Fracture maxilla and nasal bones were the most commonly encountered injuries (51.93%) followed by mandibular fractures (39.53%) and fracture of zygomatic bones (28.68%). Eighty five patients (65.90%) required mechanical ventilation, tracheostomy was needed in 29 (22.48%) patients and 81 (62.8%) patients were operated for head injuries as well. Majority of the victims were aged between 15 and 40 years. CONCLUSIONS: Maxillofacial trauma and cranial injuries are common among young males and so is the nature of injuries, that is, RSA. Besides facial injuries, head injuries are important determinant of outcome in such patients. Timely resuscitation and surgical interventions at specialized centers are of prime importance as far as a better prognosis is concerned in such injuries.

The anesthetic, critical care and surgical challenges in the management of craniopharyngioma.

Among the childhood brain neoplasms, craniopharyngioma constitutes about 2-6% of all primary intracranial tumors. Craniopharyngioma poses a multitude of challenges to the neurosurgeon, endocrinologist, oncologist, intensivist and the anesthesiologist. The morbidity and mortality due to radical surgical treatment is quite high, to the extent of 40-50%. The conservative approach with limited surgical intervention and radiotherapy assistance is taken by some neurosurgeons, but its usefulness is very doubtful. We are reporting a case of craniopharyngioma in an 18-year-old female who had progressive loss of vision and was successfully managed with combined radical surgery and medical therapy.