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Cerebrospinal Fluid Rhinorrhea, 1st Edition. Comprehensive Guide to Evaluation and Management

Raj Sindwani, Christopher Roxbury
ISBN: 9780323870726
ISBN: 9780323870726
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Περιγραφή

Offering up-to-date, multidisciplinary coverage of this nuanced and evolving field, Cerebrospinal Fluid Rhinorrhea provides a comprehensive overview of the evaluation and diagnosis, as well as the medical and surgical management options, for all causes of cerebrospinal fluid (CSF) rhinorrhea. It covers all aspects of CSF leaks, synthesizing current knowledge on pathophysiology, diagnosis, perioperative care, and operative techniques for this complex group of patients. Leading experts in otolaryngology and neurosurgery, as well as ophthalmology, neurology, and radiology, provide detailed coverage of the distinctions between management of patients with differing etiologies of CSF rhinorrhea, including spontaneous, traumatic/iatrogenic, and tumor-related.
Key Features
  • Focuses exclusively on the comprehensive evaluation, and management of patients presenting with CSF leaks from the anterior cranial base, offering a reliable, one-stop resource for experienced clinicians as well as those in training.
  • Covers the full breadth of cerebrospinal fluid rhinorrhea, with expert discussion of spontaneous CSF leaks, including evolving management techniques for patients with idiopathic intracranial hypertension; traumatic CSF leaks, including advanced management of complex anterior cranial base trauma; and up-to-date techniques for intraoperative skull base reconstruction after tumor resection.
  • Includes tips and pearls on surgical approaches and postoperative management strategies for this complex and varied patient population.
  • Features abundant high-definition images of anatomy, radiographic imaging, and intraoperative techniques, as well as videos that highlight intraoperative techniques in patients with spontaneous, traumatic, and tumor-related CSF leaks.
  • Provides a detailed review of the different laboratory, examination (endoscopic nasal, as well as ophthalmologic) and imaging studies used to evaluate patients with CSF leaks.
  • Discusses the evaluation and growing medical and procedural management options for patients with idiopathic intracranial hypertension.
  • Offers state-of-the-art reconstruction options for CSF leaks and complex skull base defects, ranging from the nasoseptal flap and beyond.
  • Addresses the controversial role of lumbar drains in CSF leak management, as will new and upcoming technological advances in operating room instrumentation.
  • An eBook version is included with purchase. The eBook allows you to access all of the text, figures and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud.
Author Information
Edited by Raj Sindwani, MD, FACS, FRCS(C), Section Head, Rhinology, Sinus and Skull Base Surgery, Quality Improvement Officer (QIO), Head and Neck Institute, Cleveland Clinic , Cleveland, Ohio and Christopher Roxbury, MD, FARS, Assistant Professor and The Director of Endoscopic Skull Base Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois

Περιεχόμενα

  • Cover image
  • Title page
  • Table of Contents
  • Copyright
  • Dedication
  • Foreword
  • Contributors
  • Video contents
  •     List of Tables
  •     List of Illustrations
  • PART I. Evaluation and Diagnosis of Cerebrospinal Fluid Rhinorrhea
  • 1.  Categorizing cerebrospinal fluid leaks: A framework for understanding
  •     Introduction
  •     Diagnostic tests
  •     Localization of the site of the cerebrospinal fluid leak
  •     Closure techniques
  •     Lumbar drain
  •     Conclusion
  •     References
  • 2.  Evaluation of the patients with cerebrospinal fluid leaks: History and physical examination
  •     Introduction
  •     Cause
  •     Symptoms and presentation
  •     Differential diagnosis
  •     Patient features and demographics
  •     Physical examination
  •     Endoscopic examination
  •     Conclusion
  •     References
  • 3.  Confirmatory testing for cerebrospinal fluid rhinorrhea
  •     Introduction
  •     Chemical markers
  •     Summary
  •     References
  • 4.  Role of imaging studies in the evaluation and localization of cerebrospinal fluid leaks
  •     Introduction
  •     Imaging protocols
  •     Summary
  •     References
  • PART II. Cerebrospinal Fluid Physiology and Anatomy of the Cranial Base
  • 5.  Cerebrospinal fluid physiology and dynamics
  •     Introduction
  •     Physiology
  •     Cerebrospinal fluid bulkflow
  •     Cerebrospinal fluid dynamics
  •     Conclusion
  •     References
  • 6.  Surgical anatomy of the anterior cranial fossa
  •     Introduction
  •     Macroscopic anatomy
  •     Endoscopic anatomy
  •     Conclusion
  •     References
  • 7.  Surgical anatomy of the middle cranial fossa
  •     Introduction
  •     Intracranial aspect
  •     Extracranial aspect
  •     References
  • 8.  Surgical anatomy of the posterior cranial fossa
  •     Introduction
  •     Anatomy of the posterior fossa
  •     Cerebrospinal fluid leakage arising from the posterior cranial fossa
  •     Conclusion
  •     References
  • PART III. Traumatic and Iatrogenic Cerebrospinal Fluid Leaks
  • 9.  Pathophysiology and clinical evaluation of iatrogenic cerebrospinal fluid rhinorrhea after sinus surgery
  •     Introduction
  •     Preoperative anatomic risk factors
  •     Preoperative physiologic risk factors
  •     Risk of iatrogenic cerebrospinal fluid leak based on surgical intervention
  •     Risk of instrumentation
  •     Evaluation of iatrogenic cerebrospinal fluid leak
  •     Conclusion
  •     References
  • 10.  Pathophysiology and clinical evaluation of blunt force and penetrating trauma of the anterior cranial base
  •     Introduction
  •     Anterior cranial fossa anatomy
  •     Pathophysiology of traumatic cerebrospinal fluid leak of the anterior cranial fossa
  •     Clinical evaluation
  •     Conclusion
  •     References
  • 11.  Imaging of anterior skull base trauma
  •     Introduction
  •     Imaging anatomy
  •     Imaging modalities
  •     Imaging findings
  •     Conclusion
  •     References
  • 12.  Surgical management of iatrogenic cerebrospinal fluid rhinorrhea
  •     Introduction
  •     Pathophysiology and presentation
  •     Surgical repair
  •     Repair strategy and considerations
  •     Postoperative care
  •     Conclusion
  •     References
  • 13.  Surgical management of large traumatic anterior cranial base defects via craniotomy
  •     Introduction
  •     Epidemiology
  •     Diagnosis and indications for surgery
  •     Surgical exposure
  •     Craniotomy and fracture elevation techniques
  •     Frontal fossa floor exploration and dural repair
  •     Closure and reconstruction
  •     Perioperative management
  •     Long-term complications
  •     Conclusion
  •     References
  • 14.  Postoperative management of traumatic cranial base defects
  •     Introduction
  •     Anatomic and structural factors impacting the risk of repair failure
  •     Patient factors impacting the risk of postoperative cerebrospinal fluid leak
  •     Medical management after skull base leak repair
  •     Temporary and permanent cerebrospinal fluid diversion
  •     Conclusion
  •     References
  • PART IV. Spontaneous Cerebrospinal Fluid Leaks and Idiopathic Intracranial Hypertension
  • 15.  Pathophysiology of spontaneous cerebrospinal fluid leaks and their relationship with idiopathic intracranial hypertension
  •     Introduction
  •     Evidence for a relationship between spontaneous cerebrospinal fluid leak and idiopathic intracranial hypertension
  •     Pathophysiology of spontaneous cerebrospinal fluid leak
  •     Conclusion
  •     References
  • 16.  Diagnosis and medical management of idiopathic intracranial hypertension
  •     Introduction
  •     Pathophysiology
  •     Diagnosis
  •     Medical management
  •     Conclusion
  •     References
  • 17.  Surgical management of refractory idiopathic intracranial hypertension
  •     Introduction
  •     Pathophysiology of idiopathic intracranial hypertension: The role of venous system obstruction and sinus stenosis
  •     Cerebral venous sinus system
  •     Surgical treatment
  •     Conclusion
  •     References
  • 18.  Ophthalmologic evaluation of idiopathic intracranial hypertension
  •     Introduction
  •     Patient history
  •     Ocular examination
  •     Ancillary testing
  •     Follow-up
  •     Special considerations
  •     Conclusion
  •     References
  • 19.  Radiologic findings in idiopathic intracranial hypertension
  •     Introduction
  •     Imaging techniques
  •     Conclusion
  •     References
  • 20.  Evaluation and management of congenital skull base defects
  •     Introduction
  •     Pathophysiology
  •     Clinical presentation
  •     Differential diagnosis
  •     Workup
  •     Treatment
  •     Prognosis
  •     Conclusion
  •     References
  • 21.  Surgical management of spontaneous cerebrospinal fluid leak of the cribriform plate
  •     Introduction
  •     Anatomy
  •     Preoperative considerations
  •     Instrumentation
  •     Surgical procedure
  •     Postoperative considerations
  •     Conclusion
  •     References
  • 22.  Surgical management of lateral sphenoid recess meningoencephaloceles and cerebrospinal fluid leaks
  •     Introduction
  •     Preoperative planning
  •     Surgical approaches to repair of lateral recess of the sphenoid sinus cerebrospinal fluid leaks
  •     Conclusion
  •     References
  • 23.  Surgical m anagement of spontaneous cerebrospinal fluid rhinorrhea arising from clival defects
  •     Introduction
  •     Classification
  •     Anatomy
  •     Embryology
  •     Patient presentation
  •     Pathophysiology
  •     Treatment
  •     Conclusion
  •     References
  • 24.  Postoperative management after cerebrospinal fluid leak repair in patients with idiopathic intracranial hypertension
  •     Introduction
  •     Postoperative management
  •     Exercise and air travel
  •     Follow-up
  •     Conclusion
  •     References
  • PART V. Endoscopic Cerebrospinal Fluid Leak Repair and Skull Base Reconstruction and After Tumor Surgery
  • 25.  Clinical evaluation of the sellar mass patient
  •     Introduction
  •     Risk factors for a cerebrospinal fluid leak
  •     Additional thoughts
  •     Conclusion
  •     References
  • 26.  Clinical evaluation of patients with skull base malignancies
  •     Introduction
  •     History and presentation
  •     Physical examination
  •     Nasal endoscopy
  •     Imaging
  •     Biopsy
  •     Surgical considerations
  •     Multidisciplinary tumor board
  •     Follow-up
  •     Conclusion
  •     References
  • 27.  Radiologic evaluation of skull base masses
  •     Introduction
  •     Preoperative imaging
  •     Postoperative imaging
  •     Postsurgical complications
  •     Conclusion
  •     References
  • 28.  Decision making in endoscopic skull base reconstruction: A graduated approach
  •     Introduction
  •     Evolution of reconstructive techniques
  •     Risk factors for postoperative cerebrospinal fluid leak
  •     Decision-making process
  •     Quality control
  •     Unanswered questions
  •     Conclusion
  •     References
  • 29.  The nasoseptal flap: The workhorse for skull base reconstruction
  •     Introduction
  •     Anatomy
  •     Surgical technique
  •     Outcomes
  •     Conclusion
  •     Acknowledgment
  •     References
  • 30.  Locoregional pedicled flap options for skull base reconstruction
  •     Introduction
  •     Intranasal vascularized flaps
  •     Extranasal vascularized flaps
  •     Conclusion
  •     References
  • 31.  Sellar reconstruction after pituitary adenoma resection
  •     Introduction
  •     Risk factors
  •     Sellar reconstruction in cases without intraoperative cerebrospinal fluid leak
  •     Sellar reconstruction in mid-risk cases and low-flow leaks
  •     Sellar reconstruction in high-risk cases
  •     Lumbar drain
  •     Revision cases
  •     Conclusion
  •     References
  • 32.  Reconstruction after transtuberculum and transplanum approaches to suprasellar pathology
  •     Introduction
  •     Historical perspective on reconstructive approaches
  •     Preoperative considerations
  •     Operative steps and reconstructive approaches
  •     Pearls and pitfalls
  •     Conclusion
  •     References
  • 33.  Endoscopic reconstruction of anterior cranial fossa defects
  •     Introduction
  •     Preoperative considerations
  •     Surgical management
  •     Specific considerations
  •     Postoperative management
  •     Conclusion
  •     References
  • 34.  Endoscopic reconstruction of middle cranial fossa defects
  •     Introduction
  •     Middle cranial fossa skull base anatomy
  •     Causes
  •     Presentation and demographics
  •     Workup and management
  •     Postoperative management
  •     Conclusion
  •     References
  • 35.  Endoscopic reconstruction of posterior cranial fossa defects
  •     Introduction
  •     Surgical techniques
  •     Reconstruction technique
  •     Postoperative care
  •     Results
  •     Conclusion
  •     References
  • 36.  Transorbital and transfrontal approaches to cerebrospinal fluid leak repair
  •     Introduction
  •     Indications and contraindications
  •     Preoperative considerations
  •     Surgical technique
  •     Reconstruction
  •     Postoperative management
  •     Outcomes
  •     Conclusion
  •     References
  • 37.  Free flap reconstruction of skull base defects
  •     Introduction
  •     Classification of skull base defects
  •     Goals of treatment
  •     Factors to consider in flap selection
  •     Commonly used microvascular free flaps for skull base reconstruction
  •     Anterolateral thigh free flap
  •     Radial forearm free flap
  •     Latissimus dorsi free flap (Fig. 37.5)
  •     Serratus anterior free flap
  •     Scapular and parascapular fasciocutaneous and osteofasciocutaneous free flaps
  •     Fibula free flap
  •     Rectus abdominus free flap
  •     Complications
  •     Conclusion
  •     References
  • 38.  Postoperative management after reconstruction following skull base tumor surgery
  •     Introduction
  •     Risk factors and risk stratification paradigms
  •     Postoperative management
  •     Complications
  •     References
  • PART VI. Cerebrospinal Fluid Diversion and Advances in Instrumentation and Biomaterials
  • 39.  Role of cerebrospinal fluid diversion in cerebrospinal fluid leak repairs and skull base surgery
  •     Introduction
  •     Spontaneous cerebrospinal fluid leaks
  •     Acetazolamide
  •     Lumbar drainage
  •     Shunting
  •     Iatrogenic (presurgical and postsurgical)
  •     Pituitary tumors
  •     Larger anterior skull base defects
  •     Fluorescein
  •     Cerebrospinal fluid leaks of the middle and posterior fossa
  •     Traumatic cerebrospinal fluid leaks
  •     Conclusion
  •     Disclosures
  •     Financial support
  •     Acknowledgments
  •     References
  • 40.  Advances in endoscopic visualization and surgical navigation
  •     Introduction
  •     Defining optimal imaging characteristics
  •     Three-dimensional endoscopic systems
  •     Fluorescence
  •     Surgical navigation
  •     Conclusion
  •     References
  • 41.  Powered instrumentation and bipolar technology in endoscopic endonasal skull base surgery
  •     Introduction
  •     Powered instrumentation
  •     Aquamantys
  •     Conclusion
  •     References
  • 42.  Evolution of synthetic graft materials and dural sealants for cerebrospinal fluid leak repair
  •     Introduction
  •     Autologous versus synthetic grafts
  •     Acellular human dermis
  •     Engineered collagen products
  •     Porcine small intestine submucosa
  •     Absorbable dural sealants and glues
  •     Rigid support grafts
  •     Imaging characteristics of synthetic materials in skull base repair
  •     Conclusion
  •     References
  • Index

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