Lessons of the month: Cerebrospinal Fluid Leak-associated Ventriculitis - a case report.

We present a case of a 74-year-old woman with headaches, pyrexia, and intermittent right-sided otorrhoea and rhinorrhoea. Her nasal discharge tested positive for Beta-2-Transferrin, confirming a cerebrospinal fluid (CSF) leak. High-resolution CT (HRCT) mastoids showed a defect in the right tegmen, and CSF within the middle ear and mastoid air cells.

Mild cognitive impairment in spontaneous intracranial hypotension and its rapid reversal by repair of a spinal cerebrospinal fluid leak.

Background: Patients with spontaneous intracranial hypotension (SIH) report difficulties in concentration and memory. To objectify these deficits, we implemented standard cognitive tests into our routine SIH workup.

Method: Retrospective, single-center report of cognitive standard tests among patients with SIH consecutively admitted from May to July 2023.

Skull defect - Frontotemporal dementia sagging brain syndrome.

Objective: Frontotemporal dementia (FTD) sagging brain syndrome is a disabling condition. An underlying spinal Cerebrospinal fluid leak can be identified in only a minority of patients and the success rate of non-directed treatments is low. Some of these patients have a remote history of craniectomy/cranioplasty and we report a positive response to custom implant cranioplasty revision many years after their initial cranioplasty.

Spontaneous intracranial hypotension - Neurological symptoms, diagnosis, and outcome.

Background: Spontaneous intracranial hypotension (SIH) is a rare secondary headache disorder caused by spinal leakage of cerebrospinal fluid. Specialized treatment of SIH consists of epidural blood patches (EBPs), fibrin patching, endovascular sealing, and surgery. The aim of this paper was to characterize SIH patients identified at a tertiary headache center.

[Repair protocol of intraoperative CSF leak after endoscopic endonasal clival malignancy resection].

To evaluate the repair protocols for intraoperative cerebrospinal fluid (CSF) leaks after endoscopic endonasal clival malignancy resection (EECR) and to analyze the risk factors of surgical complication. The clinical data of patients who underwent EECR and had intraoperative CSF leaks in XuanWu Hospital, Capital Medical University between January 2012 and January 2024 were reviewed. The pathological results, imaging data, location of the dural defect, degree of intraoperative CSF leaks, repair materials, complications such as postoperative central nervous system (CNS) infections, types of antibiotics used, bacterial culture and drug sensitivity results, secondary repair, and follow-up results were collected.

Image-guided Epidural Blood Patching and Fibrin Glue Occlusion of Cerebrospinal Fluid Leaks and Venous Fistulas.

There have been major advances in the diagnosis and treatment of spontaneous intracranial hypotension (SIH). While once thought to be a rare condition, the occurrence is not uncommon if diagnosed adequately. Our greater understanding of SIH is based on three main points: (1) awareness of the various types of spontaneous spinal cerebrospinal fluid (CSF) leaks; (2) advanced myelography with the precision to detect dural tears and CSF-venous fistulas; and (3) updated treatment techniques of epidural patching, embolization, and surgery.

Myelographic Techniques for the Localization of Cerebrospinal Fluid Leaks.

Spinal cerebrospinal fluid (CSF) leaks require advanced myelographic techniques for precise localization, which is in turn necessary for optimal treatment. Here, we will discuss the various myelographic techniques that have become available in recent years for CSF leak localization. Each of these can be used to detect many different types of spinal CSF leaks, although each modality has unique advantages and disadvantages, which will be outlined here.

Causes of Intracranial Hypotension: Spontaneous, Traumatic, and Iatrogenic Cerebrospinal Fluid Leaks.

Cerebrospinal fluid leaks are important to recognize because they can cause debilitating symptoms for patients and have life-threatening complications. Leakage of cerebrospinal fluid (CSF) from the subarachnoid space can occur at the cranial or spinal level, with distinct clinical presentations, diagnostic evaluations, and treatment modalities depending on the type and location of the leak. Spontaneous, traumatic, and iatrogenic spinal CSF leaks cause reduced intracranial CSF volume and the clinicoradiologic syndrome commonly called "intracranial hypotension".

Intrathecal Contrast-enhanced Computed Tomography and MR Cisternography for Skull Base Cerebrospinal Fluid Leaks and Other Intracranial Applications.

Acquired skull base cerebrospinal fluid (CSF) leaks can result from trauma, tumors, iatrogenic causes, or may be spontaneous. Spontaneous skull base CSF leaks are likely a manifestation of underlying idiopathic intracranial hypertension. The initial assessment of rhinorrhea or otorrhea, which may be suspected owing to an acquired skull base CSF leak, requires integration of clinical assessment and biochemical confirmation of CSF.

Imaging Anatomy of the Cerebrospinal Fluid Spaces.

The cerebrospinal fluid spaces of the spine and brain are an intricate network of tissues with complex anatomic relationships. Understanding the normal imaging anatomy and variants of these spaces is crucial for accessing the spinal subarachnoid space and evaluating patients with suspected CSF leaks. This article reviews the imaging anatomy of the cerebrospinal fluid spaces in the spine and brain with emphasis on clinically relevant anatomy for percutaneous needle access to the spinal subarachnoid space and management of patients with CSF leak.

Use of Magnetic Resonance Imaging for Postoperative Radiation Therapy Planning in Patients with Carbon Fiber-Reinforced Polyetheretherketone Instrumentation.

Purpose: Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation is being used more frequently in the spinal oncology landscape. Better visualization with this material allows for more precise postoperative stereotactic body radiation therapy (SBRT) planning using either computed tomography (CT)-myelography or magnetic resonance imaging (MRI) studies. We compared the dosimetric planning equivalencies and outcomes.

Safety and Feasibility of Internal Fixation Using Bioabsorbable Versus Titanium Materials for Short-Level Lamina Reimplantation: A Comparative Clinical Study.

Objective: Lamina-implantation is gradually becoming the main surgical method for the treatment of intraspinal tumors. Traditional titanium (Ti) internal fixation not only produces artifacts, which affects the observation of tumors and dural sac closure, but also faces the problem of secondary surgical removal. In this study, absorbable material were used in lamina replantation for the first time and was evaluated for its efficacy and safety.

Surgical management of a lateral sphenoid sinus encephalocele: 2-Dimensional operative video.

Encephaloceles are considered rare with an approximate incidence of 1 in 35,000, and sphenoid encephaloceles are even more uncommon. Two types of sphenoid encephaloceles exist: medial perisellar encephaloceles, and lateral sphenoidal encephaloceles. Surgical correction of the lateral sphenoid recess encephalocele is achieved via one of two endoscopic approaches: extended sphenoidotomy or transpterygopalatine.

ACR Appropriateness Criteria® Imaging of Suspected Intracranial Hypotension.

The clinical syndrome of intracranial hypotension refers to the symptoms caused by cerebrospinal fluid hypovolemia and is primarily characterized by postural headaches, but can be associated with a multitude of other neurological symptoms. Imaging plays a critical role in helping to establish a diagnosis of intracranial hypotension, localize the source of cerebrospinal fluid leak, and assist in directing targeted treatments. Using the best available evidence, this document provides diagnostic imaging recommendations for the workup of intracranial hypotension across various clinical presentations.

Delays in Treatment for Temporal Encephaloceles and Cerebrospinal Fluid Leaks.

Objective: Lateral skull base defects (LSBD) pose a diagnostic challenge; however, early recognition and treatment are important to avoid sequelae. This study examines the impact of health care disparities associated with time to diagnosis and treatment for patients with LSBD.

Study Design, Setting, Patients, Intervention, Outcome Measures: Multi-institutional retrospective cohort study at four U.

Superficial Siderosis: A Case Report of Underdiagnosed Disorder.

Superficial siderosis (SS) is caused by subpial hemosiderin deposition due to chronic low-grade bleeding into the subarachnoid space. Dural tears are the most common etiology. Slowly progressive gait ataxia and hearing impairment are common clinical manifestations.

Magnetic Resonance Imaging Diagnosis of Spinal Longitudinal Epidural Collections in a Spontaneous Spinal Dural Breach and Successful Surgical Treatment.

Spontaneous intracranial hypotension is generally secondary to cerebrospinal fluid leaks. Spinal magnetic resonance imaging is an important part of the diagnostic workup, especially to display spinal longitudinal epidural collections. Other causes of leaks include nerve root sleeve tear and cerebrospinal fluid-venous fistula.