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Transcranial management of CSF rhinorrhea
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Harsh Deora, Nishanth Sadashiva, Mohammed Nadeem
Although it seems trivial, the final diagnosis of CSF rhinorrhea may be confusing. Other rhinology pathology, including seasonal allergic rhinitis, perennial nonallergic rhinitis, and vasomotor rhinitis, are relatively common, and may mimic some of the signs and symptoms of CSF rhinorrhea or may occur simultaneously with a CSF leak. Furthermore, CSF rhinorrhea is often intermittent, even after trauma, which may lead to false-negative results on diagnostic testing if testing is performed during the quiescent phase. Lastly, the subarachnoid cistern is a relatively low-pressure system. Thus, leaks may be of low volume, which can lead to false-negative testing or failure to recognize that a leak even exists. In cases of high clinical suspicion and initially negative diagnostic testing, further follow-up with repeat testing is warranted.
Intracranial Hemorrhage (ICH)
Published in Swati Goyal, Neuroradiology, 2020
The most common locations include: Subdural space (usually along the interhemispheric fissure and tentorium cerebelli)Subarachnoid cisternsPosterior fossa SAH
Spinal Anesthesia
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The subarachnoid space is traversed by connective tissue trabeculae which attach the arachnoid to the pia mater. In the brain, the subarachnoid space presents wide intervals named subarachnoid cisternae and communicates medially with the ventricles (Figure 3.54). In the spine, the subarachnoid space is wide, especially caudally where it surrounds the nerves of the cauda equina (Figure 3.55): this enlargement extends from the conus medullaris (L2 to L1 vertebral bodies) to the end of the space (S4 to S2, depending upon the age) and is usually termed the lumbar cistern. Spinal needles are usually inserted into the lumbar cistern.
Surgical declarative knowledge learning: concept and acceptability study
Published in Computer Assisted Surgery, 2022
A. Huaulmé, G. Dardenne, B. Labbe, M. Gelin, C. Chesneau, J. M. Diverrez, L. Riffaud, P. Jannin
Endoscopic third ventriculostomy (ETV) is a routine neurosurgical procedure mostly used to treat obstructive hydrocephalus both in children and adults. ETV offers significant advantages over shunts and is considered the gold standard in the management of non-communicating hydrocephalus. Residents in neurosurgery have to learn and master this endoscopic technique as early as possible in their surgical curriculum. ETV is divided into five phases: (1) A burr-hole is performed in the right frontal bone (Kocher’s point); (2) A rigid endoscope is introduced through the right frontal lobe into the right frontal horn of the lateral ventricle; (3) insertion of the endoscope into the third ventricle through the foramen of Monro; (4) perforation of the floor of the third ventricle. This communication between the third ventricle and the subarachnoid cisterns allows the circulation of cerebrospinal fluid trapped in the ventricles to the subarachnoid space. Finally, (5) the endoscope is removed and the skin is closed.
Inflammation in neurocysticercosis: clinical relevance and impact on treatment decisions
Published in Expert Review of Anti-infective Therapy, 2021
Pedro T Hamamoto Filho, Gladis Fragoso, Edda Sciutto, Agnès Fleury
The second is associated with a more diffuse form of NC affecting mainly the basal subarachnoid cisterns. In such cases, the diagnosis of NC has usually been made several years ago, significant CSF inflammation exists, viable cysts may or may not be present, and arachnoiditis is the main finding. In these patients, the intensity of CSF inflammation is associated with increased cerebral blood flow [109]. Since vascular events are generally associated with other symptoms related to NC (especially ICH), the prognosis is poor. Several types of strokes, such as symptomatic and silent lacunar can occur, and different arteries can be affected [107]. In these cases, the vascular events are mainly caused by the development of the inflammatory reaction, rather than by the presence of inflammatory cysts, as in the first situation.
Unilateral chronic subdural hematoma due to spontaneous intracranial hypotension: a report of four cases
Published in British Journal of Neurosurgery, 2020
Yoshinari Osada, Ichiyo Shibahara, Atsuhiro Nakagawa, Hiroyuki Sakata, Kuniyasu Niizuma, Ryuta Saito, Masayuki Kanamori, Miki Fujimura, Shinsuke Suzuki, Teiji Tominaga
Typical CT findings in patients with concomitant CSDH and SIH include the following: bilateral subdural fluid collections,8 cerebellar tonsillar herniation, ventricular collapse, and subarachnoid cistern obliteration.17,18 Loya et al. reported 29 cases of patients being comatose due to intracranial hypotension; at least 22 of these patients had bilateral hygromas or CSDH.11 Moreover, Beck et al. reported that young patients (age ≤ 60 years) who presented with bilateral CSDH showed a close association with SIH.13 Therefore, “bilateral” is a key feature of SIH on radiological images. In our series, all four cases presented with unilateral and not bilateral CSDH.