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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.
Current approaches to cysticidal drug therapy for neurocysticercosis
Published in Expert Review of Anti-infective Therapy, 2020
There are two main forms of spinal NCC, one affecting the spinal subarachnoid space and the other affecting the spinal cord. The former is likely secondary to cysts located in subarachnoid cisterns at the base of the brain, since these cysts may move downwards into the spinal canal following the flow of CSF [84]. Intramedullary cysts are believed to be the result of metacestodes entering the parenchyma of the spinal cord by hematogenous dissemination throughout the artery of Adamkiewicz, one of the main blood vessels supplying the spinal cord (this would explain the predominance of these lesions at the thoracic level) [7]. Cysticerci in the spinal subarachnoid space may induce inflammatory or demyelinating changes in ventral and dorsal roots, in a similar way as intracranial subarachnoid cysts induce damage in cranial nerves. Intramedullary cysticerci induce a focal myelopathy related to compressive effects or to subacute or chronic inflammatory changes resembling those described in the brain parenchyma [85,86]. Knowledge of the value of cysticidal drugs for patients with spinal NCC is limited, but it may be assumed that similar regimens than those used for intracranial subarachnoid NCC may also be of value for patients with spinal subarachnoid cysts [36]. Corticosteroids are of paramount importance to reduce inflammatory damage of spinal roots, and albendazole might be the drug of choice for therapy of these lesions. Regarding therapy of patients with intramedullary cysts, a systematic review suggests that the prognosis is better after cysticidal drug therapy than when the cysts are surgically removed [87]. However, such review was based on the report of isolated cases and the evidence is just anecdotal.