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World Neurosurgery Dec 2017Choroid plexus papilloma revealed by nontraumatic cerebrospinal fluid (CSF) rhinorrhea has only been described 5 times, to our knowledge, in the literature. The... (Review)
Review
BACKGROUND
Choroid plexus papilloma revealed by nontraumatic cerebrospinal fluid (CSF) rhinorrhea has only been described 5 times, to our knowledge, in the literature. The challenges in this situation are to recognize CSF leak, to rapidly understand the pathophysiology of the leak, and to choose the best treatment strategy in emergency. We report an original case of posterior fossa choroid plexus papilloma revealed by CSF leak. We then discuss the surgical strategy and the pathophysiology of CSF leak, which is explained, in this case, by both hyperproduction of CSF and local skull base erosion.
CASE DESCRIPTION
We report the case of a 47-year-old man who has developed spontaneous rhinorrhea, right hearing loss, and confusion. A choroid plexus papilloma of the right cerebellomedullary cistern was diagnosed. Hydrocephalus and pneumocephalus were associated with an erosion of the homolateral skull base. The patient underwent surgical total tumor removal by a median suboccipital approach after implantation of a temporary external ventricular drainage. The patient recovered completely without any recurrence of CSF rhinorrhea. The 5-month postoperative images show total bone re-growth and resolution of hydrocephalus.
CONCLUSIONS
Our case shows that 1) causal reasoning is of major importance when dealing with CSF rhinorrhea and that 2) dura repair can be avoided when treating CSF leak secondary to posterior fossa choroid plexus papilloma.
Topics: Cerebrospinal Fluid Rhinorrhea; Humans; Hydrocephalus; Male; Middle Aged; Neurosurgical Procedures; Papilloma, Choroid Plexus
PubMed: 28866068
DOI: 10.1016/j.wneu.2017.08.121 -
European Archives of... Jun 2024Chronic rhinitis is when the nasal passages become inflamed and irritated, causing symptoms like nasal congestion, runny nose, sneezing, and postnasal drip that last for... (Review)
Review
BACKGROUND
Chronic rhinitis is when the nasal passages become inflamed and irritated, causing symptoms like nasal congestion, runny nose, sneezing, and postnasal drip that last for at least 12 weeks. While various medical treatments are available for chronic rhinitis, studies have shown that patients often do not comply with the treatment or report that it is ineffective. Cryotherapy for the nasal mucosa is a surgical option that has shown promise for these patients, with acceptable side effects.
AIM
Our goal is to evaluate the existing literature regarding the effectiveness and safety of cryotherapy as a treatment for chronic rhinitis.
METHODS
We searched four electronic databases for relevant studies. Data were extracted from the included studies after screening procedures. Using the random effect model, we calculated the pooled mean difference (MD) for our continuous outcomes and pooled proportions for categorical outcomes. The I test was used to detect heterogenicity. Randomized controlled trials (RCTs) were assessed for methodological quality using the Cochrane risk of bias assessment tool 2, while observational studies and single-arm studies were assessed using the National Institutes of Health's tools.
RESULTS
Our study comprised 21 studies; eighteen were eligible for analysis, with 1663 patients with chronic rhinitis. All of our assessed outcomes showed improvement with cryotherapy from their baseline status. Our pooled MDs for Total Nasal Symptom Score (rTNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and Nasal Obstruction Symptom Evaluation (NOSE) scores were as follows: ( - 3.58, 95% CI [ - 3.80, - 3.37], p < 0.001), ( - 1.48, 95% CI [ - 1.68, - 1.27], p < 0.001), and ( - 26.65, 95% CI [ - 33.98, - 19.31], p < 0.001), respectively. Regarding nasal obstruction and rhinorrhea, cryotherapy showed effectiveness in 61% and 52% of patients in the complete relief subgroup and 26% and 34% in the < 50%-relief subgroup, respectively.
CONCLUSION
We observed significant improvement in our measured outcomes as rTNSS, RQLQ, and NOSE scores compared to the baseline state, demonstrating the cryotherapy's efficacy. This improvement was consistent in all subsequent follow-up periods. However, we need more high-quality RCTs for stronger evidence to be generalized.
PubMed: 38844582
DOI: 10.1007/s00405-024-08754-2 -
Indian Journal of Otolaryngology and... Oct 2019Acquired nasopharyngeal stenosis after radiotherapy for NPC is rare. We report a case of bilateral choanal stenosis and nasopharygeal stenosis in patient treated with...
INTRODUCTION
Acquired nasopharyngeal stenosis after radiotherapy for NPC is rare. We report a case of bilateral choanal stenosis and nasopharygeal stenosis in patient treated with chemo radiotherapy for undifferentieted nasopharnygeal carcinoma.
CASE REPORT
A 68 years old man treated for undifferentiated nasopharyngeal carcinoma with chemo-radiotherapy 10 years before. He complained of complete nasal obstruction, rhinorrhea, anosmia, snoring and hearing loss. Clinical examination and imaging revealed bilateral choanal stenosis and nasopharyngeal stenosis. Patient underwent a transnasal endoscopic resection for scar tissue with stenting of posterior choanae. Restenosis was noted just after stent removal. Second endoscopic resection of stenosis was done, followed by application of mitomycin-C without stenting. Several months later, the patient has good airflow, a patent nasopharynx without reccurence of stenosis.
DISCUSSION
The use of topical mitomycin-C may prove useful in the treatment and prevention of subsequent restenosis and scar formation in larynx and tracheal. Mitomycin-C application has being shown useful in treating nasopharyngeal stenosis. It is safely used topically in various surgical sites without major side effect.
CONCLUSION
Nasopharyngeal stenosis is an unusual complication of radiotherapy that can be successfully treated with combine two modalities: surgical and mitomycin-C as an adjunct.
PubMed: 31741924
DOI: 10.1007/s12070-015-0954-0 -
International Forum of Allergy &... May 2017Management of frontal sinus trauma includes coronal or direct open approaches through skin incisions to either ablate or obliterate the frontal sinus for posterior table... (Clinical Trial)
Clinical Trial
BACKGROUND
Management of frontal sinus trauma includes coronal or direct open approaches through skin incisions to either ablate or obliterate the frontal sinus for posterior table fractures and openly reduce/internally fixate fractured anterior tables. The objective of this prospective case-series study was to evaluate outcomes of frontal sinus anterior and posterior table trauma using endoscopic techniques.
METHODS
Prospective evaluation of patients undergoing surgery for frontal sinus fractures was performed. Data were collected regarding demographics, etiology, technique, operative site, length involving the posterior table, size of skull base defects, complications, and clinical follow-up.
RESULTS
Forty-six patients (average age, 42 years) with frontal sinus fractures were treated using endoscopic techniques from 2008 to 2016. Mean follow-up was 26 (range, 0.5 to 79) months. Patients were treated primarily with a Draf IIb frontal sinusotomies. Draf III was used in 8 patients. Average fracture defect (length vs width) was 17.1 × 9.1 mm, and the average length involving the posterior table was 13.1 mm. Skull base defects were covered with either nasoseptal flaps or free tissue grafts. One individual required Draf IIb revision, but all sinuses were patent on final examination and all closed reductions of anterior table defects resulted in cosmetically acceptable outcomes.
CONCLUSION
Frontal sinus trauma has traditionally been treated using open approaches. Our findings show that endoscopic management should become part of the management algorithm for frontal sinus trauma, which challenges current surgical dogma regarding mandatory open approaches.
Topics: Adult; Endoscopy; Female; Frontal Sinus; Humans; Male; Nasal Surgical Procedures; Plastic Surgery Procedures; Skull Base; Skull Fractures; Surgical Flaps; Tomography, X-Ray Computed
PubMed: 28207197
DOI: 10.1002/alr.21897 -
ORL; Journal For Oto-rhino-laryngology... 2021The aim of this study was to investigate the efficacy of endoscopic selective vidian neurectomy in the treatment of severe persistent allergic rhinitis (AR) combined...
OBJECTIVE
The aim of this study was to investigate the efficacy of endoscopic selective vidian neurectomy in the treatment of severe persistent allergic rhinitis (AR) combined with chronic rhinosinusitis (CRS) with nasal polyps (ARwCRSwNP).
METHODS
One hundred thirty patients with moderate to severe persistent ARwCRSwNP were enrolled at Xuanwu Hospital, Capital Medical University, from September 2015 to September 2017. Patients were divided into 2 groups. Sixty-one patients (the control group) underwent conventional surgical treatment for CRS with nasal polyps and received conservative treatment for AR. Sixty-nine patients (the experimental group) received conventional surgical treatment for CRS with nasal polyps plus endoscopic selective vidian neurectomy with amputation of the posterior nasal nerve and pharyngeal branch of the vidian nerve. Clinical parameters, including visual analog scale (VAS) score, Lund-Kennedy endoscopic mucosal morphology score, and Lund-Mackay sinus computed tomography (CT) scan lesion range score, were used to analyze and evaluate the preoperative and postoperative data. Comparisons were based on patient scores, and preoperative and postoperative scores obtained at 6, 12, and 24 months were analyzed.
RESULTS
The experimental group had higher therapeutic efficacy in nasal obstruction, nasal itching, rhinorrhea, sneezing, and general symptoms than the control group (p < 0.05). No complications such as tear-secretion disorder or atrophic rhinitis occurred in the experimental group, and no significant difference in complications incidence was observed between the 2 groups (p > 0.05).
CONCLUSION
Endoscopic selective vidian neurectomy is an effective and safe technique for the management of moderate to severe persistent ARwCRSwNP.
Topics: Chronic Disease; Denervation; Endoscopy; Humans; Nasal Polyps; Rhinitis; Rhinitis, Allergic; Sinusitis; Treatment Outcome
PubMed: 33951673
DOI: 10.1159/000512083 -
American Journal of Otolaryngology 2024This systematic review and meta-analysis evaluates and compares the effects of two treatments that ablate the posterior nasal nerves for rhinitis-related symptoms:... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review and meta-analysis evaluates and compares the effects of two treatments that ablate the posterior nasal nerves for rhinitis-related symptoms: cryotherapy and radiofrequency neurolysis.
METHODS
We reviewed studies retrieved from PubMed, SCOPUS, Embase, the Web of Science and the Cochrane database up to June 2023. Papers reporting quality-of-life and rhinitis-related symptom scores before and after cryotherapy, and sham-controlled studies, were analyzed.
RESULTS
In total, 738 patients enrolled in 10 studies were evaluated. Both cryotherapy and radiofrequency neurolysis significantly improved rhinitis-related symptoms including congestion, itching, rhinorrhea, and sneezing, and quality of life during 12 months of follow-up. Radiofrequency neurolysis was significantly more effective than cryotherapy in terms of reducing total nasal symptom scores at up to 12 months postoperatively. In terms of individual symptoms, itching, rhinorrhea, and congestion were significantly alleviated or tended to be reduced more by radiofrequency neurolysis than by cryotherapy. The improvements in the minimal clinically important difference in total nasal symptom scores (1.0 point) after 3 months of cryotherapy and radiofrequency therapy were 81.8 % and 92.7 %, respectively.
CONCLUSIONS
Cryotherapy and radiofrequency neurolysis both improved rhinitis-symptom and quality-of-life scores. Especially, radiofrequency neurolysis showed the better effectiveness for improving the nasal symptoms related to the rhinitis than cryotherapy.
Topics: Humans; Quality of Life; Nasal Obstruction; Rhinitis; Ablation Techniques; Rhinorrhea; Pruritus
PubMed: 38039909
DOI: 10.1016/j.amjoto.2023.104130 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Mar 2021To investigate the relationship between the pneumatization degree of paranasal sinuses and skull base and the incidence of spontaneous cerebrospinal fluid rhinorrhea...
To investigate the relationship between the pneumatization degree of paranasal sinuses and skull base and the incidence of spontaneous cerebrospinal fluid rhinorrhea (SCSFR). Date of 107 patients with SCSFR were reviewed retrospectively. Using CT scans, investigator evaluated the pneumatization degree of paranasal sinuses and skull base, and compared classifications of various imaging characteristics between SCSFR group(case group) and nasal septum deviation group(control group), including frontal cells, Onodi cell, lateral recess of sphenoid sinus (LRSS), pneumatization of anterior clinoid process and pneumatization of posterior clinoid process. One hundred and eight fistulas are found among 107 cases. The most common site of the fistulas is found in ethmoid sinus (38.89%), followed by olfactory cleft(37.04%), sphenoid sinus (21.30%) and frontal sinus (2.77%).The incidence of Onodi cell was significantly different between case and control group(²=4.755, <0.05), and the classification of Onodi cell has a linear effect on the occurrence of SCSFR (=3.345, <0.05), which suggests the increasing level of Onodi cell can increase the probability in occurrence of SCSFR. The incidence of type Ⅲ LRSS in the case group is significantly higher than in the control group(²=18.725, <0.05),a linear correlation is found between the classification of LRSS and the incidence of SCSFR (=3.578, <0.05).There was no significant difference in the incidence of frontal cells between the two groups(²=0.672, >0.05), nor was there a linear relationship between the classification of frontal cells and the incidence of SCSFR (=0.503, >0.05). Pneumatization of anterior clinoid process and posterior clinoid process were no significant difference between case and control (>0.05),nor were there linear relationships between their classifications and SCSFR (>0.05). The most common site of SCSFR is ethmoid sinus, followed by olfactory cleft,the hyperpneumatization of the LRSS and Onodi cell are closely related to its pathogenesis.
Topics: Cerebrospinal Fluid Rhinorrhea; Humans; Paranasal Sinuses; Retrospective Studies; Rhinorrhea; Skull Base; Sphenoid Sinus
PubMed: 33794612
DOI: 10.13201/j.issn.2096-7993.2021.03.013 -
Archivos Argentinos de Pediatria Aug 2022Choanal atresia is characterized by obliteration of the posterior nasal opening. It is the most common congenital anomaly of the nasal passages. It has an incidence of 1...
Choanal atresia is characterized by obliteration of the posterior nasal opening. It is the most common congenital anomaly of the nasal passages. It has an incidence of 1 in 5000 to 7000 newborns; predominantly female. It can occur in isolation or in association with other syndromes such as CHARGE (coloboma [C], cardiac malformations [H], choanal atresia [A], psychomotor and/or growth retardation [R], genital hypoplasia [G], atrial malformations and/or deafness [E]. Clinically presents nasal obstruction, cyanosis and respiratory distress from birth when bilateral, unilateral atresias are characterized by nasal ventilatory insufficiency and unilateral rhinorrhea, which may go unnoticed. Diagnosis is made by endoscopy and imaging tests. Treatment is surgical, with different techniques and approaches. A 7-year-old male patient is presented with unilateral atresia of the right choana with microendoscopic resolution, placement of an external tutor, with good resolution.
Topics: Child; Choanal Atresia; Coloboma; Endoscopy; Female; Humans; Infant, Newborn; Male; Nasal Obstruction; Nasopharynx
PubMed: 35900957
DOI: 10.5546/aap.2022.e171 -
Neurology India 2021Hypnic headache (HH) is a rare primary headache syndrome first described by Raskin in 1988. (Review)
Review
CONTEXT
Hypnic headache (HH) is a rare primary headache syndrome first described by Raskin in 1988.
AIM
To describe the occurrence of HH in Indian patients and compare its clinicoepidemiological features to those published in the literature and attempt to trace some of the evolving concepts regarding its etiology and clinical features since it was first described.
MATERIALS AND METHODS
Patients attending the neurology outpatient department of a tertiary referral teaching hospital from 01-05-2011 to 30-04-2016 who were identified to have HH as per ICHD 3 beta criteria were included in the study. A meticulous history of the headache and comorbidities, clinical examination, Epworth Sleepiness Scale, blood counts, blood biochemistry, magnetic resonance imaging (MRI) scans of the brain and polysomnography (in selected patients) were done and the results were compared to selected international literature.
RESULTS
A total of 11 patients with HH were identified during the study period, of which 8 (72.72%) were males and 3 (27.27%) were females. The age of the patients varied from a minimum of 53 years to a maximum of 78 years (Mean: 63.36, SD: 8.09). The frequency of attacks per month ranged from 5 to 46(Mean: 20.36, SD: 11.67). The duration of each headache episode ranged from a minimum of 30 minutes to a maximum of 4 hours (Mean: 1.93, SD: 1.23). The occurrence of the headaches was maximum during the time periods of 0.00-2.00am and 2.00-4.00am (38% and 36%, respectively). The pain was dull in a majority of patients, 7 (63.63%). Trigeminal autonomic features such as lacrimation, ptosis, or rhinorrhea were not recorded from our cohort. Motor activity was noted in 7 (63.63%) cases. Two (18.18%) patients had associated migraine headaches whereas 3 (27.27%) had associated tension-type headaches. None of the patients in our series had chronic obstructive pulmonary disease. Four (36.36%) patients had systemic hypertension and 1 patient (9.09%) had diabetes mellitus. Two (18.18%) patients had symptoms of obstructive sleep apnea syndrome. Three (27.27%) patients had symptoms of excessive daytime sleepiness according to the Epworth Sleepiness Scale. Blood examinations and MRI were normal in all patients, except for the findings of a few lacunar infarcts and nonspecific T2 weighted hyperintensities in 3 patients (27.27%).
CONCLUSION
Our study proves the existence of the newly described primary headache syndrome called HH in the Indian population. On comparing our results with the international literature, the similarities are much greater than the differences. MRI voxel-based morphometry to demonstrate the loss of gray matter in the posterior hypothalamus may prove to be a reliable test to diagnose primary HH in the future.
Topics: Female; Headache; Headache Disorders, Primary; Humans; Male; Middle Aged; Migraine Disorders; Pain; Polysomnography
PubMed: 34747799
DOI: 10.4103/0028-3886.329541 -
World Neurosurgery Mar 2024Postoperative pseudomeningocele (PMC) and cerebrospinal fluid (CSF) leak are common complications following posterior fossa and posterolateral skull base surgeries. We...
Postoperative Cerebrospinal Fluid-Related Complications After Posterior Fossa and Posterolateral Skull Base Surgeries: Development of a Predictive Model and Clinical Risk Score.
BACKGROUND
Postoperative pseudomeningocele (PMC) and cerebrospinal fluid (CSF) leak are common complications following posterior fossa and posterolateral skull base surgeries. We sought to 1) determine the rate of CSF-related complications and 2) develop a perioperative model and risk score to identify the highest risk patients for these events.
METHODS
We performed a retrospective cohort of 450 patients undergoing posterior fossa and posterolateral skull base procedures from 2016 to 2020. Logistic regressions were performed for predictor selection for 3 prespecified models: 1) a priori variables, 2) predictors selected by large effect sizes, and 3) predictors with P ≤ 0.100 on univariable analysis. A final model was created by elimination of nonsignificant predictors, and the integer-based postoperative CSF-related complications (POCC) clinical risk score was derived. Internal validation was done using 10-fold cross-validation and bootstrapping with uniform shrinkage.
RESULTS
A total of 115 patients (25.6%) developed PMC and/or CSF leakage. Age >55 years (odds ratio [OR], 0.560; 95% confidence interval [CI], 0.328-0.954), body mass index >30 kg/m (OR, 1.88; 95% CI, 1.14-3.10), and postoperative CSF diversion (OR, 2.85; 95% CI, 1.64-5.00) were associated with CSF leak and PMC. Model 2 was the most predictive (cross-validated area under the receiver operating characteristic curve, 0.690). The final risk score was devised using age, body mass index class, dural repair technique, use of bone substitute, and duration of postoperative CSF diversion. The POCC score performed well (cross-validated area under the receiver operating characteristic curve, 0.761) and was highly specific (96.1%).
CONCLUSIONS
We created the first generalizable and predictive risk score to identify patients at risk of CSF-related complications. The POCC score could improve surveillance, inform doctor-patient discussions regarding the risks of surgery, and assist in perioperative management.
Topics: Humans; Middle Aged; Retrospective Studies; Cerebrospinal Fluid Leak; Skull Base; Cerebrospinal Fluid Rhinorrhea; Risk Factors; Postoperative Complications
PubMed: 38104934
DOI: 10.1016/j.wneu.2023.12.061