• Korean Journal of Bronchoesophagology
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• v.3 no.1
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• pp.169-173
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• 1997

Cerebrospinal fluid (CSF) rhinorrhea usually occurs as a result of trauma including operation. Unheated CSF rhinorrhea may induce major morbidity such as meningitis and brain abscess, etc. This paper presents a review of four cases of traumatic CSF rhinorrhea Sites of CSF leakage were easily found out by intrathecal fluorescent dye injection. Surgery was performed by external ethmoidectomy approach and dural tear and bone defect was repaired with abdominal fat and free mucosal graft taken from amputated middle turbinates. We conclude that repair using free fat and mucosal graft via external ethmoidectomy approach could be accepted as the intial method of CSF rhinorrhea management.

• Journal of Korean Neurosurgical Society
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• v.42 no.5
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• pp.403-405
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• 2007

Most posttraumatic cerebrospinal fluid (CSF) leakage is noticed by the patients with the first symptom, rhinorrhea. A 38-year-old woman presented with frequent clear continuous rhinorrhea and otorrhea for 5 years after basilar skull fracture. After this, meningitis was developed with subsequent CSF fistula. Her clinical symptom was improved by medical treatment. The dural defect and CSF leakage were not detected by computerized tomography (CT) cistemography. We report a rare case of persistent posttraumatic CSF fistula that continued for five years.

• Archives of Plastic Surgery
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• v.45 no.4
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• pp.379-383
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• 2018

Septoplasty/septorhinoplasty is a common ear, nose and throat procedure offered for those patients with deviated septum who are suffering from nasal obstruction and functional or cosmetic problems. Although it is a basic and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks. We describe two different cases of traumatic CSF leaks following septoplasty/septorhinoplasty at two different sites. The first patient suffered a CSF leak following septoplasty and presented to Alexandria University Hospital. The leak was still active at presentation and identified as coming from a defect in the roof of the sphenoid sinus and was repaired surgically. The second patient presented 4 days after her cosmetic septorhinoplasty with a CSF leak and significant pneumocephalus. She was managed conservatively. Understanding the anatomical variations of the paranasal sinuses and implementing proper surgical techniques are crucial in preventing intracranial complications when performing either septoplasty or septorhinoplasty. A good quality computed tomography of the nose and paranasal sinuses is a valuable investigation to avoid major complications especially CSF leaks following either procedure.

• Journal of Korean Neurosurgical Society
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• v.29 no.9
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• pp.1204-1208
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• 2000

Objectives : At the closure of the transsphenoidal approach(TSA), the proper sellar floor reconstruction plays an important role in preventing postoperative complications. The septal cartilage, perpendicular plate of nasal septum, and the sphenoid sinus bone are usually used to repair the sellar floor as a bone splint. The authors evaluate the usefulness of a silicone plate as a substitute for bone splint to close a defect of the sellar floor. Materials and Methods : A silicone plate was used to repair the sellar floor in 7 patients with sellar lesions which included four pituitary adenomas, two Rathke's cleft cysts and one metastatic tumor. Among seven cases, five cases underwent a standard TSAs and two received a extended TSAs. The trajectories of the approach were sublabial in four cases and endonasal routes in three cases. The silicone plate for implantation was cut to a size of slightly larger than that of bone window and inserted with a three-pronged fork, and then adjusted precisely. Results : In six patients, there were no complications which related to sellar floor reconstruction. A postoperative cerebrospinal fluid(CSF) rhinorrhea was observed in one patient with pituitary macroadenoma. Conclusions : From the authors' experience, the advantages of the silicone plate are its simplicity of molding to fit any size of sellar floor defects, and easy detection of previously created bone window at reoperation.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.355-359
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• 2009

Objective : The definition of empty sella syndrome is 'an anatomical entity in which the pituitary fossa is partially or completely filled with cerebrospinal fluid, while the pituitary gland is compressed against the posterior rim of the fossa'. Reports of this entities relating to the brain tumors not situated in the pituitary fossa, have rarely been reported. Methods : In order to analyze the incidence and relationship of empty sella in patients having brain tumors, the authors reviewed preoperative magnetic resonance imaging (MRI) of 72 patients with brain tumor regardless of pathology except the pituitary tumors. The patients were operated in single institute by one surgeon. There were 25 males and 47 females and mean patient age was 53 years old (range from 5 years to 84 years). Tumor volume was ranged from 2 cc to 238 cc. Results : The overall incidence of empty sella was positive in 57/72 cases (79.2%). Sorted by the pathology, empty sella was highest in meningioma (88.9%, p=0.042). The empty sella was correlated with patient's increasing age (p=0.003) and increasing tumor volume (p=0.016). Conclusion : Careful review of brain MRI with periodic follow up is necessary for the detection of secondary empty sella in patients with brain tumors. In patients with confirmed empty sella, follow up is mandatory for the management of hypopituitarism, cerebrospinal fluid (CSF) rhinorrhea, visual disturbance and increased intracranial pressure.