Abstract:
BACKGROUND:Spontaneous cerebrospinal fluid (CSF) leaks are largely attributed to idiopathic intracranial hypertension and typically present as skull base defects with or without prolapse of intracranial contents. However, in our practice, we have encountered a distinct type of spontaneous CSF leak that presents in a different manner. OBJECTIVE:To discuss a newly-classified, difficult to treat, subset of spontaneous CSF leaks that present as excavation of the bone of the skull base in a tunnel- or canal-like fashion by a meningocele or meningoencephalocele instead of as a localized area of bony dehiscence. METHODS:A retrospective review was performed at a tertiary care rhinology practice to identify a subset of CSF leak patients with an excavating/canal-like skull base defect visualized radiographically on computed tomography (CT) scan or magnetic resonance imaging and/or endoscopically in the operating room. RESULTS:The cohort of patients consisted of 7 females and 1 male with an average age of 53.6 years and a self-reported race of 4:3:1 African-American:Caucasian:Indian. All patients presented with CSF rhinorrhea. The most common leak site was the cribriform and upper septum. Six of the 8 patients had multiple defects and/or progression of their skull base defects, and 5 patients required multiple and/or repeat repairs in the operating room. Seven of the 8 patients underwent a cisternogram because the excavating nature of the leaks made it difficult to identify the specific leak site on high-resolution CT scan alone. CONCLUSION:In spontaneous CSF leaks that are difficult to identify or recur soon after a proper repair, an excavating pattern should be considered. Failure to recognize this type of leak and all of its tributaries, to fully unroof the excavated bone to completely resect the meningocele, and to visualize and close the site of origin will likely result in failure and recurrence of CSF leak.
journal_name
Am J Rhinol Allergyjournal_title
American journal of rhinology & allergyauthors
Loftus PA,Wise SK,Daraei P,Baugnon K,DelGaudio JMdoi
10.2500/ajra.2017.31.4413subject
Has Abstractpub_date
2017-03-01 00:00:00pages
127-134issue
2eissn
1945-8924issn
1945-8932journal_volume
31pub_type
杂志文章abstract:BACKGROUND:The histopathology and microbiology associated with silent sinus syndrome (SSS) have not been well described. OBJECTIVE:This study details the histopathological and microbiological characteristics in addition to radiographic findings of SSS in comparison to those of chronic maxillary sinusitis (CRS). METHO...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.1177/1945892421989161
更新日期:2021-01-19 00:00:00
abstract:BACKGROUND:The available olfactory evaluation tests are mainly subjective methods requiring patients' collaboration. If, for any reason, the patients refuse to honestly report what they perceive, the test reliability will be questionable; this condition is potentially observable in malingering patients because of thei...
journal_title:American journal of rhinology & allergy
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abstract:BACKGROUND:Epiphora has a significant impact on the patient's quality of life and is commonly caused by nasolacrimal duct obstruction. Dacryocystorhinostomy (DCR) has traditionally been performed via an external approach, which involves a skin incision. With the advent of endoscopes, the endonasal approach to DCR has g...
journal_title:American journal of rhinology & allergy
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abstract:PURPOSE:Activation of adenosine monophosphate-activated protein kinase (AMPK) by metformin, as a master regulator of metabolism, is involved in airway tissue remodeling. Here, we investigated the physical role of AMPK on cell migration, matrix contraction, and the production of matrix metalloproteinases (MMP) in nasal ...
journal_title:American journal of rhinology & allergy
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journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2015.29.4154
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Local allergic rhinitis (LAR) has been observed in patients without atopy. However, LAR is still underdiagnosed in patients with perennial or seasonal nasal symptoms. OBJECTIVE:The aim of this study was to determine the prevalence of LAR in young patients with a previous diagnosis of nonallergic rhinitis or...
journal_title:American journal of rhinology & allergy
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doi:10.2500/ajra.2016.30.4369
更新日期:2016-11-01 00:00:00
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journal_title:American journal of rhinology & allergy
pub_type: 杂志文章,meta分析
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abstract:BACKGROUND:This study was designed to determine if the addition of large-volume, low-positive pressure nasal irrigations delivered with isotonic sodium chloride (hereinafter "saline") added to intranasal corticosteroid therapy improves quality of life and objective measures of nasal breathing in patients with allergic ...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2014.28.4066
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to apply protein microarray technology to the study of sinonasal tissue and to identify differential protein expression in nasal polyps from aspirin-sensitive (AS) versus aspirin-tolerant (AT) patients with chronic rhinosinusitis (CRS) and CRS with nasal polyps (CRSwNPs). METHO...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2009.23.3314
更新日期:2009-05-01 00:00:00
abstract:BACKGROUND:The association between olfactory dysfunction (OD) and cognitive decline is becoming apparent in the emerging literature. However, the literature demonstrating a similar effect between gustatory dysfunction (GD) and cognition is not well established. OBJECTIVE:To determine whether OD and GD are independentl...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.1177/1945892418824451
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Patients report that nasal congestion is the most bothersome symptom of allergic rhinitis (AR). Recently, a short, patient-reported congestion screener questionnaire, the Congestion Quantifier Seven-Item Test (CQ7), was developed to identify a level of congestion that may warrant patients seeking evaluation ...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2010.24.3394
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:The clinical importance of serum squamous cell carcinoma antigen (SCCA) and SCCA subclasses has not been established for treating inverted papilloma (IP). The aim of this study was to clarify the clinical importance of serum SCCA and its subclasses in IP, compared with maxillary squamous cell carcinoma and ...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2012.26.3797
更新日期:2012-09-01 00:00:00
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journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.1177/1945892418815615
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Oxidative stress may play a role in the pathophysiology of several diseases including allergic rhinitis (AR). In children with AR an antioxidant enzyme paraoxonase (PON1) has not been previously investigated. The aim of this study was to investigate plasma PON1 activity and plasma total oxidant status (TOS)...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2013.27.3837
更新日期:2013-01-01 00:00:00
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journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
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更新日期:2016-05-01 00:00:00
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journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2010.24.3504
更新日期:2010-09-01 00:00:00
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journal_title:American journal of rhinology & allergy
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doi:10.1177/1945892418825094
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Nasal septal deviation (NSD) is a very common deformity. Because it may induce chronic upper airway obstruction in the nose, clinicians encounter some patients who have concerns about whether this can be a risk factor for general health. However, the influence of NSD on general health has rarely been studied...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2016.30.4277
更新日期:2016-03-01 00:00:00
abstract::Background The cribriform plate (CP) is a common site of spontaneous cerebrospinal fluid (SCSF) leaks. Radiographic assessment of the anterior and lateral skull base has shown thinner bone in patients with SCSFs; however, prior assessment of the CP has required postmortem cadaver dissection. Objective To develop novel...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.1177/1945892418768159
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Conclusive evidence exists that biofilms are present on the mucosa of chronic rhinosinusitis (CRS) patients. Less is known about the species constituting these biofilms. This study developed a fluorescence in situ hybridization (FISH) protocol for characterization of bacterial and fungal biofilms in CRS. ME...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2009.23.3413
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:A foreign body (FB) penetrating intracranially after passing transorbitally or transnasally is a rare occurrence. However, otolaryngologists are increasingly being asked to participate in the care of these patients for both endoscopic removal of the object and repair of any skull base defects. OBJECTIVE:To ...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章,评审
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更新日期:2017-03-01 00:00:00
abstract::Rhinitis is characterized by one or more of the following nasal symptoms: congestion, rhinorrhea (anterior and posterior), sneezing, and itching. It is classified as allergic or nonallergic, the latter being a diverse syndrome that is characterized by symptoms of rhinitis that are not the result of IgE-mediated events...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
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更新日期:2013-05-01 00:00:00
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journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2009.23.3375
更新日期:2009-11-01 00:00:00
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journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2016.30.4353
更新日期:2016-09-01 00:00:00
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journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2017.31.4453
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:The impact of middle turbinate resection (MTR) on olfaction remains a point of debate in the current literature. Few studies have objectively evaluated olfactory cleft airflow following MTR; thus, the mechanism by which MTR may impact olfaction is poorly understood. It is not known whether the postsurgical c...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.1177/1945892418816841
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:The aim of this study was to describe treatment results in patients with sinonasal inverted papilloma and to compare recent classification staging systems. METHODS:We performed a retrospective study of 79 patients with primary paranasal sinus inverted papilloma from 1978 to 2008. RESULTS:The median age at ...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
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更新日期:2010-01-01 00:00:00
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journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.1177/1945892418793540
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:Internal nasal valve collapse is a preventable complication of rhinoplasty, for which the spreader graft is the gold standard. More recently, the spreader flap technique has been espoused as an alternative to spreader grafting. Here, we evaluated the efficacy of this technique in a randomized trial setting. ...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章,随机对照试验
doi:10.2500/ajra.2014.28.3991
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:Assessing surgical competency in otolaryngology is challenging, and residency programs are now responsible for ensuring the surgical competency of their graduates. Therefore, more objective assessment tools are being incorporated into the evaluation process. Objective structured assessment of technical skill...
journal_title:American journal of rhinology & allergy
pub_type: 杂志文章
doi:10.2500/ajra.2014.28.4051
更新日期:2014-07-01 00:00:00