scholarly journals Trans-nasal endoscopic repair of cerebrospinal fluid rhinorrhoea: a retrospective analysis

2018 ◽  
Vol 4 (6) ◽  
pp. 1372
Author(s):  
Amardeep Singh ◽  
Navneet Kumar ◽  
Sarvpreet Singh Grewal
Keyword(s):  
Surgical Outcomes ◽  
Tertiary Care ◽  
Middle Turbinate ◽  
Csf Leak ◽  
Graft Material ◽  
Care Hospital ◽  
Hospital Data ◽  
Endoscopic Repair ◽  
Csf Rhinorrhoea ◽  
Rate Of Success

<p class="abstract"><strong>Background:</strong> The purpose of present study was to assess the management and surgical outcomes of trans-nasal endoscopic repair of CSF rhinorrhoea.</p><p class="abstract"><strong>Methods:</strong> A retrospective study was conducted on the basis of medical records of 8 patients (6 males and 2 females) who had undergone trans-nasal endoscopic reconstructive surgery for CSF leak in a tertiary care hospital. Data so collected was analyzed to determine the demographic and diagnostic factors with surgical outcomes. Rate of success achieved was also assessed.  </p><p class="abstract"><strong>Results:</strong> Majority of patients were in the age group of 21-40 years with mean age of 28.50 years. Main cause of leak was trauma (75%) and most common site of defect was found to be the cribriform plate of ethmoid bone (75%). 38% patients suffered from recurrent episodes of meningitis. Repair of dehiscence was done by variety of graft material like fat, fascia, middle turbinate mucosa, septal bone, cartilage or mucosa and fibrin glue. Success rate of 100% was observed. No post-surgical complications were encountered in this series.</p><p><strong>Conclusions:</strong> Trans-nasal endoscopic surgical technique is an effective and atraumatic procedure for repair of CSF rhinorrhoea with minimum morbidity and low post-operative complications. </p>

scholarly journals A retrospective study to analyze treatment of post traumatic cerebro spinal fluid rhinorrhea and role of trans cranial pedicled pericranial repair in present day context

2022 ◽  
Vol 7 (4) ◽  
pp. 111-118
Author(s):  
Shashivadhanan ◽  
Abhishek Mishra
Keyword(s):  
Retrospective Study ◽  
Skull Base ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Spinal Fluid ◽  
Csf Leak ◽  
Care Hospital ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Post Traumatic

: Skull base fractures are a major cause of morbidity and mortality in head injury. Anterior cranial Fossa (ACF) skull base fracture, leading to Cerebro Spinal Fluid (CSF) Rhinorrhea is one of the most commonly encountered presentation in ACF base fractures. The key to successful management of such cases lies in early diagnosis and surgical management before it leads to meningitis and avoidable mortality.To evaluate the cases of post traumatic CSF rhinorrhea and analyze the parameters utilized to guide the management strategies. An attempt was made to come up with guidelines for its management in a tertiary care hospital.This was a retrospective study in which all cases of traumatic CSF Rhinorrhea admitted to Tertiary care hospital were included. Patients were divided into three groups. First group was conservatively managed in which the rhinorrhea and serial imaging findings showed favourable response.In thesecond group patients were subjected to endoscopic repair by the ENT surgeon based on anatomical considerations. The third group included patients who were had failed the trial of conservative management and the site of leak did not favor endoscopic repair.The outcomes in all these groups were analyzed and conclusions drawn.A total of 54 patients were included in the study which was conducted between Jan 2014 to 2020. 24 were successfully managed conservatively,10 were managed with endoscopic repair and 20 were managed by bifrontal craniotomy and pedicled pericranial ACF Base repair. There was one case from the first group who developed CSF leak after one month necessitating ACF base repair. There was no recurrence reportedin the cases managed endoscopically, whereas one case subjected to craniotomy had recurrence requiring lumbar drain placement. With each transcranial surgery there was a refinement in the technique further minimizing complications. We have elaborated on the surgical nuances to ensurebetter outcomes. : Pedicledpericranial flap ACF base repair is an elegant approach which requires an understanding of the mechanism of CSF leak from skull base fractures. This procedure can easily be mastered and when performed correctly provides best results for cases where there are multiple ACF defects, those not accessible by endoscope and also in those cases where imaging is not able to localize the exact site of defect leading to CSF rhinorrhea. Anosmia is an in evitable complication of this procedure. However, the trade off between mortality resulting from meningitis versus anosmia makes it a viable and attractive treatment option.

scholarly journals A OBSERVATIONAL STUDY OF ENDOSCOPIC REPAIR OF CSF RHINORRHOEA

2020 ◽  
pp. 74-76
Author(s):  
Bijoy Krishna Bhadra ◽  
Soumen Biswas ◽  
Debarshi Jana
Keyword(s):  
Success Rate ◽  
Middle Turbinate ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Radiological Investigation ◽  
Nasal Endoscope ◽  
Primary Surgery ◽  
Second Surgery ◽  
Csf Rhinorrhoea ◽  
Graft Success

Background: Intrathecal fluorescein may be used to visualize CSF fistulas using a nasal endoscope. This allows the examiner to directly visualize the size of the defect, its location, and its rate of flow. The first repair of CSF leak was performed by Dandy in 1926 using a frontal craniotomy. This technique had a 60-80% success rate and was the gold standard for decades. In 1964Vrabec and Hallberg described the endonasal approach of CSF leak repair. AIMS: This study aims to establish the success rate of endoscopic surgical repair of CSF rhinorrhoca. MATERIALS AND METHODS: The study was conducted in Department of ENT IPGMER and SSKM Hospital. During the study period of 18 months, 30 patients have been admitted in our department with CSF leak (most of them were referred from neurosurgery). RESULTS: Fat and fascia lata and temporalis fascia were used to repair CSF leak in 24 patients. Bath plug technique was applied for 3 patients. Repair with vascularised flap such as Hadad flap or middle turbinate graft were used in case of 3 patients. CSF rhinorrhoea repair was successful in 28 out of 30(94%) patients after primary surgery whereas recurrence occurred in 2(6%) cases. Among them 1 patient underwent second surgery which achieved definitive closure of the leak. But one case lost follow up and did not come for second surgery. Interval between surgery and recurrence was varied and so were the causes. CONCLUSION: CSF rhinorrhoea cases can be repaired by an endoscopic approach with a high success rate. Radiological investigation of PNS and brain are equally important for selection of cases for endoscopic repair. Spontaneous leak must be checked cautiously to exclude features of raised ICT. Relapse occurs mainly for failure to delineate actual site or sites of leak and inadequate size or faulty placement of graft. Success depends not only on surgical skill but also on baseline intracranial tension, cause & site of leak and postoperative care.

scholarly journals Endoscopic Repair of Spontaneous CSF Rhinorrhoea: Results from 21 Cases

2020 ◽  
Vol 28 (1) ◽  
pp. 71-75
Author(s):  
Swapan Kumar Ghosh ◽  
Indranath Kundu ◽  
Mukesh Kumar Singh ◽  
Rajarshi Chakraborty ◽  
Suyash Banerjee
Keyword(s):  
Tertiary Care ◽  
Treatment Strategies ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Endoscopic Endonasal ◽  
Prospective Longitudinal Study ◽  
Tertiary Care Institution ◽  
Csf Rhinorrhoea ◽  
Skull Base Defect ◽  
Prospective Longitudinal

Introduction Surgery to close the skull base defect is the treatment of choice in persistent spontaneous cerebrospinal fluid rhinorrhoea with endoscopic endonasal repair being the method of choice.  This study analysed the demographics of presentation, optimal diagnostic and localisation strategies and the effectiveness of transnasal endoscopic treatment strategies  with post-operative follow-up of CSF rhinorrhoea patients in a tertiary care institution   . Materials and Methods  A prospective longitudinal study was conducted on 21 CSF rhinorrhoea patients operated on between August 2014 and August 2018 and results documented. Results CSF rhinorrhoea was found most commonly in middle aged female patients in our study. HRCT PNS was capable of identifying a leak site in 66% of the cases. All patients were operated endoscopically with no major intra-operative or post-operative complications. Resolution of CSF leak occurred in 85% of cases. Conclusion CSF rhinorrhoea can be diagnosed and endoscopic repair can be effectively performed in our existing tertiary care set-ups with good results.

Spinal Surgery During COVID-19 Pandemic in Saudi Arabia

2021 ◽  
pp. 12
Author(s):  
Faisal Konbaz ◽  
Taif Alqahtani ◽  
Nada Alharthi ◽  
Mohammad Baraja ◽  
Nazish Masud ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Tertiary Care ◽  
Case Series ◽  
Medical Intervention ◽  
Care Hospital ◽  
Hospital Data ◽  
Chi Square ◽  
Chi Square Test ◽  
The Mean ◽  
American Society

Introduction: The COVID-19 pandemic has challenged the healthcare system’s capacities around the world. Due to the alarming situation, medical activities have been restricted to allocate resources to treat COVID-19-infected patients. However, medical emergencies still need urgent medical intervention. Considering the lack of reliable data regarding spinal surgeries during the COVID-19 pandemic, the present study sought to analyze the pattern of spinal surgeries in KSA. Methodology: A case series of patients who had urgent spine surgeries during COVID-19 pandemic was conducted in a tertiary care hospital. Data on patients’ demographics, COVID-19 test result, American Society of Anesthesia Score, SSS grade, diagnosis, and data related to surgery and postoperative findings were collected. All collected data were then processed and analyzed. Surgical outcomes based on source of admission were compared using Chi-square test. Result: A total of 63 patients who underwent spine surgery during the COVID-19 pandemic were included. The mean age of the patients was 53 ± 18 years and males were predominant (59%). The positive COVID-19 patients were 3%. Almost half of the patients were classified into ASA II. The majority were categorized into grade B (65%) according to SSS. The frequently diagnosed condition was fracture (33%), followed by spinal stenosis (18%) and metastatic (10%), while the most mentioned location was lumbar (61%). Postoperative complications were found in 11% of the patients. The readmission rate within 30 days, unplanned return to OR and ICU admission were 19%, 13%, and 11%, respectively. While the mean duration between admission and surgery was 8 ± 20 days, the mean duration of length of stay was 20 ± 29 days. Further, a significant association was seen between the admission source and the surgical procedure performed and surgical indication. Conclusion: It has been demonstrated that the surgical intervention was only provided to patients requiring immediate or urgent spinal management. However, the length of hospitalization and duration between hospital admission and surgery was substantially prolonged. Further studies are warranted to determine the factors leading to prolonged hospitalization and time between hospital admission and surgery.

scholarly journals Immediate Outcomes of Traumatic Brain Injury at a Tertiary Care Hospital Of Pakistan- A Retrospective Study

2020 ◽  
Author(s):  
Maria Khan ◽  
Uzair Yaqoob ◽  
Zair Hassan ◽  
Muhammad Muizz Uddin
Keyword(s):  
Traumatic Brain Injury ◽  
Retrospective Study ◽  
Brain Injury ◽  
Tertiary Care ◽  
Epidemiological Data ◽  
Initial Assessment ◽  
Care Hospital ◽  
Hospital Data ◽  
Epidemiological Characteristics ◽  
The Impact

Abstract Background: Traumatic Brain Injury (TBI) which is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective of the study is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This retrospective study was conducted at the Lady Reading Hospital. Data were extracted from the medical record room from January 1st to December 31st, 2019. The severity of TBI was based on Glasgow Coma Scale (GCS) and was divided into mild (GCS 13-15), moderate (GCS 9-12), and severe TBI (GCS <8) based on the GCS. SPSS v.23 was used for data analysis. Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively conclusive picture of epidemiological data on the burden of TBI in Pakistan. Although a large proportion of patients had a mild TBI, they may likely be under-diagnosed. This warrants for further investigation of MTBI in population-based studies across the globe.

Factors associated with choice of delivery with or without epidural analgesia among laboring women: a cross-sectional survey at a tertiary care hospital of a developing country

2016 ◽  
Vol 44 (7) ◽  
Author(s):  
Samina Ismail ◽  
Shemila Abbasi ◽  
Sobia Khan ◽  
Abdul Monem ◽  
Gauhar Afshan
Keyword(s):  
Epidural Analgesia ◽  
Health Care Providers ◽  
Tertiary Care ◽  
Care Hospital ◽  
Care Providers ◽  
Sources Of Information ◽  
Hospital Data ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Natural Birth

AbstractAims:The aim of this study was to evaluate the factors responsible for epidural analgesia (EA) refusal among parturient patients.Methods:In this prospective cross-sectional study of six months, we included all consenting postpartum patients having a non-operative delivery in the obstetric unit of our hospital. Data were collected on a predesigned questionnaire and included information such as parity, education, reasons for delivering with or without EA, source of information and patient satisfaction. Knowledge regarding EA was assessed from patients delivering without EA.Results:From 933 patients enrolled, 730 (78.2%) delivered without EA, and 203 (21.7%) with EA. Only 11 (1.5%) patients refused EA for the reason of having natural birth process. Otherwise common reasons were misconceptions (65.9%) and lack of awareness about EA (20.5%); 70.5% had no knowledge of common side effects of EA. Among patients delivering with EA, 92.6% were offered EA by health care providers and had obstetricians and anesthesiologists as their sources of information.Conclusions:Patients in developing countries are laboring without EA, even in centers where there is a provision for it. The main reasons for not availing themselves of EA are lack of awareness and knowledge and misconceptions, rather than the desire to have un-medicated natural birth.

Perioperative outcomes in human immunodeficiency virus-infected patients – the PRO HIV study

2018 ◽  
Vol 29 (10) ◽  
pp. 968-973 ◽  
Author(s):  
Divyashree Shanthamurthy ◽  
Abi Manesh ◽  
Naveena GP Zacchaeus ◽  
Lisa R Roy ◽  
Priscilla Rupali
Keyword(s):  
Surgical Procedures ◽  
Median Duration ◽  
Surgical Outcomes ◽  
Surgical Outcome ◽  
Tertiary Care ◽  
Perioperative Outcomes ◽  
Care Hospital ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Cd4 Cell

It is estimated that a quarter of patients with HIV/AIDS undergo at least one surgical procedure in their life time. Surgical outcomes in these patients from developing countries are poorly characterized and surgeons are often concerned about poor surgical outcomes, especially when their CD4 cell counts are less than 200 cells/µl. This study evaluated the surgical outcomes of HIV-infected patients undergoing various surgical procedures over a six-year period in a large tertiary care hospital from South India. Two hundred and ninety-three patients underwent 374 surgical procedures during the study period. The median duration of HIV prior to surgery was 1.9 years (range 0–18.8 years). Two-thirds (58%) were on highly active antiretroviral therapy (HAART) at the time of surgery with the median duration of this treatment being 38 months (n = 194). About one-third (35%) of surgical procedures were performed as an emergency. Abdomino-pelvic surgeries were the most common (225, 60%). Adverse surgical outcome defined as death or post-operative infection was seen in 25 (6.6%). The post-operative infection rate was 5% (20/374). The most common of these was surgical site infection observed in nine (60%) followed by pneumonia in five patients (33%) and urinary tract infection in one patient. Day 30 mortality was 2% (n = 8) and a quarter of these were reported to be related to post-operative infectious complications. On multivariate analysis, only preoperative haemoglobin of less than 10 g/dl was significantly associated with a poor surgical outcome. HIV-related parameters such as CD4 cell counts, duration of HIV infection and HAART regimen did not seem to contribute towards an adverse surgical outcome.

Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: Learning from Our Failures

2001 ◽  
Vol 15 (5) ◽  
pp. 333-342 ◽  
Author(s):  
Paolo Castelnuovo ◽  
Silvia Mauri ◽  
Davide Locatelli ◽  
Enzo Emanuelli ◽  
Giovanni Delù ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Csf Leak ◽  
Graft Material ◽  
Literature Analysis ◽  
Endoscopic Repair ◽  
Common Procedure ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea

Endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea is becoming a common procedure. The purpose of this study was to perform a literature analysis centering cases of treatment failure and to review our 31 cases with a 1-year minimum follow-up. An extensive search of the literature was conducted, which focused on success rate, follow-up, diagnostic techniques, graft material used, failure rate, and comments on failures. A retrospective analysis of our 31 patients was carried out, and all cases were treated with the endoscopic approach with a 1-year minimum follow-up. From the literature analysis, the median success rate at the first endoscopic attempt is 90%. Our success rate was 87.1%. Failures were analyzed. A unique protocol for CSF leak diagnosis does not exist; we suggest our diagnostic algorithm. Graft material used depends on the authors’ experience, and based on this review of cases to date, did not significantly influence the success rate. The analysis of cases of failure shows that the majority of authors omit details. More research is needed to improve prevention of failures.

scholarly journals Endothelial corneal transplants: indications, clinical profile and surgical outcomes in a tertiary care hospital

2020 ◽  
Vol 76 (2) ◽  
pp. 166-171
Author(s):  
Vijay Kumar Sharma ◽  
Santosh Kumar ◽  
Sagarika Patyal ◽  
Hemant S. Trehan ◽  
Arun Kumar Yadav ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Profile ◽  
Care Hospital ◽  
Corneal Transplants

Prevalence of Sudden Speechlessness in Critical Care Units

2011 ◽  
Vol 20 (4) ◽  
pp. 439-447 ◽  
Author(s):  
Loris A. Thomas ◽  
Carmen S. Rodriguez
Keyword(s):  
Critical Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Hospital Data ◽  
Care Environment ◽  
Critical Care Units ◽  
Clinical Diagnoses ◽  
Unit Characteristic

Sudden speechlessness (SS) is commonly experienced by patients admitted to critical care units. Although literature findings document challenges associated with periods of SS, the prevalence is unknown. The purpose of this study is to determine the prevalence and characteristics of adult SS patients in four critical care units at a university-affiliated tertiary care hospital. Data are collected on 9 randomly selected days over a 4-month period. The daily prevalence of SS ranges from 16% to 24% in each unit. Characteristic data collected includes patient age, gender, medical diagnosis related to SS episode, type of speechlessness, days since SS began, and communication strategies in use. Respiratory intubation related to various clinical diagnoses is the main cause for SS. Use of multiple specific strategies to convey needs during SS periods are identified. Follow-up studies to further define the prevalence of SS in settings beyond the critical care environment are recommended.

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