phenylephrine-hydrochloride and Meningitis

Endoscopic endonasal skull base surgery (ESBS) is a well-established management strategy for anterior cranial fossa (ACF) encephaloceles in adults. However, its application to the pediatric population has not been evaluated in large-scale studies. This study systematically reviews the safety of ESBS for pediatric ACF encephaloceles.. Articles reporting on pediatric patients undergoing purely ESBS for encephaloceles were reviewed from three databases (PubMed, Scopus, and Cochrane Library). Main outcomes were post-operative cerebrospinal fluid (CSF) leak and other surgical complications.. Twenty-three articles provided data on 110 eligible patients with a mean age of 4.3 years (range birth - 18 years). Intraoperative CSF leaks occurred in 18.5% of children while post-operative CSF leaks developed in 6.0% of cases. Rates of meningitis and hydrocephalus were each 3.7%. Other complications included alar collapse, nasal stenosis, transient diabetes insipidus, pneumonia, and neurologic injury, collectively occurring in 7.0% of cases. The rate of death was 4.8%. The average duration of follow-up was 25.3 months. Encephaloceles recurred in 5.2% of patients.. ESBS for pediatric ACF encephaloceles provides a relatively favorable risk-benefit profile, with a low rate of post-operative CSF leak, other surgical complications, and disease recurrence.

Topics: Adolescent; Cerebrospinal Fluid Leak; Child; Child, Preschool; Cranial Fossa, Anterior; Encephalocele; Endoscopy; Humans; Hydrocephalus; Infant; Infant, Newborn; Intraoperative Complications; Meningitis; Neurosurgical Procedures; Nose; Postoperative Complications; Recurrence

Endoscopic endonasal approaches to the skull base pathology have developed and evolved dramatically over the past 2 decades, particularly with collaboration between neurosurgery and otolaryngology physicians. These advances have increased significantly the use of such approaches beyond just resection of pituitary adenomas, including a variety of skull base pathologies. As the field has evolved, so has our understanding of the complications accompanying endoscopic skull base surgery, as well as techniques to both avoid and manage these complications. These are discussed here.

Topics: Anti-Bacterial Agents; Cerebrospinal Fluid Leak; Cranial Nerve Diseases; Endoscopy; Humans; Intraoperative Complications; Magnetic Resonance Imaging; Meningitis; Neurosurgical Procedures; Nose; Otolaryngology; Pituitary Neoplasms; Postoperative Complications; Professional Corporations; Skull Base; Tomography, X-Ray Computed

Endoscopic skull base surgery is becoming more popular as an approach to the anterior skull base for tumors and cerebrospinal fluid (CSF) fistulae. It offers the advantages of better cosmesis and improved quality of life after surgery. We reviewed the complication rates reported in the literature.. A literature search was performed in the electronic database Ovid MEDLINE (1950 to August 25, 2015) with the search item "([Anterior] AND Skull base surgery) AND endoscopic.". We identified 82 relevant studies that included 7460 cases. An average overall complication rate of 17.1% (range 0%-68.0%) and a mortality rate of 0.4% (0%-10.0%) were demonstrated in a total of 82 studies that included 7460 cases. The average CSF leak rate for all studies was 8.9% (0%-40.0%) with meningiomas and clival lesions having the greatest CSF leak rates. The most frequent benign pathology encountered was pituitary adenomas (n = 3720, 49.8% of all cases) and the most frequent malignant tumor was esthesioneuroblastoma (n = 120, 1.6% of all cases). Studies that included only CSF fistula repairs had a lower average total complication rate (12.9%) but a greater rate of meningitis compared with studies that reported mixed pathology (2.4% vs. 1.3%). A trend towards a lower total complication rate with increasing study size was observed.. The endoscopic approach is an increasingly accepted technique for anterior skull base tumor surgery and is associated with acceptable complication rates. Increasing experience with this technique can decrease rates of complications.

Topics: Adenoma; Cerebrospinal Fluid Leak; Esthesioneuroblastoma, Olfactory; Fistula; Humans; Meningeal Neoplasms; Meningioma; Meningitis; Mortality; Nasal Cavity; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Nose; Nose Neoplasms; Pituitary Neoplasms; Postoperative Complications; Skull Base; Skull Base Neoplasms

Postoperative cerebrospinal fluid (CSF) leak is one of the most common complications after endoscopic endonasal approach to the skull base.. To analyze the effect of leukocyte-rich and platelet-rich fibrin (L-PRF) as part of a standardized endonasal skull base repair protocol on postoperative infection and CSF leak rate.. One hundred three patients who underwent an endoscopic endonasal approach and were reconstructed using a standard technique (Group A) were compared with 139 patients using the same protocol with the addition of L-PRF (Group B). Postoperative intracranial infection and CSF leak at 6 months were analyzed.. In patients with intraoperative CSF leak, postoperative leak occurred in 10.8% in Group A and 2.6% in Group B ( P .024), and in patients with intraoperative high-flow leaks, the incidences were 11.7% and 3.1%, respectively ( P .048). L-PRF reduced postoperative CSF leak by 76% in cases with intraoperative CSF leak (relative risk 0.24, 95% CI 0.06-0.87) and by 73% of patients with high-flow leak (relative risk 0.27, 95% CI 0.07-0.99). In patients undergoing surgery for diagnoses other than adenomas, there were no cases of postoperative leak in Group B, whereas in Group A occurred in 13.4% of those with intraoperative leaks ( P .047) and 15.8% with high-flow intraoperative leaks ( P .033). No significant differences were found in patients with pituitary adenoma. Meningitis occurred in 0.97% in Group A vs 2.16% in Group B ( P .639), without differences between subgroups.. L-PRF reduced the rate of postoperative CSF leaks in patients with intraoperative leaks, without differences on postoperative meningitis.

Topics: Adenoma; Cerebrospinal Fluid Leak; Endoscopy; Humans; Meningitis; Nose; Platelet-Rich Fibrin; Postoperative Complications; Retrospective Studies; Skull Base

Endoscopic endonasal skull base surgery (EESBS) is a clean-contaminated procedure. Guidelines regarding the antibiotic prophylaxis in EESBS have not been developed yet, and today, there are no universally accepted protocols. In this article, we investigated the efficacy of our new ultra-short antibiotic prophylaxis protocol for EESBS guided by the cultural results of preoperative microbiological nasal swabs.. We defined as "nasal swab-related antibiotic protocol" the administration of a first-generation cephalosporin (cefazolin 2 g) in patients whose nasal swabs revealed the presence of normal nasal flora or methicillin-sensitive Staphylococcus aureus (MSSA), and the administration of vancomycin 1 g intravenously in patients whose nasal swabs revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA) or with reported cephalosporin/penicillin allergy. This case-control study included 120 patients who underwent EESBS. The case group included 60 cases who received the "nasal swab-related antibiotic protocol," while the control group included 60 cases who received the "standard hospital antibiotic protocol" used in neurosurgery (cefazolin 2 g plus metronidazole 500 mg at induction, and 2 g of cefazolin repeated after 180 min).. The preoperative microbiological nasal swabs showed normal nasal flora in 42 patients (70%), MSSA in 17 patients (28.3%), and MRSA in 1 patient (1.6%). During the study period, no cases of meningitis or sinusitis occurred in the case group ("nasal swab-related antibiotic protocol"), while two infections (3.3%, 1 sinusitis and 1 meningitis) were reported in the control group ("standard hospital antibiotic protocol"). Mean length of hospitalization was 6.5 days for the case group and 8.5 days in the control group. "Standard hospital antibiotic protocol" is less expensive (range, 2.88-5.42 euros) compared with our new "nasal swab-related antibiotic protocol" (range, 10.02-32.56 euros), but in line with other antibiotic prophylaxis protocols reported in literature.. The low complication rates of our case series (0%) is comparable to complication rates reported in literature (1.6% for meningitis and 8% for sinusitis). Compared with other perioperative antibiotic regimens reported in literature, the "nasal swab-related antibiotic protocol" is cheap and at least equally effective. We discuss the rationale on which we based the choice of chemoprophylaxis, the timing, and the length of our regimen.. Our study confirmed the safety and efficacy of our easily applicable and low-cost antibiotic prophylaxis protocol.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Case-Control Studies; Cefazolin; Endoscopy; Female; Humans; Male; Meningitis; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Neurosurgical Procedures; Nose; Preoperative Care; Sinusitis; Skull Base; Staphylococcal Infections; Vancomycin; Young Adult

We report a patient with hypertrophic pachymeningitis and symptomatic stenosis of the superior sagittal sinus. A 71-year-old man presented with right hemiparesis, sensory-dominant aphasia, and right hemispatial neglect that had been worsening over 2 weeks. Computed tomography showed isodense crescent-shaped lesions deforming the surface of the left cerebral hemisphere, mimicking a subdural hematoma with atypical perifocal edema in the left parietal lobe. Magnetic resonance imaging showed diffuse thickening of the dura mater with contrast enhancement of his left cerebral hemisphere. Histopathological examination of the dural specimen obtained by burr-hole surgery revealed mononuclear inflammatory cell infiltration, and he was diagnosed with hypertrophic pachymeningitis. Dynamic cerebral angiography showed superior sagittal sinus stenosis with reduced venous flow through the left parietal lobe. Administration of high-dose steroid therapy led to neurological improvement. In the case of a subdural mass with atypical parenchymal edema such as a chronic subdural hematoma, other etiology should be taken into consideration.

Topics: Aged; Humans; Hyperemia; Hypertrophy; Magnetic Resonance Imaging; Male; Meningitis; Multimodal Imaging; Nose; Tomography, X-Ray Computed

Spontaneous cerebrospinal fluid (CSF) fistulas are infrequent and only 10 cases in the literature have been located in the clivus. We describe two new cases of CSF fistulas in this site and review the literature.. The first patient was a 52-year-old woman referred to our centre for intermittent rhinorrhea that had been diagnosed after an episode of meningitis. The second case was a 69-year-old man who was visited for rhinorrhea of one-year duration; he also developed meningitis during the preoperative study. In both cases, the spontaneous CSF fistula was diagnosed by beta-2-transferrin testing, CT scan and MRI. We performed an endonasal endoscopic transsphenoidal approach and used free grafts and vascularized flaps to close the clival defect. Treatment was successful in both cases.. The physiopathology of spontaneous CSF fistulas remains unknown. Possible explanations given to date in this location are pulsatility of the basilar artery, repeated Valsalva maneuvers and Marfan's disease, the two latter also related to CSF fistulas in other locations. Closure of a CSF leak towards the nasal cavity is mandatory due to potential complications. Our results support the endoscopic transsphenoidal approach using free grafts and/or pediculated flaps as a good alternative to open surgery.

Topics: Aged; Cerebrospinal Fluid Leak; Cerebrospinal Fluid Rhinorrhea; Cranial Fossa, Posterior; Female; Fistula; Humans; Magnetic Resonance Imaging; Male; Meningitis; Middle Aged; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Nose; Surgical Flaps; Tomography, X-Ray Computed; Treatment Outcome

Meningocele and meningoencephalocele of the lateral wall of the sphenoidal sinus (LWSS) are rare lesions, crossing the borders of multiple disciplines such as ear-nose-throat, maxillofacial, and neurologic surgery. We reviewed our surgical experience to analyze the role of the endoscopic endonasal approach and consider these pathologies from different perspectives.. All consecutive cases of meningocele and meningoencephalocele of LWSS operated through an endoscopic endonasal approach from 1998 to 2015 in our institutions were collected. Medical history, focusing on previous episodes of cerebrospinal fluid leak, meningitis or seizures, was considered. The outcome was assessed considering the medical condition and the postoperative neuroimaging.. The series includes 23 patients (7 male, 16 female). Mean age was 52 years (26-73 years). Eleven cases were meningoencephaloceles and 12 meningoceles. A clear cerebrospinal fluid leak occurred on in 19 patients and was associated with meningitis in 3. Two were presenting a history of epilepsy. No complications were observed, but 1 case presented seizures on waking. At follow-up (mean 84 months, 4-167) each patient is in good clinical condition with no further episodes of leaking or seizures.. Endoscopic endonasal surgery is a safe and effective approach for meningocele and meningoencephalocele of LWSS; it allows resection of herniated tissue and repair of the osteodural defect. The favorable clinical outcome and the possible effectiveness on seizures lead us to support this approach as first minimally invasive treatment also in presence of epilepsy, as a first low risk epilepsy surgical procedure.

Topics: Adult; Aged; Cerebrospinal Fluid Rhinorrhea; Encephalocele; Epilepsy; Female; Headache; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Meningitis; Meningocele; Middle Aged; Neuroendoscopy; Nose; Retrospective Studies; Sphenoid Sinus; Tomography, X-Ray Computed

We report the first case of a transnasal penetrating intracranial injury in Hong Kong by a chopstick. A 49-year-old man attempted suicide by inserting a wooden chopstick into his left nose and then pulled it out. The chopstick caused a transnasal penetrating brain injury, confirmed by contrast magnetic resonance imaging of the brain. He was managed conservatively. Later he developed meningitis without a brain abscess and was prescribed antibiotics for 6 weeks. He enjoyed a good neurological recovery. This case illustrates that clinician should have a high index of suspicion for penetrating intracranial injury due to a nasally inserted foreign body, even though it had already been removed. In such cases moreover, brain magnetic resonance imaging is the imaging modality of choice, as it can delineate the path of penetration far better than plain computed tomography.

Topics: Brain Abscess; Brain Injuries; Cooking and Eating Utensils; Foreign Bodies; Humans; Magnetic Resonance Imaging; Male; Meningitis; Middle Aged; Nose; Wounds, Penetrating

The authors report a case of a recurrent pediatric ventral pontine ependymoma that they resected through an endonasal endoscopic transclival approach. Regarding the options for a surgical approach to ventral pontine tumors, traditional far-lateral approaches are associated with considerable morbidity due to the required muscle mobilization, brain retraction, and in-line obstruction of cranial nerves before reaching the target. The endoscopic endonasal transclival approach was made appealing by eliminating all of these concerns. The patient's fully pneumatized sphenoid sinus, laterally displaced basilar artery, and the direct ventral location of the bulky disease all further supported this unconventional choice of surgical corridor to achieve a palliative brainstem decompression of an incurable recurrence.

Topics: Adolescent; Basilar Artery; Brain Stem; Brain Stem Neoplasms; Cranial Fossa, Posterior; Decompression, Surgical; Ependymoma; Fatal Outcome; Gram-Negative Bacterial Infections; Humans; Male; Meningitis; Neoplasm Recurrence, Local; Neuroendoscopy; Neurosurgical Procedures; Nose; Palliative Care; Reoperation; Sphenoid Sinus

The removal of hypophyseal tumor by transsphenoidal pituitary surgery using microsurgical instruments was first performed over 100 years ago. Operating techniques for this surgery are constantly being renewed, first by using a microscope and later on with the use of an endoscop. The authors provide an overview of the minimal invasive posterior transseptal-transsphenoidal aproach with the combined utilization of classical techniques with the assistance of the endoscop.. Sixty-one patients (33 female, 28 male, 21-84 yrs) were treated for sellar region tumor resection using an endonasal transsphenoidal aproach with the help of an endoscope. Follow ups were performed within 2-21 months.. Total tumor resection was successful in 91.8%, and partial resection in 8.2% of the patients. The rate of complications using the endoscopic method was not higher compared to that of the classical microscopic method. There was no major bleeding in any of the cases. Adverse events such as minor epistaxis occurred in 4.9%, transitional diabetes insipidus in 6.5%, inraoperative CSF leak in 16.67%, postoperative CSF leak in 11.5% and meningitis in 8.2% of the patients. After the operation the pathological hormonal production stoped in all patients except in two patients who were acromegalic. However their GH level normalized and they did not require further treatment, the IGF-1 still remained high.. The success of the surgical treatment is based on both, the proficient pre- and postoperative endocrinological care, and the minimal invasive surgical technique. The endoscope was used partially or continuously during the operation for better visualization of the operation field in multiple angles (30 degrees, 45 degrees). It was useful in differentiating between normal and tumorous glandular tissue, and also offered an enhanced view of the intrasellar (via hydroscopy) and parasellar region. Moreover the endoscopic method is able to decrease the operating time, reduce blood loss. In different stages of the surgery, depending on the anatomical and pathological situation, switching back and forth from microscope to endoscope technique, gives us the benefit of a clearer view in each situation.

Topics: Adult; Aged; Aged, 80 and over; Cerebrospinal Fluid Rhinorrhea; Diabetes Insipidus; Epistaxis; Female; Humans; Learning Curve; Male; Meningitis; Middle Aged; Neuroendoscopes; Neuroendoscopy; Nose; Pituitary Gland, Posterior; Pituitary Neoplasms; Sphenoid Sinus

Endonasal endoscopic skull base surgery (ESBS) is perceived as having a high risk of infection because it is performed through the sinuses, which are not sterile.. To identify the bacteriological characteristics, incidence, mortality, and risk factors for intracranial infection after ESBS.. A retrospective analysis of the first 1,000 ESBS procedures performed at the University of Pittsburgh Medical Center from 1998 to 2008.. In 18 cases (1.8%), the patient developed meningitis. In 2 cases, the patient died within 2 months after surgery, of noninfectious causes. In 11 cases, cerebrospinal fluid (CSF) cultures had positive results. There were no predominant pathogens. Male sex (odds ratio [OR], 3.97 [95% confidence interval {CI}, 1.21-13.03]; P = .02), history of a craniotomy or endonasal surgery (OR, 4.77 [95% CI, 1.68-13.56]; P = .02), surgery with higher levels of complexity (OR, 6.60 [95% CI, 1.77-24.70]; P = .003), the presence of an external ventricular drain or ventriculoperitoneal shunt at the time of surgery (OR, 6.38 [95% CI, 1.07-38.09]; P = .005), and postoperative CSF leak (OR, 12.99 [95% CI, 4.24-39.82]; P < .001) were risk factors for infection.. The incidence of infection of 1.8% in ESBS is comparable to that in open craniotomy. The most important risk factor was a postoperative CSF leak. All patients recovered from their infection.

Topics: Adolescent; Adult; Aged; Brain Abscess; Confidence Intervals; Cross Infection; Endoscopy; Female; Humans; Male; Meningitis; Middle Aged; Nose; Pennsylvania; Postoperative Complications; Retrospective Studies; Risk Factors; Skull Base

The annual risk of meningitis in unrepaired fistulas is widely quoted to be approximately 10% per annum. Our aim was to review our experience with cerebrospinal fluid (CSF) leaks and to calculate the overall risk and the annual incidence of meningitis, and to correlate our findings with the causation and the effect of operative intervention in a subgroup of patients who had a history of meningitis.. We prospectively collected data on all patients referred with a CSF leak to our tertiary referral center over a 12-year period between 1994 and 2006. We had a follow-up rate of 91%.. One hundred eleven patients had a proven leak on endoscopy, beta-2 transferrin, imaging, and/or fluorescein lumbar puncture. The accumulated duration of an active CSF leak in the cohort was 190 years. The total number of episodes of meningitis was 57 in 21 patients, giving an overall risk of developing meningitis of 19%, with an overall incidence of 0.3 episodes per year. There was a progressive reduction in the incidence of meningitis with time, and most episodes occurred within the first year following the onset of the CSF leak. However, the risk persisted as long as the CSF leak was active.. The overall risk of meningitis in patients with persistent CSF rhinorrhea was 19%. The annual incidence of meningitis was 0.3 episodes per year, with most episodes occurring within the first year following the onset of the leak. Endoscopic closure is the treatment of choice in most CSF leaks; if successful, it reduces the risk of meningitis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cerebrospinal Fluid Rhinorrhea; Child; Child, Preschool; Endoscopy; Female; Follow-Up Studies; Humans; Incidence; Male; Meningitis; Middle Aged; Nose; Prognosis; Prospective Studies; Risk Factors

Topics: Brain; Humans; Intubation, Gastrointestinal; Male; Meningitis; Methods; Middle Aged; Nose; Pituitary Neoplasms; Pneumocephalus; Reoperation; Sphenoid Sinus

A 63-year-old diabetic man presented with sinusitis with orbital and intracranial signs progressing over one week, due to zygomycosis. Despite control of the diabetes, surgical excision of infected tissue and antifungal therapy he died in the fifth week of illness. Pathological study showed extensive fungal infiltration of periorbital structures and mycotic thrombosis of many blood vessels with associated necrosis and infarction of fat and extraocular muscles.

Topics: Diabetes Mellitus, Type 2; Fungi; Humans; Lymphadenitis; Male; Meningitis; Middle Aged; Mycoses; Nose; Nose Diseases; Orbit; Orbital Diseases

Two patients presented with repeated bouts of meningitis. RISA cisternography established the diagnosis in both cases. An intranasal meningoencephalocele was the cause of these infections. Frontal craniotomy and section of the peduncular connection of the meningoencephalocele and sealing of the bony defect was successfully performed in both cases. Postoperative investigations showed complete cure.

Topics: Child; Cisterna Magna; Encephalocele; Humans; Male; Meningitis; Meningocele; Nose; Recurrence; Serum Albumin, Radio-Iodinated

Topics: Child; Female; Fistula; Humans; Meningitis; Nose

Traumatic cerebrospinal fluid fistulas in children are not rare as described by Harwood-Nash and Caldicott, North, and Simpson. Those involving the sphenoid bone apparently are rare, particularly in early childhood.

Topics: Cerebrospinal Fluid Rhinorrhea; Child, Preschool; Female; Humans; Meningitis; Myelography; Nasopharynx; Nose; Sphenoid Bone; Trigeminal Nerve

Topics: Adolescent; Adult; Age Factors; Anti-Bacterial Agents; Australia; Bacterial Infections; Cerebrospinal Fluid; Child; Child, Preschool; Disease Outbreaks; Echovirus Infections; Enterovirus B, Human; Feces; Female; Humans; Infant; Male; Meningitis; Meningitis, Viral; Neutralization Tests; Nose; Pharynx; Rectum; Spinal Puncture

Topics: Acinetobacter; Blood; Child, Preschool; Colistin; Drug Resistance, Microbial; Female; Humans; Kanamycin; Meningitis; Neomycin; Nitrofurantoin; Nose; Polymyxins; Skin; Sputum; Streptomycin; Tetracycline; Urine

Topics: Adult; Cerebrospinal Fluid Rhinorrhea; Female; Humans; Male; Meningitis; Nose; Skull Fractures

Topics: Cerebrospinal Fluid Rhinorrhea; Congenital Abnormalities; Craniocerebral Trauma; Diagnosis; Ethmoid Bone; Humans; Meningeal Neoplasms; Meningioma; Meningitis; Nose; Pneumocephalus; Radiography; Skull Fractures; Wounds, Gunshot

Topics: Adolescent; Cerebrospinal Fluid Rhinorrhea; Craniocerebral Trauma; Humans; Meningitis; Nose

Topics: Chloramphenicol; Drug Therapy; Meningitis; Methicillin; Nose; Nose Deformities, Acquired; Paralysis; Penicillins; Rhinoplasty; Seizures; Staphylococcal Infections; Streptomycin; Surgical Wound Infection

Topics: Adenoidectomy; Cholesteatoma; Diagnosis, Differential; Epistaxis; Foreign Bodies; Hearing Disorders; Humans; Meningitis; Nose; Otitis; Pharyngitis; Tonsillectomy; Tonsillitis

Topics: Craniotomy; Encephalocele; Humans; Meningitis; Meningitis, Pneumococcal; Neurosurgery; Neurosurgical Procedures; Nose; Postoperative Complications

Topics: Drug Resistance; Drug Resistance, Microbial; Erythromycin; Humans; Injections; Meningitis; Meningitis, Pneumococcal; Nose; Postoperative Complications; Spinal Canal; Streptococcus pneumoniae

Topics: Cerebrospinal Fluid Rhinorrhea; Humans; Meningitis; Nose; Skull; Synostosis

Topics: Humans; Meningitis; Nasal Polyps; Nasal Surgical Procedures; Nose; Polyps

Topics: Cerebrospinal Fluid; Ear, Middle; Humans; Meningitis; Nose

Topics: Humans; Meningitis; Nose; Polyps

Topics: Cerebrospinal Fluid; Meningitis; Nasopharyngitis; Nose; Penicillins