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Objective:There are no UK guidelines for the use of antibiotics and/or immunisations in patients with an active anterior skull base cerebrospinal fluid leak. This study aimed to define current UK practice in this area and inform appropriate guidelines for ENT surgeons.Method:A web-based survey of all members of the British Rhinological Society was carried out and the literature in this area was reviewed.Results:Of those who responded to the survey, 14 per cent routinely give prophylactic antibiotics to patients with cerebrospinal fluid leaks, and 34.9 per cent recommend immunisation against at least one organism, most commonly Streptococcus pneumoniae (86.7 per cent).Conclusion:There is no evidence to support the use of antibiotic prophylaxis in patients with a cerebrospinal fluid leak. We propose that all such patients are advised to seek immunisation against pneumococcus, meningococcus and haemophilus. [ABSTRACT FROM PUBLISHER]

Background:Unless the orbital contents are supported, the insertion of nasal packing material during endoscopic endonasal surgery may cause serious intracranial complications such as cerebrospinal fluid leakage.Methods:Case report and literature review.Results:We report a patient with iatrogenic cerebrospinal fluid rhinorrhoea caused by intracranial entry of a Silastic sheet inserted into the nasal cavity. This skull defect and the surrounding skull base were successfully reconstructed in a multilayer fashion via an endoscopic endonasal approach.Conclusion:This case highlights the need for caution when inserting nasal packing material. During endoscopic endonasal reduction of blowout fractures, great care must be taken to support the orbital contents, in order to avoid serious intracranial complications such as cerebrospinal fluid leakage. [ABSTRACT FROM PUBLISHER]

Introduction:Intracranial complications are recognised as rare, but serious, sequelae of endoscopic sinus surgery.Case report:A 56-year-old woman was referred after developing meningitis following elective functional endoscopic sinus surgery. Computed tomography demonstrated a significant defect of the skull base in the right posterior ethmoid, clearly visible on both coronal and sagittal sections. Operative exploration demonstrated the skull base to be intact in the posterior ethmoid area identified on the scan, and the overlying mucosa appeared undisturbed. Scans were reviewed in the light of operative findings; coronal and sagittal images were found to be reconstructions. Directly acquired coronal computed tomography, undertaken three weeks after surgery, demonstrated a complete bony plate in the right posterior ethmoid at the site previously identified as dehiscent.Discussion and conclusion:We speculate that the posterior ethmoid defect was actually an artefact of reconstruction. We cannot exclude the alternative possibility of remineralisation, but given the time frame this seems unlikely. This case highlights the need for caution when interpreting reconstructed images of the thin bony plates of the skull base and lamina papyracea, as regards both clinical significance and medicolegal reporting. While virtual defects have been reported in the superior semicircular canals as a result of reconstructed images, we believe this to be the first reported case demonstrating a similar problem in the anterior skull base. [ABSTRACT FROM PUBLISHER]

Background:Bilateral, spontaneous cerebrospinal fluid rhinorrhoea is extremely rare, with only one previous case report (this patient developed contralateral cerebrospinal fluid leakage four years after successful endoscopic repair). We present the first English-language report of simultaneous, bilateral, spontaneous cerebrospinal fluid rhinorrhoea.Objective:To recommend a simple alternative endoscopic technique for simultaneous closure of bilateral, spontaneous cerebrospinal fluid rhinorrhoea.Case report:A 47-year-old woman presented with recent onset of bilateral, spontaneous cerebrospinal fluid rhinorrhoea, a recent history suggestive of meningitis, and a past history of pneumococcal meningitis. Bony defects on both sides of the cribriform plate were closed endoscopically in the same anaesthetic session, via a uninasal, trans-septal approach, enabling both leakage sites to be sealed simultaneously.Conclusion:In cases of bilateral, spontaneous cerebrospinal fluid rhinorrhoea, uninasal, trans-septal endoscopic repair is a simple and effective technique for simultaneous closure of cerebrospinal fluid leakage. [ABSTRACT FROM PUBLISHER]

Objective: To present our experience in managing cerebrospinal fluid rhinorrhoea using the cartilage inlay (underlay) technique to repair skull base defects larger than 4 mm. Study design: Retrospective study involving patients presenting with cerebrospinal fluid rhinorrhoea between 1994 and 2008. Setting: Patients were treated in a tertiary referral centre for nose and sinus diseases. Patients' medical records were reviewed and analysed. Results: A total of 62 patients were operated upon using a cartilage inlay technique to repair bony skull base defects ranging in size from 4 to 20 mm (widest diameter). Of these 62 patients, 16 constituted revisions of earlier procedures undertaken elsewhere. The success rate of the technique was 100 per cent. Patient follow up ranged from six months to 16 years, with a median follow up of 15 months. Three patients had minor post-operative sinus infections; no serious complications were encountered. Conclusion: Extradural cartilage inlay appears to be an effective technique in the management of cerebrospinal fluid rhinorrhoea, especially for large defects and revision procedures. To our knowledge, the described patients represent the largest reported series of cerebrospinal fluid rhinorrhoea cases managed using the cartilage inlay technique. We believe that the crucial factors in our high success rate for cerebrospinal fluid fistula repair are: precise identification of the bony defect; meticulous preparation of the graft bed; careful elevation of the dura; judicious use of just enough graft tissue; and adequate graft support. [ABSTRACT FROM AUTHOR]

Objective:The majority of spontaneous cerebrospinal fluid leaks occur at the anterior skull base; few cases at the temporal bone have been described. There have been no previous reports of synchronous leaks at the anterior skull base and temporal bone in the same patient.Methods:Case report and brief review of management of spontaneous cerebrospinal fluid leaks in the nose and ear.Case report:A 34-year-old, pregnant woman presented with watery nasal discharge and unilateral middle-ear effusion. The nasal and ear secretions both proved to be cerebrospinal fluid. Radiological imaging showed defects in both the ethmoid roof and the mastoid roof (middle cranial fossa). These defects were surgically closed using duraplasties.Conclusion:A literature review indicated that this is the first reported case of synchronous spontaneous cerebrospinal fluid leaks via the anterior skull base and temporal bone. [ABSTRACT FROM PUBLISHER]

Introduction:Foreign bodies in the transnasal ethmoido-sphenoidal sinus are uncommon. We present a case of unilateral rhinorrhoea caused by a foreign body which had been lodged in the ethmoido-sphenoidal sinus for 38 years.Case report:A 40-year-old woman presented with unilateral rhinorrhoea. Computed tomography showed a foreign body located in the right ethmoido-sphenoidal sinus, with a defect of the lamina papyracea and the ethmoid roof. The endonasal approach did not permit extraction of the foreign body. A combined approach allowed the extraction of a pen cap, and the defect of the ethmoid roof was rebuilt.Conclusion:Despite its limitations, the endonasal approach remains the treatment of first choice for osteo-meningeal defects, because of its minimal invasiveness and high success rate. However, in the presented case a combined approach was needed. [ABSTRACT FROM PUBLISHER]

Objective:We report a case of traumatic cerebrospinal fluid rhinorrhoea following nasal packing with a Rapid Rhino inflatable balloon pack, as treatment for epistaxis.Method:Case report and review of the literature regarding this complication.Results:A thorough literature search was performed using PubMed. To our best knowledge, there have been no previous reports of cerebrospinal fluid rhinorrhoea following nasal packing. In our case, cerebrospinal fluid leakage occurred due to fracture of the middle turbinate at its superior skull base insertion. The cerebrospinal fluid leak resolved spontaneously without the need for surgical intervention.Conclusion:This case report highlights not only the need for an appreciation of sinonasal anatomy and the potential risks associated with nasal packing, but also the need for adequate training in the use of commercially available nasal packs by medical practitioners attending patients with epistaxis. [ABSTRACT FROM PUBLISHER]

Objective:Cerebrospinal fluid leakage is the most common complication of endoscopic trans-sphenoidal pituitary surgery. However, there is no uniformly accepted way of managing this complication when it occurs intra-operatively. This paper describes a quick, simple technique, involving layered fibrin glue and gelatin sponge, which does not compromise post-operative patient follow up.Method:Retrospective review of all endoscopic pituitary surgery cases conducted at a single institution since the introduction of this technique in 2002.Results:A total of 120 endoscopic pituitary operations were performed (96 primary procedures and 24 revisions). All intra-operative cerebrospinal fluid leaks were managed using the described method, with a failure rate of 3.6 per cent. The overall post-operative leakage rate was 1.7 per cent.Conclusion:This simple, conservative technique avoids the need for further dissection and the use of non-absorbable foreign material, and has a low incidence of post-operative cerebrospinal fluid leakage. [ABSTRACT FROM PUBLISHER]

The article discusses various reports published within the issue, including one by Cheong and Hussain on the use of antibiotics in pediatric recurrent acute otitis media, one by Savage et al. on the use of antiplatelet drugs in elective ear, nose and throat surgery and one by D. G. Lee et al. on cerebrospinal fluid rhinorrhea.