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At least 487 records · Page 27Linked to original sources
PubMed2004

The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery.

OBJECTIVE: To review the incidence of cerebrospinal fluid leak after vestibular schwannoma removal reported in the literature. DATA SOURCES: MEDLINE and PubMed literature search using the terms "acoustic neuroma" or "vestibular schwannoma," and "cerebrospinal fluid leak" or "cerebrospinal fluid fistula" covering the period from 1985 to the present in the English language literature. A review of bibliographies of these studies was also performed. STUDY SELECTION: Criteria for inclusion in this meta-analysis consisted of the availability of extractable data from studies presenting a defined group of patients who had undergone primary vestibular schwannoma removal and for whom the presence and absence of cerebrospinal fluid leakage was reported. Studies reporting combined approaches were excluded. No duplications of patient populations were included. Twenty-five studies met the inclusion criteria. DATA EXTRACTION: Quality of the studies was determined by the design of each study and the ability to combine the data with the results of other studies. All of the studies were biased by their retrospective, nonrandomized nature. DATA SYNTHESIS: Significance (p < 0.05) was determined using the chi2 test. CONCLUSIONS: Cerebrospinal fluid leak occurred in 10.6% of 2,273 retrosigmoid surgeries, 9.5% of 3,118 translabyrinthine surgeries, and 10.6% of 573 middle fossa surgeries. The type of cerebrospinal fluid leak was not associated with surgical approach. Meningitis was significantly associated with cerebrospinal fluid leak (p < 0.05). Age and tumor size were not associated with cerebrospinal fluid leak.

Cerebrospinal Fluid Otorrhea↗
PubMed1986

[A study on penetration of mezlocillin into the cerebrospinal fluid].

The concentration of antibiotics in cerebrospinal fluid is of great interest in therapeutics, especially for the treatment of the central nervous system. We studied the penetration of mezlocillin (MZPC) in 3 cases with V-P shunt and 7 cases after neurosurgical operation. After intravenous injection of 4 g MZPC in the 3 cases with V-P shunt, a peak concentration (0.26-3.6 micrograms/ml) of MZPC in the cerebrospinal fluid was reached in 2-4 hours. In the 7 cases after neurosurgical operation, cerebrospinal fluid was sampled at 4 hours after the intravenous injection of 4 g MZPC by spinal tap. Concentrations of MZPC in cerebrospinal fluid ranged from 1.1 to 17.5 micrograms/ml. The mean maximum concentration of MZPC was 5.85 micrograms/ml, which exceeded 90% MIC (minimal inhibitory concentration) against S. epidermidis, E. faecalis, H. influenzae. It is concluded MZPC can be useful for the prophylaxis of meningitis.

Adolescent↗
PubMed1976

Examination of the cerebrospinal fluid in syphilis.

In the diagnosis of neurosyphilis, a cerebrospinal fluid cell count or cerebrospinal fluid total protein are inconclusive by themselves, but together with a cerebrospinal fluid VDRL are of great diagnostic value. At present, the VDRL Slide Test on Spinal Fluid remains the serologic test of choice for the diagnosis of neurosyphilis. The significance and specificity of treponemal tests on spinal fluid remain to be established. Like all other laboratory tests, cerebrospinal fluid findings may be variable and an absolute diagnosis of neurosyphilis should not be made on the result of any one laboratory test alone, but should be viewed in light of all laboratory evidence, including serum serologic tests, and clinical findings.

Cell Count↗
PubMed1983

Neoplastic meningitis. Marked variations of cerebrospinal fluid composition in the absence of extradural block.

Cerebrospinal fluid levels of protein, glucose, and malignant cells may differ markedly at different levels of the neuraxis in patients with neoplastic meningitis, even in the absence of an extradural blockage to cerebrospinal fluid flow. The pathogenesis of these differences is unclear, but is probably related to focal disruption of the blood-cerebrospinal fluid barrier produced by neoplastic involvement of the meninges. The clinical implications of this new observation are important. When the diagnosis of neoplastic meningitis is strongly suspected, but malignant cells cannot be demonstrated by repeated examination of lumbar cerebrospinal fluid, samples should be obtained by cisternal tap if the neurologic deficits are manifestations from involvement of the cranial nerves or cerebrum. Similarly, response to intrathecal chemotherapy should be monitored with serial examinations of cerebrospinal fluid obtained from the site of most marked pretreatment abnormality.

Adult↗
PubMed1998

Age dependency of resistance to cerebrospinal fluid outflow.

OBJECT: Resistance to cerebrospinal fluid (CSF) outflow (Rout)is an important parameter in assessing the need for CSF shunt placement in patients with hydrocephalus. The normal lower limit of Rout has been estimated on the basis of the clinical effect of shunt placement in patients with varying values of Rout and in young healthy volunteers. The lack of clinical effect from CSF shunts in some elderly patients, despite elevated Rout,suggests that the normal value of Rout increases with age and may be higher in elderly persons. The aim of the present study was to examine the relationship between Rout and age in patients without known CSF dynamic disturbances. METHOD: Fifty-two patients ranging from 20 to 88 years of age and with no known CSF dynamic disorders were examined. The Rout was measured using a lumbar computerized infusion test. The correlation between Rout and age was analyzed by performing linear regression. The Rout increased significantly with patient age. The Rout in a patient in the eighth decade will be approximately 5 mm Hg/ml/minute higher than in a young patient. CONCLUSIONS: The present study shows a small but critical increase in Rout with increased patient age. A notable residual variation was present and borderline values of Rout should be regarded and used with caution.

Adult↗
PubMed1995

Evaluation and management of spontaneous temporal bone cerebrospinal fluid leaks.

Spontaneous temporal bone cerebrospinal fluid leak may be defined as a leak without an apparent precipitating cause. These transdural fistulas occur rarely, and diagnosis is predicated upon a high index of suspicion. Leaks have been reported through both middle and posterior fossa defects, although the vast majority involve the middle fossa plate. In a previous study we reported 7 cases of spontaneous temporal bone cerebrospinal fluid leaks, all involving the middle fossa tegmen. Upon further review of these cases and 5 previously unreported cases, the defect was localized to the tegmen tympani in 9 of the total 12 cases. Diagnostic methods are discussed, with the importance of high-resolution computed tomography stressed. The role of contrast cisternography is also evaluated. An outline for surgical management is presented based upon residual hearing and defect location and accessibility. A transmastoid procedure offers the advantage of visualization of both the middle and posterior fossa plates, and this approach can be supplemented with an obliterative procedure when indicated. The middle fossa approach provides optimal exposure of the tegmen plate with less likelihood of ossicular injury when dealing with tegmen tympani defects. Adjuncts to surgical therapy include intrathecal fluorescein dye and continuous postoperative lumbar cerebrospinal fluid drainage.

Journal Article↗
PubMed1997

Tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-6 concentrations in cerebrospinal fluid predict ventriculoperitoneal shunt infection.

OBJECTIVE: To determine the diagnostic value of cerebrospinal fluid tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, and IL-6 released into the cerebrospinal fluid of patients with ventriculoperitoneal shunt infection. DESIGN: Prospective, observational study. SETTING: University teaching hospital. PATIENTS: Sixty-four patients requiring cerebrospinal fluid aspiration for suspected ventriculoperitoneal shunt malfunction. INTERVENTIONS: Cerebrospinal fluid samples were obtained by shunt aspiration at the time of patient presentation. MEASUREMENTS AND MAIN RESULTS: TNF-alpha and IL-1 beta concentrations were measured by enzyme-linked immunosorbent assay, and IL-6 activity by bioassay. The sensitivity, specificity, predictive values, and overall efficiency for each cytokine were determined based on the cerebrospinal fluid culture results. Ten patients had positive cerebrospinal fluid cultures, eight of which yielded Staphylococcus species, and one each Acinetobacter and Pseudomonas. Cerebrospinal fluid TNF-alpha, IL-1 beta, IL-6, protein, and leukocyte concentrations were significantly increased in patients with shunt infection. Cerebrospinal fluid IL-6 activity had the highest diagnostic accuracy of the cytokines evaluated, with sensitivity of 80% and specificity of 98%. CONCLUSIONS: The presence of cerebrospinal fluid inflammatory cytokines strongly suggests ventriculoperitoneal shunt infection. Detection of these cytokines in the cerebrospinal fluid could be used for earlier diagnosis of bacterial infection.

Adolescent↗
PubMed1994

Is a low cerebrospinal fluid blood glucose ratio indicative of infection in patients with post haemorrhagic hydrocephalus?

Cerebrospinal fluid glucose and cerebrospinal fluid:blood glucose ratios were compared in seven patients with post haemorrhagic hydrocephalus having lumbar puncture/ventricular tap as a therapeutic measure. A control group of 10 babies was used, without intraventricular haemorrhage, and having lumbar puncture as part of a septic screen. Of 50 separate taps in the patient group, 38% had blood glucose measured and 76% had CSF glucose measured. Median cerebrospinal fluid glucose was 1.2 mmol (range, 0.4-2.5 mmol/l) in the patient group and 3.1 mmol/l (range, 1.4-10.3 mmol/l) in the control group. The median cerebrospinal fluid:blood glucose ratio in the patient group was 0.235 (range, 0.07-0.53) and in the control group was 0.709 (range, 0.6-1.4). Hypoglycorrhachia appears to be a normal finding in patients with post haemorrhagic hydrocephalus and does not indicate infection in these infants. Measurement of cerebrospinal fluid:blood glucose ratio is not warranted when cerebrospinal fluid is drained purely as a therapeutic measure in these patients.

Blood Glucose↗
PubMed1985

The relationship of beta-endorphin and ACTH in the cerebrospinal fluid and plasma of adult surgical patients.

Cerebrospinal fluid and plasma beta-endorphin/beta-lipotropin immunoreactivity and adrenocorticotropin hormone were determined in simultaneously obtained samples from 25 healthy, adult surgical patients about to undergo spinal anesthesia using radioimmunoassay techniques. Cerebrospinal fluid adrenocorticotropin concentrations were significantly higher than those in plasma (25.76 +/- 2.11 fm/ml vs. 8.83 +/- 0.84 fm/ml), whereas beta-endorphin/beta-lipotropin concentrations in cerebrospinal fluid were significantly lower than those in plasma (6.60 +/- 0.43 fm/ml vs. 3.35 +/- 0.30 fm/ml). In cerebrospinal fluid, a significant positive correlation was found between beta-endorphin/beta-lipotropin and adrenocorticotropin (r = 0.64, p less than 0.01), whereas no such relationship could be demonstrated in plasma. This suggests that beta-endorphin/beta-lipotropin and adrenocorticotropin might enter the cerebrospinal fluid via a mechanism unrelated to their entry into plasma. This may have implications for the pharmacologic manipulation of these peptides within the central nervous system.

Adrenocorticotropic Hormone↗
PubMed1991

Effect of intracranial pressure on cerebrospinal fluid formation in isolated brain ventricles.

The effect of intracranial pressure on cerebrospinal fluid formation has been studied in cats by ventricular perfusion with the aqueduct of Sylvius blocked (isolated ventricular perfusion). It has been found that intracranial pressure has a considerable effect on the rate of cerebrospinal fluid formation, while increases in pressure cause a significant and prolonged decrease in cerebrospinal fluid formation. The effect was observed in animals whether they were initially perfused under lower or under higher intracranial pressure. Cerebrospinal fluid absorption has been studied under the above conditions and it has been noted that the ventricles are capable of significant cerebrospinal fluid absorption, since in isolated ventricles cerebrospinal fluid formation and absorption were in balance at physiological intracranial pressure. In addition, cerebrospinal fluid formation rate within the isolated brain ventricles has been compared with the formation rate in the whole cerebrospinal fluid system. Since only about 30% of the total cerebrospinal fluid formation was observed by isolated ventricular perfusion, it seems that the brain ventricles are not the exclusive site of cerebrospinal fluid formation.

Animals↗
PubMed1982

Relationship between prolactin in the serum and cerebrospinal fluid of ovariectomized female rhesus monkeys.

The entry of prolactin into the cerebrospinal fluid from the blood, and the relation between levels in the two compartments were studied under a variety of conditions in ovariectomized rhesus monkeys. Prolonged treatment with either domperidone or sulpiride, both dopamine-receptor blockers, elevated prolactin levels in serum and cerebrospinal fluid proportionally equally, so that the cerebrospinal fluid serum ratio was unchanged from controls (circa 12-20%). Gel filtration showed that only 'little' (monomeric) prolactin entered the cerebrospinal fluid in such monkeys. Following acute elevations of blood prolactin after a single injection of either sulpiride or ovine prolactin, cerebrospinal fluid levels increased linearly over a 90 min sampling period, despite falling serum levels. The rate of entry of prolactin into the cerebrospinal fluid was similar after either procedure, and was independent of absolute serum or cerebrospinal fluid levels, suggesting a rate-limiting mechanism. Furthermore, retrograde portal blood flow from the pituitary is not necessary to account for these results. Clearance of prolactin from the third ventricle was studied following intraventricular injection of prolactin. Prolactin was removed from the cerebrospinal fluid by a mechanism whose efficiency compares with that in serum, so that the half-life of prolactin in either compartment is about the same. Measurement of sodium, potassium and calcium in the cerebrospinal fluid during prolonged hyperprolactinaemia showed no change, indicating that the central effects of prolactin are not due to alteration of these electrolytes. These results show that cerebrospinal fluid levels of prolactin, and hence, those surrounding the brain, can be inferred accurately from those in the blood, and suggest that there may be a selective mechanism regulating the entry of prolactin into the cerebral compartment.

Animals↗
PubMed2001

Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage.

OBJECTIVES: To evaluate the effect of controlled lumbar cerebrospinal fluid drainage in adult patients with refractory intracranial hypertension. DESIGN: Prospective, pre- vs. postintervention study. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: Twenty-three patients with severe traumatic brain injury or delayed ischemia after subarachnoid hemorrhage with intracranial hypertension refractory to aggressive treatment, including repeated applications of tromethamine, hypertonic saline solution, barbiturate coma, and decompressive craniectomy. Patients were considered for controlled lumbar cerebrospinal fluid drainage if basal cisterns on computerized tomography scan were discernible. INTERVENTIONS: After institution of a lumbar drain, cerebrospinal fluid was gradually aspirated, and then, continuous cerebrospinal fluid drainage was maintained under control of intracranial pressure (ICP) and pupillary status. MEASUREMENTS AND MAIN RESULTS: ICP and cerebral perfusion pressure before and after initiation of lumbar cerebrospinal fluid drainage and related complications were documented. The neurologic outcome of the patients was assessed according to the Glasgow Outcome Scale 6 months after injury. As a result of lumbar cerebrospinal fluid drainage, all patients demonstrated an immediate and lasting decrease of ICP and a concomitant increase of cerebral perfusion pressure. Two patients temporarily showed a unilateral fixed and dilated pupil 6 and 8 hrs after onset of lumbar cerebrospinal fluid drainage, respectively. Ten patients showed a favorable outcome, four patients survived with a severe permanent neurologic deficit, one patient remained in a persistent vegetative state, and eight patients died. CONCLUSIONS: Controlled lumbar cerebrospinal fluid drainage significantly reduces refractory intracranial hypertension. The danger of transtentorial or tonsillar herniation is minimized by considering lumbar drainage in the presence of discernible basilar cisterns only.

Adolescent↗