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CSF Rhinorrhea and Infection

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CSF Rhinorrhea

Abstract

Cerebrospinal fluid (CSF) rhinorrhea is a symptom caused by the leakage of CSF into the nasal sinus, resulting from a defect in the skull base [1].

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References

  1. Tohge R, Takahashi M. Cerebrospinal fluid rhinorrhea and subsequent bacterial meningitis due to an atypical clival fracture. Intern Med. 2017;56(14):1911–4.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wax MK, Ramadan HH, Ortiz O, Wetmore SJ. Contemporary management of cerebrospinal fluid rhinorrhea. Otolaryngol Head Neck Surg. 1997;116(4):442–9.

    Article  PubMed  CAS  Google Scholar 

  3. Lewin W. Cerebrospinal fluid rhinorrhea in nonmissile head injuries. Neurosurgery. 1966;12(CN_suppl_1):237–52. http://academic.oup.com/neurosurgery/article/12/CN_suppl_1/237/4099203.

    Article  Google Scholar 

  4. Wang EW, Vandergrift WA, Schlosser RJ. Spontaneous CSF leaks. Otolaryngol Clin North Am. 2011;44(4):845–56. https://doi.org/10.1016/j.otc.2011.06.018.

    Article  PubMed  Google Scholar 

  5. Thomson SC. The cerebrospinal fluid. Its spontaneous escape from the nose. With observations on its position and function in the human subject. J Nerv Ment Dis. 1900;27(2):125.

    Article  Google Scholar 

  6. Aarabi B, Leibrock LG. Neurosurgical approaches to cerebrospinal fluid rhinorrhea. Ear Nose Throat J. 1992;71(7):300–5. http://journals.sagepub.com/doi/10.1177/014556139207100704.

    Article  PubMed  CAS  Google Scholar 

  7. Singh R, Bandyopadhyay M. Median defect in the skull. Singapore Med J. 2008;49(2):92–4.

    Google Scholar 

  8. Boseley ME, Tami TA. Endoscopic management of anterior skull base encephaloceles. Ann Otol Rhinol Laryngol. 2004;113(1):30–3. http://journals.sagepub.com/doi/10.1177/000348940411300106.

    Article  PubMed  Google Scholar 

  9. Miller C. Case of hydrocephalus chronicus, with some unusual symptoms and appearances on dissection. Trans Med Chir Soc Edinb. 1826;2:243–8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406566/.

    PubMed  PubMed Central  Google Scholar 

  10. Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope. 2000;110(7):1166–72. http://doi.wiley.com/10.1097/00005537-200007000-00019.

    Article  PubMed  CAS  Google Scholar 

  11. Ratilal BO, Costa J, Sampaio C, Pappamikail L. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2011;(8).

    Google Scholar 

  12. Yilmazlar S, Arslan E, Kocaeli H, Dogan S, Aksoy K, Korfali E, et al. Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases. Neurosurg Rev. 2006;29(1):64–71.

    Article  PubMed  Google Scholar 

  13. Deklotz TR, Chia SH, Lu W, Makambi KH, Aulisi E, Deeb Z. Meta-analysis of endoscopic versus sublabial pituitary surgery. Laryngoscope. 2012;122(3):511–8.

    Article  PubMed  Google Scholar 

  14. Tabaee A, Anand VK, Barrón Y, Hiltzik DDH, Brown SM, Kacker A, et al. Endoscopic pituitary surgery: a systematic review and meta-analysis: clinical article. J Neurosurg. 2009;111:545–54.

    Article  PubMed  Google Scholar 

  15. Naunheim MR, Sedaghat AR, Lin DT, Bleier BS, Holbrook EH, Curry WT, et al. Immediate and delayed complications following endoscopic skull base surgery. J Neurol Surg Part B Skull Base. 2015;76(5):390–6.

    Article  Google Scholar 

  16. Ivan ME, Bryan Iorgulescu J, El-Sayed I, McDermott MW, Parsa AT, Pletcher SD, et al. Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery. J Clin Neurosci. 2015;22(1):48–54. https://doi.org/10.1016/j.jocn.2014.08.009.

    Article  PubMed  Google Scholar 

  17. Chowdhury T, Prabhakar H, Bithal PK, Schaller B, Dash HH. Immediate postoperative complications in transsphenoidal pituitary surgery: a prospective study. Saudi J Anaesth. 2014;8(3):335–41.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kumar S, Darr A, Hobbs CG, Carlin WV. Endoscopic, endonasal, trans-sphenoidal hypophysectomy: retrospective analysis of 171 procedures. J Laryngol Otol. 2012;126(10):1033–40.

    Article  PubMed  CAS  Google Scholar 

  19. Karnezis TT, Baker AB, Soler ZM, Wise SK, Rereddy SK, Patel ZM, et al. Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery. Int Forum Allergy Rhinol. 2016;6(11):1117–25.

    Article  PubMed  Google Scholar 

  20. Jakimovski D, Bonci G, Attia M, Shao H, Hofstetter C, Tsiouris AJ, et al. Incidence and significance of intraoperative cerebrospinal fluid leak in endoscopic pituitary surgery using intrathecal fluorescein. World Neurosurg. 2014;82:E513–23. https://doi.org/10.1016/j.wneu.2013.06.005.

    Article  PubMed  Google Scholar 

  21. Narayan V, Nanda A. 15—Skull base surgery complications: an overview. In: Complications in neurosurgery. Elsevier Inc. p. 77–8. https://doi.org/10.1016/B978-0-323-50961-9.00015-3.

  22. Lewin W. Cerebrospinal fluid rhinorrhœa in closed head injuries. Br J Surg. 1954;42(171):1–18. http://doi.wiley.com/10.1002/bjs.18004217102.

    Article  PubMed  CAS  Google Scholar 

  23. Tebruegge M, Curtis N. Epidemiology, etiology, pathogenesis, and diagnosis of recurrent bacterial meningitis. Clin Microbiol Rev. 2008;21(3):519–37. http://cmr.asm.org/cgi/doi/10.1128/CMR.00009-08.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Friedman JA, Ebersold MJ, Quast LM. Persistent posttraumatic cerebrospinal fluid leakage. Neurosurg Focus. 2008;9(1):1–5.

    Article  Google Scholar 

  25. Adriani KS, Brouwer MC, van de Beek D. Risk factors for community-acquired bacterial meningitis in adults. Neth J Med. 2015;73(2):53–60. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L602940133%0Ahttp://limo.libis.be/resolver?&sid=EMBASE&issn=03002977&id=doi:&atitle=Risk+factors+for+community-acquired+bacterial+meningitis+in+adults&stitle=Neth.+J.+Med.&title=Neth.

    PubMed  CAS  Google Scholar 

  26. Koso-Thomas AK, Harley EH. Traumatic cerebrospinal fluid fistula presenting as recurrent meningitis. Otolaryngol Head Neck Surg. 1995;112(3):469–72.

    Article  PubMed  CAS  Google Scholar 

  27. Friedman JA, Ebersold MJ, Quast LM. Post-traumatic cerebrospinal fluid leakage. World J Surg. 2001;25(8):1062–6.

    Article  PubMed  CAS  Google Scholar 

  28. Davis CEDD. Discussion on Injuries of the Frontal and Ethmoidal Sinuses. Proc R Soc Med. 1942;35(12):805–10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1998470/.

    Google Scholar 

  29. Adson AW. Repair of defects in ethmoid and frontal sinuses resulting in cerebrospinal rhinorrhea. Arch Surg. 1949;58(5):623. http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/archsurg.1949.01240030633006.

    Article  CAS  Google Scholar 

  30. Dandy WE. Pneumocephalus (intracranial penumatocele or aerocele). Arch Surg. 1926;12(5):949. http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/archsurg.1926.01130050003001.

    Article  Google Scholar 

  31. Dandy WE. Treatment of rhinorrhea and otorrhea. Arch Surg. 1944;49(2):75. http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/archsurg.1944.01230020080001.

    Article  Google Scholar 

  32. Jamieson KG, Yelland JDN. Surgical repair of the anterior fossa because of rhinorrhea, aerocele, or meningitis. J Neurosurg. 1973;39(3):328–31. https://thejns.org/view/journals/j-neurosurg/39/3/article-p328.xml.

    Article  PubMed  CAS  Google Scholar 

  33. Mincy JE. Posttraumatic cerebrospinal fluid fistula of the frontal fossa. J Trauma Inj Infect Crit Care. 1966;6(5):618–22. https://insights.ovid.com/crossref?an=00005373-196609000-00007.

    Article  CAS  Google Scholar 

  34. Russell T, Cummins BH. Cerebrospinal fluid rhinorrhea 34 years after trauma: a case report and review of the literature. Neurosurgery. 1984;15(5):705–6. https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/00006123-198411000-00013.

    Article  PubMed  CAS  Google Scholar 

  35. Oh J-W, Kim S-H, Whang K. Traumatic cerebrospinal fluid leak: diagnosis and management. Korean J Neurotrauma. 2017;13(2):63.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Schlosser RJ, Bolger WE. Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope. 2004;114(2):255–65. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed6&NEWS=N&AN=2004068325.

    Article  PubMed  Google Scholar 

  37. Hasheminia D, Kalantar Motamedi MR, Hashemzehi H, Nazeri R, Movahedian B. A 7-year study of 1,278 patients with maxillofacial trauma and cerebrospinal fluid leak. J Maxillofac Oral Surg. 2015;14(2):258–62. https://doi.org/10.1007/s12663-014-0630-z.

    Article  PubMed  Google Scholar 

  38. Zapalac JS, Marple BF, Schwade ND. Skull base cerebrospinal fluid fistulas: a comprehensive diagnostic algorithm. Otolaryngol Head Neck Surg. 2002;126(6):669–76.

    Article  PubMed  Google Scholar 

  39. Choi D, Spann R. Traumatic cerebrospinal fluid leakage: risk factors and the use of prophylactic antibiotics. Br J Neurosurg. 1996;10(6):571–6. http://www.tandfonline.com/doi/full/10.1080/02688699646880.

    Article  PubMed  CAS  Google Scholar 

  40. Clemenza JW, Kaltman SI, Diamond DL. Craniofacial trauma and cerebrospinal fluid leakage. A retrospective clinical study. J Oral Maxillofac Surg. 1995;53(9):1004–7.

    Article  PubMed  CAS  Google Scholar 

  41. Guo K, Heng L, Zhang H, Ma L, Zhang H, Jia D. Risk factors for postoperative intracranial infections in patients with pituitary adenoma after endoscopic endonasal transsphenoidal surgery: pneumocephalus deserves further study. Neurosurg Focus. 2019;47(2):E5.

    Article  PubMed  Google Scholar 

  42. Vaz-Guimaraes F, Koutourousiou M, de Almeida JR, Tyler-Kabara EC, Fernandez-Miranda JC, Wang EW, et al. Endoscopic endonasal surgery for epidermoid and dermoid cysts: a 10-year experience. J Neurosurg. 2019;130(2):368–78.

    Article  Google Scholar 

  43. Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS, et al. Acute bacterial meningitis in adults—a review of 493 episodes. N Engl J Med. 2002;328(1):21–8. http://www.nejm.org/doi/abs/10.1056/NEJM199301073280104.

    Article  Google Scholar 

  44. Adriani KS, van de Beek D, Brouwer MC, Spanjaard L, de Gans J. Community-acquired recurrent bacterial meningitis in adults. Clin Infect Dis. 2007;45(5):e46–51.

    Article  PubMed  Google Scholar 

  45. Bijlsma MW, Brouwer MC, Kasanmoentalib ES, Kloek AT, Lucas MJ, Tanck MW, et al. Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study. Lancet Infect Dis. 2016;16(3):339–47. https://doi.org/10.1016/S1473-3099(15)00430-2.

    Article  PubMed  Google Scholar 

  46. Dzupova O, Rozsypal H, Prochazka B, Benes J. Acute bacterial meningitis in adults: predictors of outcome. Scand J Infect Dis. 2009;41(5):348–54.

    Article  PubMed  CAS  Google Scholar 

  47. Kono Y, Prevedello DM, Snyderman CH, Gardner PA, Kassam AB, Carrau RL, et al. One thousand endoscopic skull base surgical procedures demystifying the infection potential: incidence and description of postoperative meningitis and brain abscesses. Infect Control Hosp Epidemiol. 2014;32(1):77–83.

    Article  Google Scholar 

  48. Eljamel MS, Foy PM. Acute traumatic CSF fistulae: the risk of intracranial infection. Br J Neurosurg. 1990;4(5):381–5. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed2&NEWS=N&AN=1990381027.

    Article  PubMed  CAS  Google Scholar 

  49. Nandapalan V, Watson ID, Swift AC. Beta-2-transferrin and cerebrospinal fluid rhinorrhoea. Clin Otolaryngol. 1996;21(3):259–64. http://doi.wiley.com/10.1111/j.1365-2273.1996.tb01737.x.

    Article  PubMed  CAS  Google Scholar 

  50. Giunta G, Piazza I. Recurrent bacterial meningitis occurring five years after closed head injury and caused by an intranasal post-traumatic meningo-encephalocele. Postgrad Med J. 1991;67(786):377–9. http://pmj.bmj.com/cgi/doi/10.1136/pgmj.67.786.377.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. Pappas DG, Hammerschlag PE, Hammerschlag M. Cerebrospinal fluid rhinorrhea and recurrent meningitis. Clin Infect Dis. 1993;17(3):364–8. https://academic.oup.com/cid/article-lookup/doi/10.1093/clinids/17.3.364.

    Article  PubMed  Google Scholar 

  52. Van Aken MO, Feelders RA, De Marie S, Delwel EJ, Romijn JA, Van Der Lely AJ, et al. Surgery: postoperative external lumbar drainage reduces the risk for meningitis. Pituitary. 2004;7(2):89–93.

    Article  PubMed  Google Scholar 

  53. Jahangiri A, Wagner J, Han SW, Zygourakis CC, Han SJ, Tran MT, et al. Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations. J Neurosurg. 2014;121(1):67–74. https://thejns.org/view/journals/j-neurosurg/121/1/article-p67.xml.

    Article  PubMed  Google Scholar 

  54. Lindstrom DR, Toohill RJ, Loehrl TA, Smith TL. Management of cerebrospinal fluid rhinorrhea: the Medical College of Wisconsin experience. Laryngoscope. 2004;114(6):969–74. http://mail.google.com/mail/?ui=2&view=bsp&ver=1qygpcgurkovy%5Cnpapers2://publication/uuid/24E7E450-3BF3-40B0-A139-C7F0BB1006CF.

    Article  PubMed  Google Scholar 

  55. Dunn CJ, Alaani A, Johnson AP. Study on spontaneous cerebrospinal fluid rhinorrhoea: its aetiology and management. J Laryngol Otol. 2005;119(1):12–5.

    Article  PubMed  CAS  Google Scholar 

  56. Cairns H. Injuries of the frontal and ethmoidal sinuses with special reference to cerebrospinal rhinorrhœa and aeroceles. J Laryngol Otol. 1937;52(9):589–623. https://www.cambridge.org/core/product/identifier/S0022215100043991/type/journal_article.

    Article  Google Scholar 

  57. Ommaya AK. Cerebrospinal fluid rhinorrhea. Neurology. 1964;14(2):106. http://www.neurology.org/cgi/doi/10.1212/WNL.14.2.106.

    Article  PubMed  CAS  Google Scholar 

  58. Vrabec DP, Hallberg OE. Cerebrospinal fluid rhinorrhea: intranasal approach, review of the literature, and report of a case. Arch Otolaryngol Head Neck Surg. 1964;80(2):218–29. http://archotol.ama-assn.org/cgi/doi/10.1001/archotol.1964.00750040224022.

    Article  CAS  Google Scholar 

  59. Ziu M, Savage JG, Jimenez DF. Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures. Neurosurg Focus. 2012;32(6):E3.

    Article  PubMed  Google Scholar 

  60. Daudia A, Biswas D, Jones NS. Risk of meningitis with cerebrospinal fluid rhinorrhea. Ann Otol Rhinol Laryngol. 2007;116(12):902–5. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed8&NEWS=N&AN=2007625131.

    Article  PubMed  Google Scholar 

  61. Eljamel MSM, Foy PM. Non-traumatic CSF fistulae: clinical history and management. Br J Neurosurg. 1991;5(3):275–9.

    Article  PubMed  CAS  Google Scholar 

  62. Lloyd KM, DelGaudio JM, Hudgins PA. Imaging of skull base cerebrospinal fluid leaks in adults. Radiology. 2008;248:725–36.

    Article  PubMed  Google Scholar 

  63. Meco C, Oberascher G. Comprehensive algorithm for skull base dural lesion and cerebriospinal fluid fistula diagnosis. Laryngoscope. 2004;114(6):991–9. http://doi.wiley.com/10.1097/00005537-200406000-00007.

    Article  PubMed  Google Scholar 

  64. Wind JJ, Caputy AJ, Roberti F. Spontaneous encephaloceles of the temporal lobe. Neurosurg Focus. 2008;25(6):1–6.

    Article  Google Scholar 

  65. Kerr JT, Chu FWK, Bayles SW. Cerebrospinal fluid rhinorrhea: Diagnosis and management. Otolaryngol Clin North Am. 2005;38:597–611.

    Article  PubMed  Google Scholar 

  66. ter Horst L, Brouwer MC, van der Ende A, van de Beek D. Community-acquired bacterial meningitis in adults with cerebrospinal fluid leakage. Clin Infect Dis. 2019;70(11):2256–61. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz649/5531894.

    Article  PubMed Central  Google Scholar 

  67. Ansari S, Carron DB, Smith MJ. Recurrent late onset post-traumatic meningitis. J Pak Med Assoc. 1994;44(8):193–4.

    PubMed  CAS  Google Scholar 

  68. Eljamel MSM, Foy PM. Post-traumatic CSF fistulae, the case for surgical repair. Br J Neurosurg. 1990;4(6):479–83. http://www.tandfonline.com/doi/full/10.3109/02688699008993796.

    Article  PubMed  CAS  Google Scholar 

  69. Levin S, Nelson KE, Spies HW, Lepper MH. Pneumococcal meningitis: the problem of the unseen cerebrospinal fluid leak. Am J Med Sci. 1972;264(4):319–27. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000441-197210000-00010.

    Article  PubMed  CAS  Google Scholar 

  70. Deveci Ö, Uysal C, Varol S, Tekin R, Bozkurt F, Bekçibaşı M, et al. Erişkin posttravmatik tekrarlayan menenjitlerin değerlendirilmesi. Ulus Travma ve Acil Cerrahi Derg. 2015;21(4):261–5.

    Google Scholar 

  71. Aarabi B. Causes of infections in penetrating head wounds in the Iran-Iraq war. Neurosurgery. 1989;25(6):923–6. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006123-198912000-00011.

    Article  PubMed  CAS  Google Scholar 

  72. Meirowsky AM, Caveness WF, Dillon JD, Rish BL, Mohr JP, Kistler JP, et al. Cerebrospinal fluid fistulas complicating missile wounds of the brain. J Neurosurg. 1981;54(1):44–8. https://thejns.org/view/journals/j-neurosurg/54/1/article-p44.xml.

    Article  PubMed  CAS  Google Scholar 

  73. Abuabara A. Cerebrospinal fluid rhinorrhoea management. Injury. 2004;14(6):561.

    Google Scholar 

  74. Dumont AS, Nemergut EC, Jane JA, Laws ER. Postoperative care following pituitary surgery. J Intens Care Med. 2005;20:127–40.

    Article  Google Scholar 

  75. van Aken MO, de Marie S, van der Lely A, Singh R, van den Berge JH, Poublon RML, et al. Risk factors for meningitis after transsphenoidal surgery. Clin Infect Dis. 1997;25(4):852–6. https://academic.oup.com/cid/article-lookup/doi/10.1086/515533.

    Article  PubMed  Google Scholar 

  76. Black PM, Zervas NT, Candia GL. Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery. 1987;20(6):920–4. https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/00006123-198706000-00017.

    Article  PubMed  CAS  Google Scholar 

  77. Ciric I, Mikhael M, Stafford T, Lawson L, Garces R. Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results. J Neurosurg. 1983;59(3):395–401.

    Article  PubMed  CAS  Google Scholar 

  78. Kennedy DW, Cohn ES, Papel ID, Holliday MJ. Transsphenoidal approach to the sella. Laryngoscope. 1984;94(8):1066–74. http://doi.wiley.com/10.1288/00005537-198408000-00015.

    Article  PubMed  CAS  Google Scholar 

  79. Bernal-Sprekelsen M, Alobid I, Mullol J, Trobat F, Tomás-Barberán M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinology. 2005;43(4):277–81. http://doi.wiley.com/10.1097/00005537-199912000-00012.

    PubMed  Google Scholar 

  80. Kryzanski JT, Annino DJ, Gopal H, Heilman CB. Low complication rates of cranial and craniofacial approaches to midline anterior skull base lesions. Skull Base. 2008;18(4):229–42.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Laws ER, Trautmann JC, Hollenhorst RW. Transsphenoidal decompression of the optic nerve and chiasm. Visual results in 62 patients. J Neurosurg. 1977;46(6):717–22.

    Article  PubMed  Google Scholar 

  82. Li HY, Yu HX, Liu G. [Clinical analysis of brain abscess after endoscopic repairment of cerebrospinal fluid rhinorrhea]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018;53(9):650–4. http://www.ncbi.nlm.nih.gov/pubmed/30293255.

  83. Jane JA, Laws ER. The surgical management of pituitary adenomas in a series of 3,093 patients. J Am Coll Surg. 2001;193(6):650–9. http://ac.els-cdn.com.ezproxy.auckland.ac.nz/S1072751501011012/1-s2.0-S1072751501011012-main.pdf?_tid=3f26a8ec-61f6-11e7-af39-00000aab0f01&acdnat=1499309771_77ddce1e3545adc3132bf20323c94776.

    Article  Google Scholar 

  84. Blennow K, Fredman P. Detection of cerebrospinal fluid leakage by isoelectric focusing on polyacrylamide gels with silver staining using the PhastSystemTM. Acta Neurochir (Wien). 1995;136(3–4):135–9.

    Article  CAS  Google Scholar 

  85. Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas. World Neurosurg. 2012;77(2):329–41. https://doi.org/10.1016/j.wneu.2011.07.011.

    Article  PubMed  Google Scholar 

  86. van de Beek D, de Gans J, Tunkel AR, Wijdicks EFM. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006;354(1):44–53. https://academic.oup.com/cid/article-lookup/doi/10.1086/425368.

    Article  PubMed  Google Scholar 

  87. van de Beek D, Drake JM, Tunkel AR. Nosocomial bacterial meningitis. N Engl J Med. 2010;362(2):146–54. http://www.nejm.org/doi/abs/10.1056/NEJMra0804573.

    Article  PubMed  Google Scholar 

  88. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267–84. https://academic.oup.com/cid/article-lookup/doi/10.1086/425368.

    Article  PubMed  Google Scholar 

  89. Asad S, Peters-Willke J, Brennan W, Asad S. Clival defect with primary CSF rhinorrhea: a very rare presentation with challenging management. World Neurosurg. 2017;106:1052.e1–4. https://doi.org/10.1016/j.wneu.2017.07.011.

    Article  Google Scholar 

  90. Maitra S, Ghosh SK. Recurrent pyogenic meningitis—a retrospective study. QJM. 1989;73(1):919–29.

    PubMed  CAS  Google Scholar 

  91. Kaufman BA, Tunkel AR, Pryor JC, Dacey RG. Meningitis in the neurosurgical patient. Infect Dis Clin North Am. 1990;4(4):677–701.

    Article  PubMed  CAS  Google Scholar 

  92. Korinek AM, Baugnon T, Golmard JL, Van Effenterre R, Coriat P, Puybasset L. Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery. 2006;59(1):126–32.

    Article  PubMed  Google Scholar 

  93. McClelland S, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 2007;45(1):55–9.

    Article  PubMed  Google Scholar 

  94. Baltas I, Tsoulfa S, Sakellariou P, Vogas V, Fylaktakis M, Kondodimou A. Posttraumatic meningitis: bacteriology, hydrocephalus, and outcome. Neurosurgery. 1994;35(3):422–7. https://academic.oup.com/neurosurgery/article/35/3/422/2757632.

    Article  PubMed  CAS  Google Scholar 

  95. Baer ET. Post-dural puncture bacterial meningitis. Anesthesiology. 2006;105:381–93. http://insights.ovid.com/crossref?an=00000542-200608000-00022.

    Article  PubMed  Google Scholar 

  96. Weisfelt M, van de Beek D, Spanjaard L, de Gans J. Nosocomial bacterial meningitis in adults: a prospective series of 50 cases. J Hosp Infect. 2007;66(1):71–8.

    Article  PubMed  CAS  Google Scholar 

  97. Mayhall CG, Archer NH, Lamb VA, Spadora AC, Baggett JW, Ward JD, et al. Ventriculostomy-related infections. N Engl J Med. 1984;310(9):553–9. http://www.nejm.org/doi/abs/10.1056/NEJM198403013100903.

    Article  PubMed  CAS  Google Scholar 

  98. Dorsett M, Liang SY. Diagnosis and treatment of central nervous system infections in the emergency department. Emerg Med Clin North Am. 2016;34(4):917–42. https://linkinghub.elsevier.com/retrieve/pii/S0733862716300542.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Scholsem M, Scholtes F, Collignon F, Robe P, Dubuisson A, Kaschten B, et al. Surgical management of anterior cranial base fractures with cerebrospinal fluid fistulae. Neurosurgery. 2008;62(2):463–71. https://academic.oup.com/neurosurgery/article/62/2/463/2558524.

    Article  PubMed  Google Scholar 

  100. Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, et al. 2017 Infectious Diseases Society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis*. Clin Infect Dis. 2017;64(6):701–6.

    Article  CAS  Google Scholar 

  101. Romanowski B, Tyrrell DL, Weir BK, Goldsand G. Meningitis complicating transsphenoidal hypophysectomy. Can Med Assoc J. 1981;124(9):1172–5. http://www.ncbi.nlm.nih.gov/pubmed/7237338.

    PubMed  PubMed Central  CAS  Google Scholar 

  102. Blomstedt GC. Infections in neurosurgery: a retrospective study of 1143 patients and 1517 operations. Acta Neurochir (Wien). 1985;78(3–4):81–90.

    Article  CAS  Google Scholar 

  103. Buckwold FJ, Hand R, Hansebout RR. Hospital acquired bacterial meningitis in neurosurgical patients. J Neurosurg. 1977;46(4):494–500.

    Article  PubMed  CAS  Google Scholar 

  104. Flad TM, McKenna TJ. Meningitis as a late complication of surgically and medically treated pituitary adenoma. Clin Endocrinol (Oxf). 1991;35(5):419–22.

    Article  Google Scholar 

  105. Skedros DG, Cass SP, Hirsch BE, Kelly RH. Sources of error in use of beta-2 transferrin analysis for diagnosing perilymphatic and cerebral spinal fluid leaks. Otolaryngol Neck Surg. 1993;109(5):861–4.

    Article  CAS  Google Scholar 

  106. Pretto Flores L, De Almeida CS, Casulari LA, Andrioli G, De Divitiis E, Foroglou G. Positive predictive values of selected clinical signs associated with skull base fractures. J Neurosurg Sci. 2000;44(2):77–82.

    PubMed  CAS  Google Scholar 

  107. Tunkel AR, Scheld WM. Bacterial meningitis. Philadelphia: Lippincott Williams & Wilkins; 2001.

    Google Scholar 

  108. Chapin-Robertson K, Dahlberg SE, Edberg SC. Clinical and laboratory analyses of cytospin-prepared gram stains for recovery and diagnosis of bacteria from sterile body fluids. J Clin Microbiol. 1992;30(2):377–80.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  109. Swartz MN. Infections of the central nervous system Edited by W. Michael Scheld, Richard J. Whitley, and David T. Durack. 2nd ed. Philadelphia: Lippincott-Raven Publishers, 1997. 1,039 pp., illustrated. $205. Clin Infect Dis. 1997;24(6):1288.

    Article  Google Scholar 

  110. Feigin RD, McCracken GH, Klein JO. Diagnosis and management of meningitis. Pediatr Infect Dis J. 1992;11(9):785. https://insights.ovid.com/crossref?an=00006454-199209000-00039.

    Article  PubMed  CAS  Google Scholar 

  111. Gray LD, Fedorko DP. Laboratory diagnosis of bacterial meningitis. Clin Microbiol Rev. 1992;5(2):130–45.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  112. Saravolatz LD, Manzor O, VanderVelde N, Pawlak J, Belian B. Broad-range bacterial polymerase chain reaction for early detection of bacterial meningitis. Clin Infect Dis. 2003;36(1):40–5.

    Article  PubMed  CAS  Google Scholar 

  113. Oakley GM, Alt JA, Schlosser RJ, Harvey RJ, Orlandi RR. Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2016;6(1):8–16.

    Article  PubMed  Google Scholar 

  114. Algin O, Hakyemez B, Gokalp G, Ozcan T, Korfali E, Parlak M. The contribution of 3D-CISS and contrast-enhanced MR cisternography in detecting cerebrospinal fluid leak in patients with rhinorrhoea. Br J Radiol. 2010;83(987):225–32.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  115. Mostafa BE, Khafagi A. Combined HRCT and MRI in the detection of CSF rhinorrhea. Skull Base. 2004;14(3):157–62.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Shetty PG, Shroff MM, Sahani DV, Kirtane MV. Evaluation of high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula. Am J Neuroradiol. 1998;19(4):633–9.

    PubMed  PubMed Central  CAS  Google Scholar 

  117. Tuntiyatorn L, Laothammatas J. Evaluation of MR cisternography in diagnosis of cerebrospinal fluid fistula. J Med Assoc Thail. 2004;87(12):1471–6.

    Google Scholar 

  118. Eberhardt KEW, Hollenbach HP, Deimling M, Tomandl BF, Huk WJ. MR cisternography: a new method for the diagnosis of CSF fistulae. Eur Radiol. 1997;7(9):1485–91.

    Article  PubMed  CAS  Google Scholar 

  119. Eljamel MS, Pidgeon CN, Toland J, Phillips JB, O’Dwyer AA. MRI cisternography, and the localization of CSF fistulae. Br J Neurosurg. 1994;8(4):433–7. https://www.tandfonline.com/doi/abs/10.3109/02688699408995111.

    Article  PubMed  CAS  Google Scholar 

  120. Stafford Johnson DB, Brennan P, Toland J, O’Dwyer AJ. Magnetic resonance imaging in the evaluation of cerebrospinal fluid fistulae. Clin Radiol. 2005;51(12):837–41.

    Article  Google Scholar 

  121. van de Beek D, de Gans J, Spanjaard L, Vermeulen M, Dankert J. Antibiotic guidelines and antibiotic use in adult bacterial meningitis in The Netherlands. J Antimicrob Chemother. 2002;49(4):661–6.

    Article  PubMed  Google Scholar 

  122. Whitney CG, Farley MM, Hadler J, Harrison LH, Lexau C, Reingold A, et al. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med. 2000;343(26):1917–24. http://www.nejm.org/doi/abs/10.1056/NEJM200012283432603.

    Article  PubMed  CAS  Google Scholar 

  123. Fraser A, Gafter-Gvili A, Paul M, Leibovici L. Antibiotics for preventing meningococcal infections. In: Fraser A, editor. Cochrane database of systematic reviews. Wiley: Chichester; 2006. http://doi.wiley.com/10.1002/14651858.CD004785.pub3.

    Google Scholar 

  124. Radetsky M. Duration of treatment in bacterial meningitis. Pediatr Infect Dis J. 1990;9(1):2–9. https://insights.ovid.com/crossref?an=00006454-199001000-00002.

    Article  PubMed  CAS  Google Scholar 

  125. O’Neill P, Heath C, Shann F, Henry D, Hilton-Jones D, Squier MV, et al. Meningitis. Lancet. 1993;341(8844):530. https://linkinghub.elsevier.com/retrieve/pii/014067369390287Q

    Article  PubMed  Google Scholar 

  126. Scheld WM, Koedel U, Nathan B, Pfister H. Pathophysiology of bacterial meningitis: mechanism(s) of neuronal injury. J Infect Dis. 2002;186(s2):S225–33.

    Article  PubMed  CAS  Google Scholar 

  127. Van der Flier M, Geelen SPM, Kimpen JLL, Hoepelman IM, Tuomanen EI. Reprogramming the host response in bacterial meningitis: how best to improve outcome? Clin Microbiol Rev. 2003;16(3):415–29.

    Article  PubMed  PubMed Central  Google Scholar 

  128. Tunkel AR, Scheld WM. Pathogenesis and pathophysiology of bacterial meningitis. Clin Microbiol Rev. 1993;6(2):118–36.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  129. Van De Beek D, De Gans J. Dexamethasone and pneumococcal meningitis. Ann Intern Med. 2004;141:327. http://annals.org/article.aspx?doi=10.7326/0003-4819-141-4-200408170-00028.

    Article  PubMed  Google Scholar 

  130. Brouwer MC, Mcintyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015;2016(3).

    Google Scholar 

  131. de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347(20):1549–56. http://www.nejm.org/doi/abs/10.1056/NEJMoa021334.

    Article  PubMed  Google Scholar 

  132. Assiri AM, AlAsmari FA, Zimmerman VA, Baddour LM, Erwin PJ, Tleyjeh IM. Corticosteroid administration and outcome of adolescents and adults with acute bacterial meningitis: a meta-analysis. Mayo Clin Proc. 2009;84(5):403–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  133. Tice AD, Strait K, Ramey R, Hoaglund PA. Outpatient parenteral antimicrobial therapy for central nervous system infections. Clin Infect Dis. 1999;29(6):1394–9.

    Article  PubMed  CAS  Google Scholar 

  134. Waler JA, Rathore MH. Outpatient management of pediatric bacterial meningitis. Pediatr Infect Dis J. 1995;14(2):89.

    Article  PubMed  CAS  Google Scholar 

  135. Van De Beek D, De Gans J, McIntyre P, Prasad K. Steroids in adults with acute bacterial meningitis: a systematic review. Lancet Infect Dis. 2004;4(3):139–43.

    Article  PubMed  Google Scholar 

  136. Klugman KP, Friedland IR, Bradley JS. Bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with acute bacterial meningitis. Antimicrob Agents Chemother. 1995;39(9):1988–92.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  137. Viladrich PF, Gudiol F, Linares J, Pallares R, Sabate I, Rufi G, et al. Evaluation of vancomycin for therapy of adult pneumococcal meningitis. Antimicrob Agents Chemother. 1991;35(12):2467–72.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  138. Tos M. Course of and sequelae to 248 petrosal fractures. Acta Otolaryngol. 1973;75(2–6):353–4.

    Article  PubMed  CAS  Google Scholar 

  139. Price DJE, Sleigh JD. Control of infection due to Klebsiella aerogenes in a neurosurgical unit by withdrawal of all antibiotics. Lancet. 1970;296(7685):1213–5.

    Article  Google Scholar 

  140. Rathore MH. Do prophylactic antibiotics prevent meningitis after basilar skull fracture? Pediatr Infect Dis J. 1991;10(2):87–8. https://insights.ovid.com/crossref?an=00006454-199102000-00001.

    Article  PubMed  CAS  Google Scholar 

  141. Stankiewicz JA. Cerebrospinal fluid fistula and endoscopic sinus surgery. Laryngoscope. 1991;101:250–6.

    Article  PubMed  CAS  Google Scholar 

  142. Carrau RL, Snyderman C, Janecka IP, Sekhar L, Sen C, D’Amico F. Antibiotic prophylaxis in cranial base surgery. Head Neck. 1991;13(4):311–7.

    Article  PubMed  CAS  Google Scholar 

  143. Carroll WR, Rosenstiel D, Fix JR, De la Torre J, Solomon JS, Brodish B, et al. Three-dose vs extended-course clindamycin prophylaxis for free-flap reconstruction of the head and neck. Arch Otolaryngol Head Neck Surg. 2003;129(7):771–4.

    Article  PubMed  Google Scholar 

  144. Coskun H, Erisen L, Basut O. Factors affecting wound infection rates in head and neck surgery. Otolaryngol Head Neck Surg. 2000;123(3):328–33.

    Article  PubMed  CAS  Google Scholar 

  145. McIntyre PB, O’Brien KL, Greenwood B, Van De Beek D. Effect of vaccines on bacterial meningitis worldwide. Lancet. 2012;380:1703–11.

    Article  PubMed  Google Scholar 

  146. Brouwer MC, Tunkel AR, Van De Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010;23:467–92.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  147. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the Immunocompromised Host. Clin Infect Dis. 2014;58(3):e44–100. https://academic.oup.com/cid/article/58/3/e44/336537.

    Article  PubMed  Google Scholar 

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Aldosary, O.F., Sohail, M.R., Tleyjeh, I.M. (2022). CSF Rhinorrhea and Infection. In: AlQahtani, A.A., Castelnuovo, P., Casiano, R., Carrau, R.L. (eds) CSF Rhinorrhea. Springer, Cham. https://doi.org/10.1007/978-3-030-94781-1_36

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