International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea
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- Christos Georgalas
- Endoscopic Skull Base Centre Athens Hygeia Hospital Erythrou Stavrou 4 Maroussi Athens, 15123 Greece
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- Amanda Oostra
- Department of Neurosurgery Evangelismos University Hospital Athens Athens Greece
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- Shahzada Ahmed
- Department of ENT and Skull Base Surgery Birmingham Hospital Birmingham UK
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- Paolo Castelnuovo
- Department of Otorhinolaryngology University of Insubria Varese Italy
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- Iacopo Dallan
- Department of Otolaryngology ‐ Head and Neck Surgery Azienda Ospedaliero‐Universitaria Pisana Pisa Italy
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- Wouter van Furth
- Department of Neurosurgery Leiden University Medical Center (LUMC) Leiden Netherlands
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- Richard J. Harvey
- Sydney ENT clinic Sydney Australia
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- Philippe Herman
- Department of Otolaryngology Hôpital Lariboisière Paris France
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- Dimitrios Kombogiorgas
- Department of Neurosurgery Hygeia Hospital Athens Greece
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- Davide Locatelli
- Neurosurgical Clinic, Insubria University, ASST Settelaghi Varese Italy
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- Cem Meco
- Department of ORL‐HNS Ankara University Medical School Ankara Turkey
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- Jim N. Palmer
- Otorhinolaryngology–Head and Neck Surgery Hospital of the University of Pennsylvania Philadelphia PA
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- Otavio Piltcher
- ENT Department Hospital de Clinicas de Porto Alegre ‐ UFRGS Brazil
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- Anshul M. Sama
- ENT Surgeon Spire Nottingham Hospital Nottingham UK
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- Hesham Saleh
- Department of Otolaryngology ‐ Head and Neck Surgery Charing Cross Hospital London UK
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- Raj Sindwani
- ENT Cleveland Clinic Cleveland OH
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- Thibaut Van Zele
- Department of Otorhinolaryngology UZ Ghent University Hospital Gent Belgium
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- Bradford A. Woodworth
- Department of Otolaryngology University of Alabama at Birmingham Birmingham AL
抄録
<jats:sec><jats:title>Background</jats:title><jats:p>The association between spontaneous cerebrospinal fluid (CSF) leak/rhinorrhea and idiopathic intracranial hypertension (IIH) has been increasingly recognized over the last years. However, considerable variability of opinion regarding the assessment, investigations, and management of patients with spontaneous CSF rhinorrhea remains.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A consensus group was formed from experts from Europe, Asia, Australia, South and North America. Following literature review and open discussions with members of the panel, a set of 61 statements was produced. A modified Delphi method was used to refine expert opinion with 3 rounds of questionnaires and a consensus group meeting in Santo‐Rhino meeting in September 2019.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Fifty statements (82% of total) on spontaneous CSF leak and IIH reached consensus. In 38 of 50 statements, the median response was 7 (strongly agree) and in the 12 remaining statements the median response was 6 (agree). Eleven statements were excluded because they did not reach consensus and one new statement was added during SantoRhino meeting. The final statements refer to patient history and clinical examination ("History taking should include presence of headache, tinnitus and visual defects"), investigations (role of Thin Slice Computed Tomography and CISS/FLAIR sequences in Magnetic Resonance Imaging), principles of management (watchful waiting or measures to reduce ICP are supplementary but cannot subsitute surgical closure), surgical technique, intraoperative, early postoperative and long term management.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>We present fifty consensus statements on the diagnosis, investigation, and management of spontaneous CSF rhinorrhea based on the currently available evidence and expert opinion. Although by no means comprehensive and final, we believe they can contribute to the standardization of clinical practice. Early diagnosis, prompt surgical closure of the defect, assesment for and treatment of potentially co‐existing idiopathic intracranial hypertension in a comprehensive multidisciplinary approach are essential in order to successfully manage spontaneous CSF rhinorrhea, reduce associated morbidity and prevent recurrence.</jats:p></jats:sec>
収録刊行物
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- International Forum of Allergy & Rhinology
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International Forum of Allergy & Rhinology 11 (4), 794-803, 2020-10-25
Wiley