Purpose: To report a case of cerebrospinal fluid (CSF) leakage during dacryocystorhinostomy (DCR) in a patient with Mobius syndrome and history of meningoencephalocele. Patient and findings: This 12-year-old girl had undergone an operation for meningoencephalocele at infancy by a neurosurgeon and was referred because of nasolacrimal drainage obstruction. She underwent DCR surgery at age 10 and 12 years. CSF leakage was detected during surgery. The authors describe the course and management of this patient. Conclusion: In patients with any history of surgery or trauma in the periorbital region, the ophthalmologist should be ready to manage CSF leakage during DCR.  

The purpose of this study is to determine the incidence and complications of skull base fx (such as CSF leakage and intracranial injuries) after head trauma. Retrospectively from Qct. 2000 to Sep 2003, 26133 patients were admitted with head trauma at the neurosurgical Department of Shahid Kamiab Hospital. 1072 cases of these patients had skull fx. Among them 93 cases were admitted with skull base fx. CSF leakage, pneumocephalus, and intracranial hematoma were the most common complications. Many of them needed medical and conservative treatment, while the others need surgery. The worse the preoperative medical management, the less likely the preoperative recovery. Early recognition, prompt and correct treatment are both essential for optimal management and reducing mortality and complications.

Cerebrospinal fluid (CSF) leakage is a rare but grave condition that needs meticulous and well-timed intervention. Autologous materials, such as temporalis fascia, temporalis muscle, fascia lata, cortical bone, cartilage, and fat, are widely available. We have presented a simple and effective method for the management of the small to moderate (up to 15mm) dural defects occurring during the surgeries of the skull base. We have used a free muscle graft in a sand clock fashion (dumbbell-shaped) through the defect. This procedure enables the surgeon to close the defect and cease the leak even in the anatomically difficult areas, which are not uncommon when the surgical operation is on the skull base.

Background: Hydrocephalus is a condition in which there is an abnormal build-up of cerebrospinal fluid within the ventricles and/or subarachnoid space, which leads to elevated intracranial pressure (ICP). CSF contains growth factors and cytokines secreted from the choroids plexus as well as subcommissural organs which are known as modulators of neurogenesis, differentiation and brain extracellular microenvironment and also show changes associated with neurological disorders and abnormalities of development. VEGF is the prime hypoxia inducible angiogenic factor. We assumed that increased ICP leads to reduced oxygen tension in brain tissue, which triggers VEGF gene transcription.Material and Method: Measurements were performed on CSF and serum aliquots obtained from control (n=16) and hydrocephalic patients (n=14), age- and sex-matched, were collected by lumbar puncture (LP) in the children hospital medical center of Tehran from 2006 to 2008. VEGF and total protein concentrations were determined by enzyme-linked immunosorbent assays (ELISA) and Bradford method, respectively.Results: VEGF and total protein concentrations were significantly elevated in hydrocephalus CSF samples compared with those in controls (p<0.05, p<0.001, respectively). There was only a slight insignificant elevation in serum VEGF concentrations.Conclusion: Under normal conditions there is only diffuse expression of VEGF in the brain, with the exception of some specialized cells of the choroid plexus. In contrast, under local or systemic hypoxia, neurons, astrocytes, and microglial cells all show enhanced VEGF expression. The present study shows that VEGF concentrations are much higher in the CSF of children with hydrocephalus than in control samples and VEGF may be involved in hydrocephalus pathophysiology.

Background: M. pneumonia infection in children is usual and diagnosis of its neurologic complications for rapid treatment is very important. To compare the CSF M. pneumonia antibody level between febrile children with acute neurologic signs (Menigoencephalitis, Guillan Barre Syndrome(GBS), Transverse myelitis, Ataxia and so on) with unaffected ones.Methods: A cross sectional/ case control study in pediatric wards of Rasoul-e-Akram & Mofid hospitals (2007-2009) was done. The amount of Specific M. pneumoniae IgG (ELISA)antibody level determined in CSF of 55 cases and in 10 controls. Chi square values (CI 95%, p<0.05) calculated for all categorical variables. Sensitivity; specificity; Positive Predictive Value (PPV); Negative Predictive Value (NPV) of CSF antibody level determined by using the Area under the ROC Curve.Results: Cases (n=55) aged between five month to 13 years with mean age of 3.84±3.43 years. Area Under Curve (AUC) in ROC was 0.876 (%95 CI, 0.78- 0.96; p<0.0001). Cut off level for antibody was0.0025 with 73% sensitivity; 90% specificity; 100% PPV; 28.8% NPV. CSF antibody level had significant difference between cases and controls [0.08±0.26 Versus 0.001±0.001; p: 0.02]; It had poor agreement between cases and controls (Kappa=0.27). Lowest amount seen in cases with aseptic meningitis; highest amount observed in cases with GBS and cases with focal neurologic signs.Conclusion: The presence of very low amount (0.0025) of M. pneumoniae antibody in CSF of febrile children with acute neurologic signs had 70% sensitivity and 90% specificity; 100% PPV; but had low (28.8%) NPV. M. pneumoniae would be a rare cause in cases with aseptic meningitis. Finding the M. pneumoniae -DNAs in CSF are not so frequent(2%) but in high suspicious cases adding this test to determining the CSF antibody level might be helpful.

Background & Aim: Posttraumtic cerebrospinal fluid (CSF) leakage frequently results from skull base fractures. Risk of meningitis increases with prolonged CSF leakage prophylactic. Antibiotic prophylaxis in these cases is contraversial. Materials & Methods: In this retrospective study; among 1670 head trauma cases, 108 patients evaluated whom afflicted by posttraumatic CSF leakage, and admitted in neurosurgery ward of Tabriz Imam Khomeini hospital, from 1376-1380. Forty seven patients had rhinorrhea and 61 had otorrhea. Results: Incidence of meningitis in patients with rhinorrhea (2918%) was significartly higher than patients with otorrhea(9.8%) (P=0.0047). The incidence of meningitis was higher significantly, when rhinorrhea or otorrhea continued for more than 7 days (P=0.0001). Prophylactic antibiotic didn't cause significant difference in occurance of meningitis in both groups of rhinorrhea and otorrhea (P>0.05). In group without antibiotic prophylaxis, streptococcus pneumonia was the most common cause of meningitis (90 %). Conclusion: CSF leakage often ceases with conservative management. Prolonged CSF leakage associates with high rate of meningitis. Prophylactic antbiotic hasn't significant effect for prevention. Early diagnosis and treatment of CSF leakage are important factors in prevention of meningitis and its morbidides.

Background: Fetal cerebro- spinal fluid (CSF) contains many neurotrophic and growth factors. Rat pheochromocytoma PC12 cells have been widely used as an in vitro model of neuronal differentiation that undergo differentiation to sympathetic neuron-like cells in response to NGF, bFGF, EGF and GDNF.Materials and methods: CSF was removed by tapping the cisterna magna of Wistar rat fetuses (E17- E20). PC12 cells were cultured in RPMI plus 10% FBS. The cell viability and cell proliferation were measured by MTT assay.Neural differentiation markers (MAP-2 and b-III tubulin) expressions were analyzed by immunocytochemistry.Results: MAP-2 and b-III tuobulin were expressed in PC12 cells cultured in CSF supplemented medium, but not in the cells from control cultures. Viability and cell proliferation were significantly elevated in PC12 cells cultured in CSF supplemented medium in E18 compared with control ones. A significant neuronal-like outgrowth appeared as early as Day 3 after the application of the CSF supplemented medium E17 and E19.Conclusion: Our data are in the same line with pervious studies that clarify crucial role of CSF neurotrophic factors in neuronal differentiation. Taken together we address PC12 neuronal differentiation to CSF induction by its components especially growth factors.

Dear Editor: We read with interest the paper by Lu and colleagues on radionuclide cisternography (RNC) entitled "The Value of Changing Position in the Detection of CSF Leakage in Spontaneous Intracranial Hypotension Using Tc-99m DTPA Scintigraphy: Two Case Reports", claiming an additive value of scanning the patients in the upright position for the detection of cerebrospinal fluid (CSF) leakage. In two cases of spontaneous intracranial hypotension (SIH), the authors observed the appearance of multiple images of increased radioactivity on both sides of the spinal canal after changing the patient position, which were interpreted as direct signs of CSF leaks.

Background: Hydrocephalus is a condition in which there is an abnormal build-up of cerebrospinal fluid within the ventricles and/or subarachnoid space, which leads to elevated intracranial pressure (ICP). VEGF is the prime hypoxia inducible angiogenic factor. We assumed that increased ICP leads to reduced oxygen tension in brain tissue, which triggers VEGF gene transcription so, in the current work we aimed to study VEGF alternation in hydrocephalus.Material and Method: Measurements were performed on CSF and serum aliquots obtained from control (n=20) and hydrocephalic patients (n=25), ageand sex-matched, were collected by lumbar puncture (LP) in the children hospital medical center of Tehran from 2006 to 2008. VEGF and total protein concentrations were determined by enzyme-linked immunosorbent assays (ELISA) and Bradford method, respectively.Results: VEGF and total protein concentrations were significantly elevated in hydrocephalus CSF samples compared with those in controls (p<0.05, p<0.001, respectively). There was only a slight insignificant elevation in serum VEGF concentrations.Conclusion: Under normal conditions there is only diffuse expression of VEGF in the brain. In contrast, under local or systemic hypoxia, neurons, astrocytes, and microglial cells all show enhanced VEGF expression. The present study shows that VEGF concentrations are much higher in the CSF of children with hydrocephalus than in control samples and VEGF may be involved in hydrocephalus pathophysiology.

A sensitive method using ion-pair extraction was developed by liquid chromatography tandem mass spectrometry (LC– MS/MS) for measurement of 4-methylimidazole (4-MI) in NMRI mice plasma and cerebrospinal fluid (CSF). Detection was done by electrospray positive ionization mass spectrometry in the multiple-reaction monitoring (MRM) mode. The validation method was applied to quantification of 4-MI in plasma and CSF samples using oral doses of 100, 200, and 300 mg/kg in NMRI mice. The efficiency of the method was evaluated in terms of linearity (R 2 > 0. 99), recovery (98– 107%, 3 levels) and precision (8– 10%, 3 levels, n = 6). Limit of detection (LOD) and limit of quantification (LOQ) were 25 ng/mL and 50 ng/mL, respectively. The results obtained showed that the exposure to oral doses of 4-MI in mice makes different concentrations in plasma and CSF and causes significant changes in mice. This study was the first report for determination of 4-MI in plasma and CSF samples in mice. Our results suggest that LC-MS/MSbased on ion-pair extraction is a robust method with high detection ability for measurement of 4-MI in plasma and CSF samples. Therefore, the developed method can be useful for evaluation and monitoring of imidazole derivatives in biological samples.