Comparison of high‐flow CSF leak closure with nasoseptal flap following endoscopic endonasal approach in adult and pediatric populations

2021 ◽  
Author(s):  
Peter Papagiannopoulos ◽  
Charles C.L. Tong ◽  
Hannah J. Brown ◽  
Jennifer E. Douglas ◽  
Christina M. Yver ◽  
...  
Keyword(s):  
High Flow ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Pediatric Populations

scholarly journals Concerns of cerebrospinal fluid leak in aggressive expanded endonasal endoscopic approach for craniopharyngiomas

2020 ◽  
Vol 10 (4) ◽  
pp. 154-156
Author(s):  
Marlon Ortiz Machín ◽  
Omar López Arbolay
Keyword(s):  
Cerebrospinal Fluid ◽  
Third Ventricle ◽  
Cerebrospinal Fluid Leak ◽  
Endoscopic Approach ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Fluid Leak

Cerebrospinal fluid leak represents a frequent complication in Craniopharyngioma´s Endoscopic Endonasal Approach. A descriptive observational investigation was performed in 50 adult patients operated of Craniopharyngiomas by aggressive Expanded Endonasal Endoscopic Approach (EEEA) in “Hermanos Ameijeiras” Hospital since 2010 to 2019 using nasoseptal flap. The 14% of all patients develop CSF leak and 85,7 % of these cases had a great communication into third ventricle creating a cisternoventricular space. Was identified relation with tumor size, hypothalamic invasion and adhesion strength of tumour. Surgical cavity suffered hydrostatic and hydrodynamic pression than lead to CSF leak independent of multilayer reparation.

Endoscopic Endonasal Approaches to the Clivus with No Violation of the Nasopharynx: Surgical Anatomy and Clinical Illustration

2021 ◽  
Author(s):  
Carlos D. Pinheiro-Neto ◽  
Laura Salgado-Lopez ◽  
Luciano C.P.C. Leonel ◽  
Serdar O. Aydin ◽  
Maria Peris-Celda
Keyword(s):  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Surgical Anatomy ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Abstract Background Despite the use of vascularized intranasal flaps, endoscopic endonasal posterior fossa defects remain surgically challenging with high rates of postoperative cerebrospinal fluid leak. Objective The aim of the study is to describe a novel surgical technique that allows complete drilling of the clivus and exposure of the craniovertebral junction with preservation of the nasopharynx. Methods Two formalin-fixed latex-injected anatomical specimens were used to confirm feasibility of the technique. Two surgical approaches were used: sole endoscopic endonasal approach and transnasion approach. The sole endonasal approach was used in a patient with a petroclival meningioma. Results In both anatomical dissections, the inferior clivectomy with exposure of the foramen magnum was achieved with a sole endoscopic endonasal approach. The addition of the transnasion approach helped to complete drilling of the inferior border of the foramen magnum and exposure of the arch of C1. Conclusion This study shows the anatomical feasibility of total clivectomy and exposure of the craniovertebral junction with preservation of the nasopharynx. A more favorable anatomical posterior fossa defect for the reconstruction is achieved with this technique. Further clinical studies are needed to assess if this change would impact the postoperative CSF leak rate.

scholarly journals Endoscopic Endonasal Reconstruction of High-Flow Cerebrospinal Fluid Leak with Fascia Lata “Button” Graft and Nasoseptal Flap: Surgical Technique and Case Series

2019 ◽  
Vol 81 (06) ◽  
pp. 645-650
Author(s):  
Roshni V. Khatiwala ◽  
Karthik S. Shastri ◽  
Maria Peris-Celda ◽  
Tyler Kenning ◽  
Carlos D. Pinheiro-Neto
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Fascia Lata ◽  
High Flow ◽  
Csf Leak ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Csf Diversion ◽  
Csf Leaks

Abstract Background The endoscopic endonasal approach (EEA) has become increasingly used for resection of skull base tumors in the sellar and suprasellar regions. A nasoseptal flap (NSF) is routinely used for anterior skull base reconstruction; however, there are numerous additional allografts and autografts being used in conjunction with the NSF. The role of perioperative cerebrospinal fluid (CSF) diversion is also unclear. Objective This study was aimed to analyze success of high-flow CSF leak repair during EEA procedures without use of CSF diversion through lumbar drainage. Methods A retrospective chart review of patients who had intraoperative high-flow CSF leak during EEA procedures at our institution between January 2013 and December 2017 was performed. CSF leaks were repaired with use of a fascia lata button graft and nasoseptal flap, without use of perioperative lumbar drains. Results A total of 38 patients were identified (10 male, 28 female). Patient BMIs ranged from 19.7 to 49 kg/m2 (median = 31 kg/m2), with 18 patients meeting criteria for obesity (BMI > 30 kg/m2) and 12 patients overweight (25 kg/m2 < BMI < 29.9 kg/m2). There was no incidence of postoperative CSF leak. Conclusion In our experience, the nasoseptal flap used in conjunction with the fascia lata button graft is a safe, effective and robust combination for cranial base reconstruction with high-flow intraoperative CSF leaks, without need for lumbar drains.

scholarly journals Expanded Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma

2018 ◽  
Vol 79 (S 02) ◽  
pp. S194-S195
Author(s):  
Justin Davanzo ◽  
Neerav Goyal ◽  
Brad Zacharia
Keyword(s):  
Optic Chiasm ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Expanded Endonasal Approach ◽  
Close Proximity ◽  
Dural Opening ◽  
Neurologically Intact ◽  
Video Abstract

AbstractThis video abstract demonstrates the use of the expanded endoscopic endonasal approach for the resection of a retrochiasmatic craniopharyngioma. These tumors are notoriously difficult to treat, and many approaches have been tried to facilitate safe and effective resection. The endoscopic endonasal approach has been increasingly utilized for selected sellar/suprasellar pathology. We present the case of a 39-year-old man who was found to have a cystic, partially calcified suprasellar mass consistent with a craniopharyngioma. To facilitate robust skull base repair, a vascularized nasoseptal flap was harvested. A wide sphenoidotomy was performed and the sella and tuberculum were exposed. After the dural opening and arachnoid dissection, the stalk was identified, merging seamlessly with the tumor capsule. The lesion was then internally debulked with the use of an ultrasonic aspirator. The capsule was then dissected off of the optic chiasm, thalamus, and hypothalamus. The cavity was inspected with an angled endoscope to ensure complete resection. A multilayered reconstruction was performed using autologous fascia lata, the previously harvested nasoseptal flap, and dural sealant. Postoperatively, the patient did have expected panhypopituitarism but remained neurologically intact and had improvement in his vision. In conclusion, this video demonstrates how an expanded endonasal approach can be used to safely resect a craniopharyngioma, even when in close proximity to delicate structures such as the optic chiasm.The link to the video can be found at: https://youtu.be/tahjHmrXhc4.

Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions

2007 ◽  
Vol 106 (3) ◽  
pp. 400-406 ◽  
Author(s):  
Ilya Laufer ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Sella Turcica ◽  
Significant Risk ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Rathke Cleft Cyst ◽  
Extended Transsphenoidal Approach ◽  
Csf Leakage ◽  
Planum Sphenoidale

Object The extended transsphenoidal approach is a less invasive method for removing purely suprasellar lesions compared with traditional transcranial approaches. Most advocates have used a sublabial incision and a microscope and have reported a significant risk of cerebrospinal fluid (CSF) leakage. The authors report on a series of purely endoscopic endonasal surgeries for resection of suprasellar supradiaphragmatic lesions above a normal-sized sella turcica with a low risk of CSF leakage. Methods A purely endoscopic endonasal approach was used to remove suprasellar lesions in a series of 10 patients. Five lesions were prechiasmal (three tuberculum sellae and two planum sphenoidale meningiomas) and five were post-chiasmal (four craniopharyngiomas and one Rathke cleft cyst). The floor of the planum sphenoidale and the sella turcica was reconstructed using a multilayer closure with autologous and synthetic materials. Spinal drainage was performed in only five cases. Complete resection of the lesions was achieved in all but one patient. The pituitary stalk was preserved in all but one patient, whose stalk was invaded by a craniopharyngioma and who had preoperative diabetes insipidus (DI). Vision improved postoperatively in all patients with preoperative impairment. Six patients had temporary DI; in five, the DI became permanent. Four patients with craniopharyngiomas required cortisone and thyroid replacement. After a mean follow up of 10 months, there was only one transient CSF leak when a lumbar drain was clamped prematurely on postoperative Day 5. Conclusions A purely endoscopic endonasal approach to suprasellar supradiaphragmatic lesions is a feasible minimally invasive alternative to craniotomy. With a multilayer closure, the risk of CSF leakage is low and lumbar drainage can be avoided. A larger series will be required to validate this approach.

scholarly journals Endoscopic endonasal repair of sphenoid cerebrospinal fluid leak, review and institutional experience

2019 ◽  
Vol 5 (2) ◽  
pp. 241
Author(s):  
Isra Al-Jazeeri ◽  
Hassan Al-Jazeeri ◽  
Ali Al-Momen
Keyword(s):  
Demographic Data ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Uncommon Presentation ◽  
Pubmed Database ◽  
Intracranial Complications ◽  
Csf Leaks

<p class="abstract"><strong>Background:</strong> Rhinogenic CSF leaks are not an uncommon presentation. Considering the possibility of drastic intracranial complications if left untreated, makes the management of such cases of outmost importance. Most of the non-traumatic CSF leaks will need a surgical repair. And since the introduction of the endoscopic nasal surgeries, these repairs are done almost always through the endoscopic endonasal approach.</p><p class="abstract"><strong>Methods:</strong> Retrospective review of cases with endoscopic repair of sphenoid CSF leak, who presented to King Fahad Specialist Hospital in Dammam (KFSH-D), from November 2003 to December 2017. And the U.S. National Library of Medicine (Pubmed) database was searched for “Sphenoid CSF Leak”.  </p><p class="abstract"><strong>Results:</strong> We had a total of 12 cases. The demographic data, diagnostic investigations and operative data were retrieved and reviewed.</p><p class="abstract"><strong>Conclusions:</strong> We advise using high resolution CT and intra-operative fluroscein for a reliable localization. And we found no complications with use of correct concentration of fluroscein. Endoscopic endonasal approach for repair of sphenoid CSF leak was found to be both effective and safe.</p>

scholarly journals Endoscopic Endonasal Transclival Approach to Ventral Pontine Cavernous Malformation: Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiao Dong ◽  
Xiaoyu Wang ◽  
Anwen Shao ◽  
Jianmin Zhang ◽  
Yuan Hong
Keyword(s):  
Case Report ◽  
High Risk ◽  
Cavernous Malformation ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Dorsal Approach ◽  
Endoscopic Endonasal ◽  
Cavernous Malformations ◽  
Individualized Approach

Ventral medial pontine cavernous malformations are challenging due to the location in eloquent tissue, surrounding critical anatomy, and potential symptomatic bleeding. Conventional approaches, such as anterolateral, lateral and dorsal approach, are associated with high risk of deleterious consequences due to excessive traction and damage to the surrounding tissues. The authors present an endoscopic endonasal approach for the resection of midline ventral pontine cavernous malformations, which follows principles of optimal access to brainstem cavernous malformations as the “two-point method.” No CSF leak or any other complications are obtained. The successful outcomes indicate that an individualized approach should be chosen before the surgery for brainstem cavernous malformations. With the advance of techniques, endoscopic endonasal approach could provide the most direct route to ventral pontine lesions with safety and efficiency.

Bilateral Smell Preservation is Routinely Possible following Endoscopic Endonasal Approach for Sellar/Suprasellar Lesions

2019 ◽  
Author(s):  
Kuan-Chung Ting ◽  
Wei-Hsin Wang ◽  
Edward C. Kuan ◽  
Yung-Yang Lin ◽  
Ming-Ying Lan
Keyword(s):  
Effective Means ◽  
Tertiary Care ◽  
Pituitary Tumors ◽  
Olfactory Function ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
The Impact

Abstract Objective The endoscopic endonasal approach (EEA) has been shown to be an effective means to access sellar lesions. However, there are limited studies centered on evaluating olfactory function after surgery. In this study, we assessed the pre- and postoperative olfactory function of patients who underwent EEA for sellar and suprasellar lesions. The impact of nasoseptal flap use on olfaction was further analyzed. Study Design A retrospective study. Setting A tertiary-care referral center in Taiwan. Participants Patients with sellar and suprasellar lesions who underwent EEA and pre- and postoperative olfaction assessment from August 2015 to March 2018 were included in the study. Main Outcome Measures The patients' olfactory function was examined pre-and postoperatively using the Sniffin' Sticks odor identification test. Data regarding demographics, olfactory scores, pathology, reconstructive technique, graft usage, and extent of resection were retrieved. Results A total of 106 patients (36 males and 70 females) were enrolled, with a mean age of 51 years. There were 76 pituitary tumors, 12 Rathke's cleft cysts, 7 craniopharyngiomas, 7 meningiomas, and 4 other lesions. The nasoseptal flap was used in 39 patients for skull base reconstruction, and these patients had no statistically significant change between pre- and postoperative olfactory scores (p = 0.283). Moreover, a statistically significant improvement of olfactory scores was found in patients in whom the nasoseptal flap was not used. Conclusions Olfactory function may be reliably preserved after EEA, with or without nasoseptal flap harvest and use.

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