Approaches to Repairing Skull Base Defects for the Prevention of Cerebrospinal Fluid (CSF) Leakage

2020 ◽  
pp. 177-197
Author(s):  
Faruk Altınel ◽  
Ali Arslantaş ◽  
Jeffrey Janus
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Csf Leakage ◽  
Skull Base Defects

scholarly journals Immediate complications associated with high-flow cerebrospinal fluid egress during endoscopic endonasal skull base surgery

2014 ◽  
Vol 37 (4) ◽  
pp. E3 ◽  
Author(s):  
Edward E. Kerr ◽  
Daniel M. Prevedello ◽  
Ali Jamshidi ◽  
Leo F. Ditzel Filho ◽  
Bradley A. Otto ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Preventive Measures ◽  
Skull Base Surgery ◽  
High Volume ◽  
High Flow ◽  
Endoscopic Endonasal ◽  
Tension Pneumocephalus ◽  
Csf Leakage ◽  
Skull Base Defects

Endoscopic expanded endonasal approaches (EEAs) to the skull base are increasingly being used to address a variety of skull base pathologies. Postoperative CSF leakage from the large skull base defects has been well described as one of the most common complications of EEAs. There are reports of associated formation of delayed subdural hematoma and tension pneumocephalus from approximately 1 week to 3 months postoperatively. However, there have been no reports of immediate complications of high-volume CSF leakage from EEA skull base surgery. The authors describe two cases of EEAs in which complications related to rapid, large-volume CSF egress through the skull base surgical defect were detected in the immediate postoperative period. Preventive measures to reduce the likelihood of these immediate complications are presented.

Extradural cartilage inlay graft in cerebrospinal fluid fistula repair

2010 ◽  
Vol 124 (12) ◽  
pp. 1294-1297 ◽  
Author(s):  
P Thulasi Das ◽  
D Balasubramanian
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Success Rate ◽  
Bony Defect ◽  
Cerebrospinal Fluid Fistula ◽  
Fistula Repair ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Skull Base Defects ◽  
Fluid Fistula

AbstractObjective:To present our experience in managing cerebrospinal fluid rhinorrhoea using the cartilage inlay (underlay) technique to repair skull base defects larger than 4 mm.Study design:Retrospective study involving patients presenting with cerebrospinal fluid rhinorrhoea between 1994 and 2008.Setting:Patients were treated in a tertiary referral centre for nose and sinus diseases. Patients' medical records were reviewed and analysed.Results:A total of 62 patients were operated upon using a cartilage inlay technique to repair bony skull base defects ranging in size from 4 to 20 mm (widest diameter). Of these 62 patients, 16 constituted revisions of earlier procedures undertaken elsewhere. The success rate of the technique was 100 per cent. Patient follow up ranged from six months to 16 years, with a median follow up of 15 months. Three patients had minor post-operative sinus infections; no serious complications were encountered.Conclusion:Extradural cartilage inlay appears to be an effective technique in the management of cerebrospinal fluid rhinorrhoea, especially for large defects and revision procedures. To our knowledge, the described patients represent the largest reported series of cerebrospinal fluid rhinorrhoea cases managed using the cartilage inlay technique. We believe that the crucial factors in our high success rate for cerebrospinal fluid fistula repair are: precise identification of the bony defect; meticulous preparation of the graft bed; careful elevation of the dura; judicious use of just enough graft tissue; and adequate graft support.

Cerebrospinal fluid leak repair: utility of intrathecal fluorescein for correct topographic identification of the skull base defects

2022 ◽  
Author(s):  
Francesco Missale ◽  
Alessandro Ioppi ◽  
Alessandro Ascoli ◽  
Paola Lovino Camerino ◽  
Andrea Luigi Camillo Carobbio ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Skull Base Defects ◽  
Fluid Leak

The Utility of Computed Tomography and Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leak

2019 ◽  
Vol 34 (3) ◽  
pp. 342-347
Author(s):  
John P. Flynn ◽  
Anna Pavelonis ◽  
Luke Ledbetter ◽  
Vidur Bhalla ◽  
Sameer A. Alvi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Diagnostic Yield ◽  
Ct Imaging ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Slice Thickness ◽  
Leak Localization ◽  
Skull Base Defects

Background Intrathecal fluorescein (IF) has become a common tool for localization of cerebrospinal fluid (CSF) leak, but despite frequent use, IF lacks Food and Drug Administration approval. The diagnostic ability of high-resolution computed tomography (HRCT) has increased over several decades. Subspecialized rhinology training within otolaryngology has, similarly, allowed for dedicated skull base surgeons to become more adept at CSF leak localization. Objectives To evaluate the utility of HRCT and IF in CSF leak localization. To identify certain patient populations in which IF has added utility. To analyze the ability of fellowship-trained neuroradiologist and rhinologist to localize CSF leak sites. Methods Data were collected from a single, tertiary care academic institution. Patients admitted for CSF leak between 2003 and 2016 were included. Diagnostic yield of preoperative imaging and IF for identification of leak site was analyzed. Fellowship-trained neuroradiologist and rhinologist performed retrospective review of CT imaging and identified CSF leak sites. Results One hundred and two patients underwent CSF leak repair. Skull base defects were preoperatively localized to exact sinus on imaging report in 67% of patients. Preoperative imaging stratified by CT slice thickness of 0.625 mm identified leak site in 88.9% of cases. Blinded retrospective review by a neuroradiologist and rhinologist was able to localize the CSF leak to the correct or adjacent sinus in >80% of cases. IF was useful for intraoperative localization in 73% of cases. When preoperative imaging failed at leak site localization, IF was able to correctly identify leak site in 75% of cases. Conclusions The diagnostic yield of IF and CT imaging was equivalent, with each modality localizing leak site approximately two-thirds of the time. CT imaging with 0.625 mm slice thickness proved more efficacious in identification of skull base defects. IF demonstrated increased utility in instances where preoperative imaging has failed at leak site identification.

scholarly journals The Surgical Treatment of Posttraumatic Skull Base Defects with Cerebrospinal Fluid Leak

2017 ◽  
Vol 79 (02) ◽  
pp. 205-216 ◽  
Author(s):  
Ashish Thapa ◽  
Bing-Xi Lei ◽  
Mei-Guang Zheng ◽  
Zhong-Jun Li ◽  
Zheng-Hao Liu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Skull Base ◽  
Surgical Approach ◽  
Common Factors ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Skull Base Defect ◽  
The Common ◽  
Skull Base Defects

Objectives The objective was to explore further the surgical treatment of posttraumatic skull base defects with cerebrospinal fluid (CSF) leak and to identify the most common factors affecting the surgical treatment of posttraumatic skull base defect with CSF leak retrospectively. Materials and Methods This study included 144 patients with head trauma having skull base defect with CSF leak who had been surgically treated at Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from 1998 to June 2016. There were 113 (78.5%) males and 31 (21.5%) females, with age ranging from 1 to 78 years and mean age of 26.58 ± 14.95 years. We explored the surgical approaches for the treatment of the skull base defect and the graft materials used and also measured the association among surgical approaches; location, size, and type of skull base defects; presence or absence of associated intracranial pathologies; postoperative complications; outcome; age; Glasgow outcome score (GOS) at discharge; and days of hospital stay. Results The location, size, and types of skull base defect and the presence of associated intracranial pathologies were the common factors identified not only for choosing the appropriate surgical approach but also for choosing the materials for defect repair, timing of the surgery, and the method used for the defect as well as leak repair. The statistically significant correlation with p < 0.001 was found in this study. Conclusion From this study, we could conclude that size, location, and types of the defect and the presence of associated intracranial injuries were the common factors that affected the surgical treatment of posttraumatic skull base defect with CSF leak. Hence, the importance of careful evaluation of these factors is essential for proper selection of the surgical approach and for avoiding unnecessary hassles.

Safety and Efficacy of TachoSil (Absorbable Fibrin Sealant Patch) Compared With Current Practice for the Prevention of Cerebrospinal Fluid Leaks in Patients Undergoing Skull Base Surgery: A Randomized Controlled Trial

Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 847-853 ◽  
Author(s):  
Bernard George ◽  
Christian Matula ◽  
Lars Kihlström ◽  
Enrique Ferrer ◽  
Vilhelm Tetens
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Dura Mater ◽  
Primary Endpoint ◽  
Current Practice ◽  
Skull Base Surgery ◽  
Csf Leak ◽  
Similar Frequency ◽  
Csf Leakage ◽  
Csf Leaks

Abstract BACKGROUND: Cerebrospinal fluid (CSF) leakage associated with incomplete sealing of the dura mater is a major complication of intradural procedures. OBJECTIVE: To compare the efficacy and safety of adjunctive TachoSil (Takeda Pharma A/S, Roskilde, Denmark) with current practice for the prevention of postoperative CSF leaks in patients undergoing elective skull base surgery involving dura mater closure. METHODS: Patients were intraoperatively randomized to TachoSil or current practice immediately before primary dura closure by suturing ± duraplasty. Choice of adjunctive treatment in the current practice group was at the surgeon's discretion. Primary efficacy endpoint was occurrence of clinically evident verified postoperative CSF leak or clinically evident pseudomeningocele within 7 weeks after surgery or treatment failure (third application of trial treatment or use of other treatment). RESULTS: A total of 726 patients were randomized to TachoSil (n = 361) or current practice (n = 365). More current practice patients had sutures plus duraplasty for primary dura closure compared with TachoSil (49.6% vs 35.7%) and fewer had sutures only (45.5% vs 63.2%). The primary endpoint of estimated leak rate favored TachoSil with events in 25 (6.9%) patients vs 30 (8.2%) current practice patients; however, this was not statistically significant (odds ratio: 0.82; 95% confidence interval: 0.47, 1.43; P = .485). Both treatments were well tolerated with similar frequency of adverse events. CONCLUSION: Very low rates of postoperative CSF leaks can be achieved in patients undergoing skull base surgery of various indications. Although the study did not meet its primary endpoint, TachoSil appears to be safe and effective for the prevention of CSF leaks and associated complications.

scholarly journals Double Skull Base Defects with Primary Spontaneous Cerebrospinal Fluid Leaks in a Single Patient: Temporal and Sphenoid Bones

Skull Base ◽  
2010 ◽  
Vol 20 (06) ◽  
pp. 455-458 ◽  
Author(s):  
Benjamin Schmitt ◽  
Jean-Michel Badet ◽  
Jean-Claude Chobaut ◽  
Laurent Tavernier
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Single Patient ◽  
Cerebrospinal Fluid Leaks ◽  
Skull Base Defects

Lymphangioma of the skull base bones leading to cerebrospinal fluid rhinorrhea

2008 ◽  
Vol 2 (4) ◽  
pp. 273-276 ◽  
Author(s):  
Eiji Ito ◽  
Kiyoshi Saito ◽  
Tetsuya Nagatani ◽  
Masaaki Teranishi ◽  
Yuzuru Kamei ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Skull Base ◽  
Histopathological Examination ◽  
Bone Destruction ◽  
Lytic Lesion ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage ◽  
The Right

Lymphangioma localized to the bones of the skull base is rare. The authors report herein the case of a 5-year-old boy who presented with lymphangioma of the bone, localized to the skull base and leading to cerebrospinal fluid (CSF) rhinorrhea with meningitis. Neuroimaging demonstrated lytic destruction with a cyst in the right middle skull base. The patient was successfully treated with resection of the tumor and prevention of CSF leakage. Histopathological examination revealed a lymphangioma. An enlarging lymphangioma can lead to bone destruction. A differential diagnosis of a lytic lesion for a cyst at the skull base is important for proper case management.

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