scholarly journals Endoscopic Endonasal Repair of Sphenoid Sinus Cerebrospinal Fluid Leaks: Our Experience

2015 ◽  
Vol 67 (4) ◽  
pp. 412-416 ◽  
Author(s):  
Trichy Narayanan Janakiram ◽  
Vijayalakshmi Subramaniam ◽  
Palak Parekh
Keyword(s):  
Cerebrospinal Fluid ◽  
Sphenoid Sinus ◽  
Endoscopic Endonasal ◽  
Cerebrospinal Fluid Leaks

Lateral Transorbital Versus Endonasal Transpterygoid Approach to the Lateral Recess of the Sphenoid Sinus—A Comparative Anatomic Study

2018 ◽  
Vol 16 (5) ◽  
pp. 600-606 ◽  
Author(s):  
Joao T Alves-Belo ◽  
Joao Mangussi-Gomes ◽  
Huy Q Truong ◽  
Salomon Cohen ◽  
Paul A Gardner ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Sphenoid Sinus ◽  
Alternative Pathway ◽  
Invasive Procedure ◽  
Minimal Risk ◽  
Endoscopic Endonasal ◽  
Lateral Recess ◽  
Cerebrospinal Fluid Leaks ◽  
Working Distance ◽  
Neurovascular Structures

Abstract BACKGROUND The treatment of cerebrospinal fluid leaks of the lateral recess of the sphenoid sinus (LRSS) faces difficulties due to the deep location of the osseous defect. When treated with craniotomies, brain retraction is a concern. The endoscopic endonasal transpterygoid approach (EETA) is a direct and less invasive procedure; however, it may require transection of the vidian nerve (VN). OBJECTIVE To investigate the feasibility of a lateral transorbital approach (LTOA) as an alternative pathway to the LRSS that avoids VN sacrifice. METHODS Six embalmed heads with well-pneumatized LRSS were preselected by inspecting their computed tomography scans. One LTOA and one EETA were performed on 1 side of each specimen. The approaches were compared regarding working distance and neurovascular structures being sacrificed. The working area of the LTOA was also measured. RESULTS The average working distances were 59.9 (±2.94) mm for the LTOA and 76.4 (±3.99) mm for the EETA (P < .001). The LTOA generated a working area with a diameter of 9 to 14 mm. The EETA demanded the sacrifice of VN and the sphenopalatine artery in all specimens to expose the LRSS. No neurovascular structures were found in the trajectory of the LTOA. CONCLUSION The LTOA to the LRSS is feasible, with minimal risk of injuring neurovascular structures. It offers a shorter pathway when compared to the EETA. Although the LTOA provides no options for vascularized flap reconstruction, it allows immediate access to muscle grafts. The LTOA may serve as an alternative to treating cerebrospinal fluid leaks of the LRSS.

Improved Sinonasal Quality of Life Outcomes Following Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Leaks

2020 ◽  
Author(s):  
Feras Y. Ackall ◽  
Lyndon Chan ◽  
Kevin Choi ◽  
Jordan Teitelbaum ◽  
Patrick Codd ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cerebrospinal Fluid ◽  
Life Outcomes ◽  
Endoscopic Endonasal ◽  
Quality Of Life Outcomes ◽  
Cerebrospinal Fluid Leaks

scholarly journals Complications of Extended Endoscopic Endonasal Surgery in Elderly Patients

2018 ◽  
Vol 79 (S 03) ◽  
pp. S287-S288 ◽  
Author(s):  
Tyler Kenning ◽  
Carlos Pinheiro-Neto
Keyword(s):  
Cerebrospinal Fluid ◽  
Elderly Population ◽  
Operative Time ◽  
The Elderly ◽  
High Flow ◽  
Endoscopic Endonasal ◽  
Surgical Interventions ◽  
Perioperative Morbidity ◽  
Increased Risk ◽  
Cerebrospinal Fluid Leaks

AbstractExtended endoscopic endonasal procedures are not unique among surgical interventions in carrying increased risk in the elderly population. There are, however, components of the procedure, namely high-flow cerebrospinal fluid leaks, that do result in the potential for increased perioperative morbidity for these patients. We present the case of a 77-year-old male with a large invasive pituitary macroadenoma resected through a transplanum-transtuberculum-transsellar endonasal approach. A gross total resection was obtained with resolution of the patient's preoperative ophthalmologic deficits. One month postoperatively, the patient developed progressive lethargy and cranial imaging demonstrated a left convexity subacute subdural hematoma. This was evacuated through a twist drill craniostomy. Despite measures to limit the operative time of the initial endonasal procedure as well as the absence of a postoperative cerebrospinal fluid fistula, the patient still developed this complication. Along with more typical potential causes of postoperative decline following extended endonasal procedures, problems from high-flow intraoperative cerebrospinal fluid leaks alone can result in morbidity in the elderly population. This should be acknowledged preoperatively and a high suspicion should exist for the presence of intracranial hemorrhage in these patients with any postoperative deficits. Additional intraoperative measures can be utilized to minimize such risks.The link to the video can be found at: https://youtu.be/EkLmt2T8_UE.

Endoscopic Endonasal Management of Petroclival Cerebrospinal Fluid Leaks: Anatomical Study and Preliminary Clinical Experience

2008 ◽  
Vol 51 (06) ◽  
pp. 336-339 ◽  
Author(s):  
P. Castelnuovo ◽  
I. Dallan ◽  
M. Bignami ◽  
A. Pistochini ◽  
P. Battaglia ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Experience ◽  
Anatomical Study ◽  
Endoscopic Endonasal ◽  
Cerebrospinal Fluid Leaks

scholarly journals Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects

2019 ◽  
Vol 81 (05) ◽  
pp. 553-561
Author(s):  
Gülpembe Bozkurt ◽  
Mario Turri-Zanoni ◽  
Elisa Coden ◽  
Federico Russo ◽  
Hassan Ahmed Elhassan ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Dry Eye ◽  
Sphenoid Sinus ◽  
Cerebrospinal Fluid Leak ◽  
Significant Morbidity ◽  
Endoscopic Endonasal ◽  
Lateral Recess ◽  
Fluid Leak ◽  
Extensive Surgery

Background Lesions affecting sphenoid sinus lateral recess (SSLR) are difficult to visualize and manipulate through the transnasal routes, especially when the sinus is highly pneumatized. External approaches to this area involve extensive surgery and are associated with significant morbidity. The aims of this study are to present our experience with the endoscopic transpterygoid approach as a method for approaching lesions of the SSLR and to evaluate the outcomes of this procedure.Methods Clinical charts of patients who had lesions in the SSLR and who were treated at our institution from September 1998 to June 2018 were retrospectively reviewed. All these patients were managed by the endoscopic endonasal transpterygoid approach.Results Thirty-nine patients were identified. No cerebrospinal fluid leak recurrences were observed during follow-up (range: 1–19.7 years; median: 2.3 years). Hypoesthesia (temporary, 1; persistent, 4) in the region innervated by the maxillary branch of the trigeminal nerve was detected in five (12.8%) patients, while symptoms due to the Vidian nerve damage (dry eye, 3; dry nasal mucosa, 1) were present in four (10%) patients.Conclusions Although the endoscopic endonasal transpterygoid approach is an excellent corridor for dealing with lesions of the SSLR, limited rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention should be discussed during preoperative counselling.

scholarly journals Management of Cerebrospinal Fluid Rhinorrhea in the Sphenoid Sinus Lateral Recess Through an Endoscopic Endonasal Transpterygoid Approach With Obliteration of the Lateral Recess

2020 ◽  
pp. 014556132095514
Author(s):  
Chao He ◽  
Hong-Tao Zhen
Keyword(s):  
Cerebrospinal Fluid ◽  
Sphenoid Sinus ◽  
Surgical Repair ◽  
Endoscopic Endonasal ◽  
Simple Method ◽  
Lateral Recess ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Surgical Access ◽  
Skull Base Defect

Background: Cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess is a rare occurrence and poses unique challenges due to limited surgical access for surgical repair. Objective: To report our experience of surgical repair of cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess through an endoscopic endonasal transpterygoid approach with obliteration of the lateral recess. To evaluate the efficiency of this surgical procedure. Methods: A retrospective study. Twelve cases with cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess were reviewed. Assisted by image-guided navigation, cerebrospinal fluid rhinorrhea was repaired through an endoscopic endonasal transpterygoid approach, with obliteration of the lateral recess. Complications and recurrence were recorded. Medical photographs were used. Results: This surgical approach provided a relatively spacious corridor to dissect the sphenoid sinus lateral recess and do postoperative surveillance. The repair area completely healed in 3 months after surgery. Cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess was successfully repaired on the first attempt in all cases (100%). No main complications or recurrence was observed during a mean follow-up time of 40.3 months. Conclusion: The endoscopic endonasal transpterygoid approach gives appropriate access for the treatment of spontaneous cerebrospinal fluid rhinorrhea in the sphenoid sinus lateral recess. Multilayer reconstruction of a skull base defect with obliteration of the lateral recess is a reliable and simple method.

Endoscopic Endonasal Transethmoidal Transcribriform Transfovea Ethmoidalis Approach to the Anterior Cranial Fossa and Skull Base

Neurosurgery ◽  
2010 ◽  
Vol 66 (5) ◽  
pp. 883-892 ◽  
Author(s):  
Jeffrey P. Greenfield ◽  
Vijay K. Anand ◽  
Ashutosh Kacker ◽  
Michael J. Seibert ◽  
Ameet Singh ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Sphenoid Sinus ◽  
Malignant Tumors ◽  
Anterior Skull Base ◽  
Anterior Cranial Fossa ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Lumbar Drainage ◽  
Cranial Fossa

Abstract OBJECTIVE The anterior skull base, in front of the sphenoid sinus, can be approached using a variety of techniques including extended subfrontal, transfacial, and craniofacial approaches. These methods include risks of brain retraction, contusion, cerebrospinal fluid leak, meningitis, and cosmetic deformity. An alternate and more direct approach is the endonasal, transethmoidal, transcribriform, transfovea ethmoidalis approach. METHODS An endoscopic, endonasal approach was used to treat a variety of conditions of the anterior skull base arising in front of the sphenoid sinus and between the orbits in a series of 44 patients. A prospective database was used to detail the corridor of approach, closure technique, use of intraoperative lumbar drainage, operative time, and postoperative complications. Extent of resection was determined by a radiologist using volumetric analysis. RESULTS Pathology included meningo/encephaloceles (19), benign tumors (14), malignant tumors (9), and infectious lesions (2). Lumbar drains were placed intraoperatively in 20 patients. The CSF leak rate was 6.8% for the whole series and 9% for intradural cases. Leaks were effectively managed with lumbar drainage. Early reoperation for cerebrospinal fluid (CSF) leak occurred in 1 patient (2.2%). There were no intracranial infections. Greater than 98% resection was achieved in 12 of 14 benign and 5 of 9 malignant tumors. CONCLUSION The endoscopic, endonasal, transethmoidal, transcribriform, transfovea ethmoidalis approach is versatile and suitable for managing a variety of pathological entities. This minimal access surgery is a feasible alternative to transcranial, transfacial, or combined craniofacial approaches to the anterior skull base and anterior cranial fossa in front of the sphenoid sinus. The risk of CSF leak and infection are reasonably low and decrease with experience. Longer follow-up and larger series of patients will be required to validate the long-term efficacy of this minimally invasive approach.

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