Salvage endoscopic nasoseptal flap repair of persistent cerebrospinal fluid leak after open skull base surgery

2012 ◽  
Vol 33 (6) ◽  
pp. 735-740 ◽  
Author(s):  
Jean Anderson Eloy ◽  
Evelyne Kalyoussef ◽  
Osamah J. Choudhry ◽  
Soly Baredes ◽  
Chirag D. Gandhi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Cerebrospinal Fluid Leak ◽  
Nasoseptal Flap ◽  
Flap Repair ◽  
Fluid Leak

scholarly journals Pediatric skull base reconstruction: case report of a tunneled temporoparietal fascia flap

2016 ◽  
Vol 17 (3) ◽  
pp. 371-377 ◽  
Author(s):  
Jeffrey C. Rastatter ◽  
Patrick C. Walz ◽  
Tord D. Alden
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Nasoseptal Flap ◽  
Pediatric Case ◽  
Clival Chordoma ◽  
Temporoparietal Fascia ◽  
Temporoparietal Fascia Flap ◽  
Fluid Leak ◽  
Fascia Flap

The authors of this report present a pediatric case involving the use of a tunneled temporoparietal fascia flap to reconstruct a skull base defect for a multiply recurrent clival chordoma and cerebrospinal fluid leak, demonstrate the surgical technique through illustrations and intraoperative photos, and review the pertinent literature. A 9-year-old female patient underwent extensive clival chordoma resection via both the endoscopic and open approaches, which ultimately exhausted the bilateral nasoseptal flaps and other intranasal reconstructive options. Following proton beam radiation and initiation of chemotherapy, tumor recurrence was managed with further endoscopic resection, which was complicated by a recalcitrant cerebrospinal fluid leak. A tunneled temporoparietal fascia flap was used to provide vascular tissue to augment an endoscopic repair of the leak and reconstruction of the skull base. While the nasoseptal flap remains the workhorse for many pediatric and adult endoscopic skull base reconstructions, the tunneled temporoparietal fascia flap has a demonstrated efficacy in adults when the nasoseptal flap and other intranasal flaps are unavailable. This report documents a pediatric case, serving as a step toward establishing this technique in the pediatric population.

Little Insights from Big Data: Cerebrospinal Fluid Leak After Skull Base Surgery and the Limitations of Database Research

2019 ◽  
Vol 127 ◽  
pp. e561-e569 ◽  
Author(s):  
Avital Perry ◽  
Panagiotis Kerezoudis ◽  
Christopher S. Graffeo ◽  
Lucas P. Carlstrom ◽  
Maria Peris-Celda ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Big Data ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Cerebrospinal Fluid Leak ◽  
Database Research ◽  
Fluid Leak

A Novel Technique for Endoscopic Repair of Large Anterior Skull Base Defects: The PDS Wrap

2019 ◽  
Vol 34 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Karan Jolly ◽  
Okechukwu Okonkwo ◽  
Georgios Tsermoulas ◽  
Shahzada K. Ahmed
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Skull Base ◽  
Brain Herniation ◽  
Novel Technique ◽  
Endoscopic Skull Base Surgery ◽  
Fluid Leak ◽  
The Brain

Background Endoscopic skull base surgery continues to push boundaries with increased complexity of work and subsequently larger defects requiring repair. Robust repair following endoscopic skull base surgery is essential to reduce significant postoperative complications such as cerebrospinal fluid leak, meningitis, and pneumocephalus. Objective To describe and further validate our novel technique of using a polydioxanone plate wrap used in large anterior skull base resections where brain herniation can be of concern. Method After large resections where there is obvious brain herniation, our PDS (polydioxanone) wrap can be deployed to provide rigid support to the brain. The PDS plate is wrapped in a dural graft material and sutured closed in order to allow deployment by releasing the sutures when in position under the bony ridge of the defect. Conclusion Till date we have successfully used this technique in 3 patients following large skull base resections of olfactory meningiomas, where there was herniation of the brain. Postoperatively, there was no evidence of cerebrospinal fluid leak. We therefore recommend the use of the PDS wrap to prevent brain herniation and provide additional support to the repair.

Posterior nasoseptal flap in the reconstruction of skull base defects following endonasal surgery

2019 ◽  
Vol 133 (05) ◽  
pp. 380-385
Author(s):  
C Singh ◽  
N Shah
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
High Flow ◽  
Anterior Skull Base ◽  
Nasoseptal Flap ◽  
Lumbar Drain ◽  
Endonasal Reconstruction ◽  
Skull Base Defects ◽  
Fluid Leak

AbstractObjectiveTo study the clinical outcomes of a posterior nasoseptal flap used in the endonasal reconstruction of anterior skull base defects.MethodsThe early harvested flap was used to reconstruct anterior skull base defects in patients with high-flow on-table cerebrospinal fluid leak. Post-operatively, the patients were analysed for cerebrospinal fluid leak and bleeding.ResultsOf the 100 patients, 87 had macro defects while 13 had micro defects. Non-secretary lesions were present in 60 patients, while secretary lesions were present in 40 patients. Cerebrospinal fluid leak was present in all the patients undergoing surgery, and the majority of them had a lumbar drain fitted. Post-operatively, two patients experienced bleeding and only two patients had a cerebrospinal fluid leak.ConclusionThe use of a posterior nasoseptal flap for reconstruction of the anterior skull base amongst patients with a high-flow intra-operative cerebrospinal fluid leak can help prevent post-operative cerebrospinal fluid leak. Its applicability to wide patient profiles, with respect to age, size of defect and diagnosis, make it a versatile choice for reconstruction after endonasal anterior skull base surgical procedures.

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