S281 – Closure of Anterior Skull Base Cerebrospinal Fluid Fistulas

Objectives 1) Describe the presenting symptoms, etiology, treatment, and long-term outcomes of patients with anterior skull base CSF fistulas treated endoscopically at our institution. 2) Study the association between closure techniques and complications, and between the use of image guidance surgery (IGS) and complications. Methods A retrospective analysis of patients with anterior CSF fistulas treated endoscopically from November 2004 to December 2007. Demographic and surgical data were collected. Postoperative complications, recurrence, and need for revision surgery were determined. Associations between the use of IGS and complications, and between the closure technique and complications were analyzed using Fisher Exact Test. Results Endoscopic repair of anterior skull base defect was performed in 19 cases. The etiology was spontaneous leak in 10 patients, menigoencephalocele in 7 patients, previous sinus surgery in 1 patient, and trauma in 1 patient. 5 patients had suffered bacterial meningitis before surgery. The most common location of leak was the cribiform plate (9 patients), followed by the ethmoid roof (5 patients). An overlay technique was used for repair in 61% of the procedures. One patient presented with leak recurrence, and underwent successful revision surgery. No statistical significance was found between the use of IGS and complications. The mean follow-up was 17 months. Our overall initial rate of closure was 94%, and 100% after a second procedure. At the last follow-up, none of the patients reported episodes of meningitis postoperatively. Conclusions Endoscopic repair of anterior skull base CSF fistulas has a high success rate and lower morbidity and mortality when compared with open approaches.

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Single surgeon experience with minimally invasive supraorbital craniotomy versus bifrontal craniotomy for anterior skull base meningiomas

Surgical Neurology International ◽

10.25259/sni_767_2020 ◽

2020 ◽

Vol 11 ◽

pp. 458

Author(s):

Scott Christopher Seaman ◽

Muhammad Salman Ali ◽

Anthony Marincovich ◽

Carlos Osorno-Cruz ◽

Jeremy D. W. Greenlee

Keyword(s):

Minimally Invasive ◽

Skull Base ◽

Statistical Significance ◽

Extent Of Resection ◽

Anterior Skull Base ◽

Presenting Symptoms ◽

Surgeon Experience ◽

Transcranial Approach ◽

Skull Base Meningiomas ◽

Supraorbital Craniotomy

Background: Anterior skull base meningiomas (ASBMs) account for about 10% of meningiomas. Bifrontal craniotomy (BFC) represents the traditional transcranial approach to accessing meningiomas in these locations. Supraorbital craniotomy (SOC) provides a minimally invasive subfrontal corridor in select patients. Here, we present our series of ASBM accessed by SOC and BFC by a single surgeon to review decision-making and compare outcomes in both techniques. Methods: Thirty-three patients were identified with ASBM. Age, tumor characteristics, presenting symptoms, postoperative complications, and outcomes were analyzed. Results: Bifrontal and SOC were performed in 13 and 20 patients, respectively. Mean follow-up time was 98.4 months. Patients undergoing SOC had smaller tumor size, located farther from the posterior table of frontal sinus, had less peritumoral edema, and decreased length of stay compared to patients undergoing BFC. Extent of resection was slightly better with BFC (99.8%) compared to SOC (91.8%), although this difference did not reach statistical significance. Recurrence-free survival and rate of re-do surgeries were not different between two groups. BFC was associated with higher rates of postoperative encephalomalacia. Conclusion: SOC provides an excellent surgical option for ASBMs providing comparable extent of resection, minimal manipulation of brain, and excellent cosmetic outcomes for patients. The patient selection is key to maximize the benefits from this approach.

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Endonasal endoscopic repair of anterior skull-base fistulas: the Kuala Lumpur experience

The Journal of Laryngology & Otology ◽

10.1258/002221505774783421 ◽

2005 ◽

Vol 119 (11) ◽

pp. 866-874 ◽

Cited By ~ 20

Author(s):

B S Gendeh ◽

A Mazita ◽

B M Selladurai ◽

T Jegan ◽

J Jeevanan ◽

...

Keyword(s):

Skull Base ◽

Middle Turbinate ◽

Pituitary Surgery ◽

Fascia Lata ◽

Anterior Skull Base ◽

Endoscopic Procedure ◽

Sinus Surgery ◽

Kuala Lumpur ◽

Endoscopic Repair ◽

Tertiary Referral Centre

The purpose of this retrospective study is to determine the pattern of cerebrospinal fluid (CSF) rhinorrhoea presenting to our tertiary referral centre in Kuala Lumpur and to assess the clinical outcomes of endonasal endoscopic surgery for repair of anterior skull base fistulas. Sixteen patients were treated between 1998 and 2004. The aetiology of the condition was spontaneous in seven and acquired in nine patients. In the acquired category, three patients had accidental trauma and this was iatrogenic in six patients (five post pituitary surgery), with one post endoscopic sinus surgery (ESS). Imaging included computed tomography (CT) scan and magnetic resonance imaging (MRI). Endoscopic repair is less suited for defects in the frontal sinuses with prominent lateral extension and defects greater than 1.5 cm in diameter involving the skull base. Fascia lata, middle turbinate mucosa, nasal perichondrium and ear fat (’bath plug’) were the preferred repair materials in the anterior skull base, whereas fascia lata, cartilage and abdominal fat obliteration was preferentially used in the sphenoid leak repair. Intrathecal sodium flourescein helped to confirm the site of CSF fistula in 81.3 per cent of the patients. Ninety per cent of the patients who underwent ’bath plug’ repair were successful. The overall success rate for a primary endoscopic procedure was 87.5 per cent, although in two cases a second endoscopic procedure was required for closure. In the majority of cases endoscopic repair was successful, and this avoids many of the complications associated with craniotomy, particularly in a young population. Therefore it is our preferred option, but an alternative procedure should be utilized should this prove necessary.

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Endoscopic Repair of Large Skull Base Defects after Powered Sinus Surgery

Otolaryngology ◽

10.1016/s0194-5998(03)00521-7 ◽

2003 ◽

Vol 129 (3) ◽

pp. 204-209 ◽

Cited By ~ 23

Author(s):

Christopher A. Church ◽

Alexander G. Chiu ◽

Winston C. Vaughan

Keyword(s):

Skull Base ◽

Sinus Surgery ◽

Intracranial Injury ◽

Endoscopic Repair ◽

Endoscopic Techniques ◽

Tissue Removal ◽

Cerebrospinal Fluid Leaks ◽

Pathology Reports ◽

Skull Base Defects

OBJECTIVES: To evaluate the management of patients with large skull base defects (> 2 cm) and intracranial injury caused by powered endoscopic sinus surgery. STUDY DESIGN AND SETTING: All patients treated for postendoscopic sinus surgery skull base injury over a 4-year period were reviewed. RESULTS: Three patients with skull base defects greater than 2 cm in size and associated intracranial injury from powered ESS were identified. All patients presented with active cerebrospinal fluid leaks. CT scans showed intracranial injury and pathology reports revealed brain tissue removal. Using image-guided endoscopic techniques, all defects were addressed with multilayer repair. Closure was achieved in all patients on the first attempt, with an average follow-up of 27 months. CONCLUSIONS: The use of powered instrumentation along the skull base can be dangerous and can result in extensive skull base defects with associated loss of dura and gray matter. Large ethmoid roof defects and significant intracranial injury, however, are not absolute contraindications to endoscopic repair.

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Arthroscopic SLAP IIb Repair Using Knot-tying Versus Knotless Suture Anchors: Is There a Difference?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00107 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0010

Author(s):

Justin W. Arner ◽

Joseph De Groot ◽

James P. Bradley

Keyword(s):

Revision Surgery ◽

Statistical Significance ◽

Return To Play ◽

Shoulder Injuries ◽

Overhead Athletes ◽

Pain Scores ◽

Sport Type ◽

Surgical Data ◽

Small Cohort

Objectives: SLAP IIb surgical outcomes have traditionally been less predictable when compared to other shoulder injuries. Traditional knotted anchors may partially be to blame by abrading the rotator cuff leading to tearing and pain. Methods: Seventy-four athletes who underwent arthroscopic SLAP IIb repair with traditional (n=42) and knotless anchors (n=32) at minimum 2-year follow-up were evaluated. Demographic, surgical data, return to play (RTP), KJOC, ASES, stability, ROM, strength, and pain scores were compared. Results: Knotless anchors had slightly higher RTP (93.5%, 58.1% same level) vs. traditional (90.2%, 53.7% same level), but was not statistically significant. Knotless anchors were less likely to require revision surgery (9%) compared to traditional anchors (17%), but was not statistically significant. There was no difference in KJOC, ASES, stability, ROM, strength, and pain between the two anchor types (Table 1). Pain was the only variable linked to decreased RTP (p < 0.0001). Younger patients had significantly poorer KJOC (p = 0.02) and ASES scores (p = 0.02) but no difference in RTP. No difference in outcome measures or RTP was found with gender, age, overhead athletes, number of anchors, or sport type (Table 2). Average follow-up was 6.5 years. Conclusion: Knotless anchors required less revision surgery, had higher RTP, ASES, and KJOC scores; however, statistical significance was not achieved in this relatively small cohort. Further evaluation, such as case matching and assessment of a larger sample size should be done. Possible other advantages such as tensioning and surgical time may also be important when considering lower profile knotless fixation.

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Long-Term Follow-Up After Maxillary Sinus Balloon Sinuplasty and ESS

Ear Nose & Throat Journal ◽

10.1177/0145561320986030 ◽

2021 ◽

pp. 014556132098603

Author(s):

Anni Koskinen ◽

Marie Lundberg ◽

Markus Lilja ◽

Jyri Myller ◽

Matti Penttilä ◽

...

Keyword(s):

Maxillary Sinus ◽

Revision Surgery ◽

University Hospital ◽

Sinus Surgery ◽

Control Group ◽

University Hospitals ◽

Balloon Sinuplasty ◽

Long Term Follow Up

Objectives: The aim of this controlled follow-up study was to compare the need for revision surgery, long-term efficacy, and satisfaction in chronic rhinosinusitis patients who had undergone maxillary sinus operation with either balloon sinuplasty or traditional endoscopic sinus surgery (ESS) technique. Methods: Thirty-nine ESS patients and 36 balloon patients of our previously described cohort, who had been primarily operated in 2008 to 2010, were contacted by phone. Symptoms, satisfaction, and need for revision surgery were asked. In addition, we collected data of patients who had undergone primary maxillary sinus balloon sinuplasty in the Helsinki University Hospital during the years 2005 to 2019. As a control group, we collected data of patients who had undergone primary maxillary sinus ESS at 3 Finnish University Hospitals, and 1 Central Hospital in years 2005, 2008, and 2011. Results: Altogether, 77 balloon patients and 82 ESS patients were included. The mean follow-up time was 5.3 years in balloon group and 9.8 years in ESS group. Revision surgery was performed on 17 balloon patients and 6 ESS patients. In the survival analysis, the balloon sinuplasty associated significantly with a higher risk of revision surgery compared to ESS. According to the phone interviews, 82% of ESS patients and 75% of balloon patients were very satisfied with the primary operation. Conclusion: Although the patient groups expressed equal satisfaction and change in symptoms after the operations, the need for revision surgery was higher after balloon sinuplasty than after ESS. This should be emphasized when counselling patients regarding surgical options.

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The “Parachute” technique for the endoscopic repair of high-flow anterior skull-base CSF leaks

World Neurosurgery ◽

10.1016/j.wneu.2021.05.006 ◽

2021 ◽

Author(s):

Giorgio Fiore ◽

Giulio Andrea Bertani ◽

Giorgio Giovanni Carrabba ◽

Claudio Guastella ◽

Giovanni Marfia ◽

...

Keyword(s):

Skull Base ◽

High Flow ◽

Anterior Skull Base ◽

Endoscopic Repair ◽

Csf Leaks

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Transnasal endoscopic approach for pediatric skull base lesions: a case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.4.peds18693 ◽

2019 ◽

Vol 24 (3) ◽

pp. 246-257 ◽

Cited By ~ 1

Author(s):

Jennifer L. Quon ◽

Lily H. Kim ◽

Peter H. Hwang ◽

Zara M. Patel ◽

Gerald A. Grant ◽

...

Keyword(s):

Skull Base ◽

Pediatric Population ◽

Case Series ◽

Length Of Hospital Stay ◽

Skull Base Tumors ◽

Presenting Symptoms ◽

Institutional Experience ◽

Transnasal Endoscopic Approach ◽

Skull Base Lesions

OBJECTIVETransnasal endoscopic transsphenoidal approaches constitute an essential technique for the resection of skull base tumors in adults. However, in the pediatric population, sellar and suprasellar lesions have historically been treated by craniotomy. Transnasal endoscopic approaches are less invasive and thus may be preferable to craniotomy, especially in children. In this case series, the authors present their institutional experience with transnasal endoscopic transsphenoidal approaches for pediatric skull base tumors.METHODSThe authors retrospectively reviewed pediatric patients (age ≤ 18 years) who had undergone transnasal endoscopic transsphenoidal approaches for either biopsy or resection of sellar or suprasellar lesions between 2007 and 2016. All operations were performed jointly by a team of pediatric neurosurgeons and skull base otolaryngologists, except for 8 cases performed by one neurosurgeon.RESULTSThe series included 42 patients between 4 and 18 years old (average 12.5 years) who underwent 51 operations. Headache (45%), visual symptoms (69%), and symptoms related to hormonal abnormalities (71%) were the predominant presenting symptoms. Improvement in preoperative symptoms was seen in 92% of cases. Most patients had craniopharyngiomas (n = 16), followed by pituitary adenomas (n = 12), Rathke cleft cysts (n = 4), germinomas (n = 4), chordomas (n = 2), and other lesion subtypes (n = 4). Lesions ranged from 0.3 to 6.2 cm (median 2.5 cm) in their greatest dimension. Gross-total resection was primarily performed (63% of cases), with 5 subsequent recurrences. Nasoseptal flaps were used in 47% of cases, fat grafts in 37%, and lumbar drains in 47%. CSF space was entered intraoperatively in 15 cases, and postoperative CSF was observed only in lesions with suprasellar extension. There were 8 cases of new hormonal deficits and 3 cases of new cranial nerve deficits. Length of hospital stay ranged from 1 to 61 days (median 5 days). Patients were clinically followed up for a median of 46 months (range 1–120 months), accompanied by a median radiological follow-up period of 45 months (range 3.8–120 months). Most patients (76%) were offered adjuvant therapy.CONCLUSIONSIn this single-institution report of the transnasal endoscopic transsphenoidal approach, the authors demonstrated that this technique is generally safe and effective for different types of pediatric skull base lesions. Favorable effects of surgery were sustained during a follow-up period of 4 years. Further refinement in technology will allow for more widespread use in the pediatric population.

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Anterior skull base: High risk areas in endoscopic sinus surgery in chronic rhinosinusitis: A computed tomographic analysis

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/bf02907616 ◽

2005 ◽

Vol 57 (1) ◽

pp. 5-8

Author(s):

Arif Ali ◽

Mary Kurien ◽

N. K. Shyamkumar ◽

Selvaraj

Keyword(s):

High Risk ◽

Skull Base ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Anterior Skull Base ◽

Sinus Surgery ◽

Computed Tomographic ◽

Risk Areas ◽

Tomographic Analysis

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Chondrosarcomas of the skull base and temporal bone

The Journal of Laryngology & Otology ◽

10.1017/s0022215107006081 ◽

2007 ◽

Vol 121 (8) ◽

pp. 725-735 ◽

Cited By ~ 25

Author(s):

L R Lustig ◽

J Sciubba ◽

M J Holliday

Keyword(s):

Radiation Therapy ◽

Skull Base ◽

Temporal Bone ◽

Histological Grade ◽

Tumour Control ◽

Presenting Symptoms ◽

Rare Tumours ◽

Temporal Bones ◽

Symptoms And Signs

AbstractObjective:To evaluate the clinical presentation and outcomes of treatment for patients with chondrosarcomas involving the skull base and temporal bone.Study design:Retrospective review.Setting:Tertiary medical centre.Patients:Cases of histologically confirmed chondrosarcoma involving the skull base and temporal bones.Intervention:Surgery.Main outcome measures:Demographic features of presenting patients; presenting symptoms and signs; surgical approach employed; use of post-operative radiation therapy; histological grade of tumour; and interval of post-operative follow up.Results: Twelve patients were identified with chondrosarcomas involving the skull base, with post-operative follow up ranging from three to 33 years. The average age at presentation was 42 years. The most common presenting symptoms were diplopia, decreased visual acuity and headaches. Five of the 12 patients required multiple surgical procedures.Conclusions:Patients with chondrosarcoma involving the skull base and temporal bone may present in a variety of ways. Surgical resection, even subtotal, in combination with radiation therapy, can often provide good tumour control over many years for these rare tumours.

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