Novel Surgical Treatment of Recurrent CSF Leak by Temporoparietal Temporalis Myofascial Flap: A Series of 6 Cases

OBJECTTechniques for combined extradural and intradural decompression with expansile duraplasty for Chiari malformation type I (CM-I) have been well described, with various allogenic and autologous materials used for duraplasty. However, the approach and surgical technique used for duraplasty in our treatment of CM-I and developed by the senior author in the 1990s has not been described.METHODSA prospective database was initiated in March 2003 to denote the use of cervical fascia for duraplasty and incorporate an ongoing detailed record of complications during the surgical treatment of children and adults with CM-I with and without syringomyelia. A total of 389 surgeries for CM-I were performed on 379 patients from March 2003 to June 2016. A total of 123 posterior procedures were performed on 123 patients in which both a posterior fossa extradural and intradural decompression with duraplasty (extra-intradural) was performed. In this paper the authors describe the surgical technique for harvesting and using cervical fascia for duraplasty in the surgical treatment of CM-I and analyze and discuss complications from a prospective database spanning 2003–2016.RESULTSThe authors found that cervical fascia can be harvested in patients of all ages (2–61 years old) without difficulty, and it provides a good substitute for dura in creating an expansile duraplasty in patients with CM-I. Cervical fascia is an elastic-like material with a consistency that allows for a strong watertight closure. Harvesting the cervical fascia graft does not require any further extension of the incision superiorly or inferiorly to obtain the graft. Complications were uncommon in this study of 123 children and adults. The risk of any type of complication (aseptic meningitis, CSF leak, pseudomeningocele, infection, development of hydrocephalus, and need for ventriculoperitoneal shunt) for the 78 patients in the pediatric age group was 0%. The risk of complication in the adult group was 6.7% (1 patient with aseptic meningitis and 2 patients with CSF leak).CONCLUSIONSAutologous cervical fascia is easy to obtain in patients of all ages and provides an effective material for duraplasty in the treatment of CM-I. Complications from the combination of both an extradural and intradural decompression with autologous cervical fascia duraplasty are uncommon.

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Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

Journal of Neurosurgery ◽

10.3171/jns.1998.88.2.0243 ◽

1998 ◽

Vol 88 (2) ◽

pp. 243-246 ◽

Cited By ~ 150

Author(s):

Wouter I. Schievink ◽

Vittorio M. Morreale ◽

John L. D. Atkinson ◽

Fredric B. Meyer ◽

David G. Piepgras ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Surgical Treatment ◽

Intracranial Hypotension ◽

Csf Leak ◽

Preoperative Imaging ◽

Content Type ◽

Surgical Exploration ◽

Fine Print ◽

Csf Leaks

Object. Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. Methods. Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22–61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. Conclusions. All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3–58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

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Surgical Treatment of CSF Leak via Endoscopic Endonasal Approaches: Case Series

10.1055/s-0039-1679774 ◽

2019 ◽

Author(s):

Bakhtiyar Pashaev ◽

Dmitriy Bochkarev ◽

Valeriy Danilov ◽

Andrey Alekseev ◽

Vladimir Krasnozhon

Keyword(s):

Surgical Treatment ◽

Case Series ◽

Csf Leak ◽

Endoscopic Endonasal

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

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1606555 ◽

2017 ◽

Vol 79 (02) ◽

pp. 205-216 ◽

Cited By ~ 1

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.

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Surgical treatment of post-lumbar puncture dural CSF leak causing chronic headache

Journal of Neurosurgery ◽

10.3171/jns.1982.57.5.0703 ◽

1982 ◽

Vol 57 (5) ◽

pp. 703-707 ◽

Cited By ~ 18

Author(s):

Hugh Harrington ◽

H. Richard Tyler ◽

Keasley Welch

Keyword(s):

Surgical Treatment ◽

Lumbar Puncture ◽

Subarachnoid Space ◽

Contrast Material ◽

Csf Leak ◽

Lumbar Region ◽

Dural Defect ◽

Duration Of Symptoms ◽

Content Type ◽

Radiographic Technique

✓ A-58-year-old woman experienced incapacitating headache and occipital paresthesiae for 5 years after lumbar myelography. Conservative methods of treatment failed. Successive investigations for a suspected cerebrospinal fluid (CSF) leak were unrevealing. Leakage of CSF from the subarachnoid space into the epidural space in the lumbar region was finally confirmed when oil-soluble contrast material (Pantopaque), injected into the cervical subarachnoid space, was revealed by a specific technical modification to be escaping from the lumbar sac. Repair of the dural defect with dorsolumbar fascia resulted in almost complete alleviation of symptoms. This case is unusual because of the radiographic technique used, the duration of symptoms, and the rarity of reports of successful surgical treatment for this serious complication of lumbar puncture.

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Penetrating Brain Injuries

Neurotrauma ◽

10.1093/med/9780190936259.003.0018 ◽

2019 ◽

pp. 155-166

Author(s):

Zachary L. Hickman ◽

Konstantinos Margetis

Keyword(s):

Decision Making ◽

Surgical Treatment ◽

Brain Injury ◽

High Risk ◽

Brain Injuries ◽

Csf Leak ◽

Low Velocity ◽

Cerebrovascular Injury ◽

Mass Lesions ◽

Posttraumatic Seizures

Penetrating brain injury (PBI) may result from missiles (high velocity) or non-missiles (low velocity), with the latter having a better prognosis and more frequently resulting in favorable patient outcomes. Certain risks, complications, and management principles are common across all types of PBI. These include the potential for the development of mass lesions, cerebral edema, and neurological deterioration, as well as a high risk of concomitant cerebrovascular injury, CSF leak, infection, and posttraumatic seizures. In most cases, urgent surgical treatment is warranted to mitigate these associated risks. This chapter will focus primarily on the assessment, diagnostic workup, decision making, and management of non-missile and low-velocity PBI.

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The advantages of using auto-fat tissue in the reconstruction of defects of the skull base in patients with CSF leak

OTORHINOLARYNGOLOGY 2-3(2) 2019 - OTORHINOLARYNGOLOGY ◽

10.37219/2528-8253-2018-2-18 ◽

2018 ◽

pp. 18-23

Author(s):

Dmitry Zabolotny ◽

Diana Zabolotnaya ◽

Eldar Ismagilov

Keyword(s):

Cerebrospinal Fluid ◽

Surgical Treatment ◽

Skull Base ◽

Csf Leak ◽

Fat Tissue ◽

Cerebrospinal Fluid Fistula ◽

Overlay Technique ◽

Skull Base Defect ◽

Group 2 ◽

Fluid Fistula

Relevance: At present, the method of repair of the cerebrospinal fluid fistula using mucous flaps according to the “overlay” technique is widely used in the reconstruction of the skull base and is generally accepted. We have developed an original method for reconstructing defects of the skull base in the presence of a cerebrospinal fluid fistula, using an auto-fat tissue and placing it in two layers. Objectives: To conduct a comparative assessment of methods for the reconstruction of the skull base defect in patients with CSF leak using endoscopic endonasal approach. Materials and methods: Under our supervision there were 46 patients with CSF leak. Depending on the technique of cerebrospinal fluid fistula repair, all patients were divided into 2 groups. The first group of 20 patients consisted of patients who underwent surgery with auto-fat tissue according to our proposed technique. The second group - 26 patients were patients who underwent repair of the skull base defect using the standard overlay technique - a mucous flap on the feeding vascular pedicle. The criterion for evaluating the effectiveness of surgical treatment was patient complaints and data from objective research methods (endoscopic examination of the nasal cavity). Results: After 3 months after surgical treatment, a patient of group 1 had a recurrence of liquorrhea, patients of group 2 after 3 months had a recurrence of liquorrhea in 3 patients, after 6 months in 2 patients of group 2 there was a recurrence of liquorrhea. Findings: When the size of the bone defect of the base of the skull is up to 0.6 cm, the original technique proposed by us for plastics of the cerebrospinal fluid fistula with an auto-fat tissue in two layers provides a tight closure of the bone defect and the defect of the dura mater. When using this method of plastics, the risk of the development of a recurrence of CSF leak is significantly reduced in comparison with the plastics of the cerebrospinal fluid fistula with the use of overlay grafts.

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Petroclival meningiomas: study on outcomes, complications and recurrence rates

Journal of Neurosurgery ◽

10.3171/2010.11.jns10326 ◽

2011 ◽

Vol 114 (5) ◽

pp. 1268-1277 ◽

Cited By ~ 57

Author(s):

Anil Nanda ◽

Vijayakumar Javalkar ◽

Anirban Deep Banerjee

Keyword(s):

Surgical Treatment ◽

Wound Dehiscence ◽

Residual Tumor ◽

Gross Total Resection ◽

Csf Leak ◽

Recurrence Rates ◽

Total Resection ◽

Petroclival Meningiomas ◽

Orbitozygomatic Approach

Object Petroclival meningiomas are notoriously difficult lesions to manage surgically, given the critical neurovascular structures that are intimately associated with the tumors. In this paper, the authors' aim was to review their series of patients with petroclival meningiomas who underwent surgical treatment; emphasis was placed on evaluating modes of presentation, postoperative neurological outcome, complications, and recurrence rates. Methods Fifty patients underwent surgical treatment for petroclival meningiomas. The majority of the patients were women (72%). The authors retrospectively reviewed the patients' medical records, imaging studies, and pathology reports to analyze presentation, surgical approach, neurological outcomes, complications, and recurrence rates. Results Headache was the most common presentation (58%). The most commonly used approach was the transpetrous approach (in 16 patients), followed by the orbitozygomatic approach (in 13). Gross-total resection was performed in 14 patients (28%), and in the remaining patients there was residual tumor (72%). Eighteen patients with tumor remnants were treated with Gamma Knife surgery. New postoperative cranial neuropathies were noted in 22 patients (44%). The most common cranial nerve (CN) deficit following surgery was CN III dysfunction (in 11 patients) and facial weakness (in 10). In 9 patients, the CN dysfunction was transient (41%), and 7 patients had permanent dysfunction (32%). Eight patients developed hydrocephalus and all required placement of a ventriculoperitoneal shunt. A CSF leak was noted in only 2 patients (4%), and wound dehiscence was noted in 1. The CSF leaks and the wound dehiscence occurred in patients who were undergoing reoperations. Adequate radiographic follow-up (minimum 6 months) was available for 31 patients (62%). The mean follow-up was 22.1 months. In 6 patients, tumor progression or recurrences were noted. The median time to recurrence was 84 months. At the time of discharge from the hospital, 92% of the patients had good outcomes (Glasgow Outcome Scale Scores 4 and 5). Three patients died of causes not directly related to the surgery. Conclusions Petroclival meningiomas still pose a formidable challenge to neurosurgeons. In their series, the authors used multiple skull base approaches and careful microneurosurgical technique to achieve a good functional outcome (Glasgow Otcome Scale Score 4 or 5) in 92% of patients, although the extent of gross-total resection was only 28%. The authors' primary surgical goal was to achieve maximal tumor resection while maintaining or improving neurological function. The authors favor the treatment of residual tumor or recurrent tumor with stereotactic radiosurgery.

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Surgical Treatment for Olfactory Groove Meningiomas: A Meta-Analysis of the Literature

10.21203/rs.3.rs-953431/v1 ◽

2021 ◽

Author(s):

Wei Wang ◽

Cong Chen ◽

Siqi Chen

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Surgical Resection ◽

Fixed Effects ◽

Meta Analysis ◽

Csf Leak ◽

Cochrane Library ◽

Significant Heterogeneity ◽

Olfactory Groove ◽

Csf Leakage

Abstract Background Surgical resection of olfactory groove meningiomas (OGMs) is challenging and lots of surgical approaches can be chosen. We conducted a systematic review and meta-analysis of the studies investigating surgical resection of OGMs to better understand the surgical treatment of OGMs.Methods PubMed, Embase and Cochrane Library were used to search the studies reporting treatment outcomes of surgery for patients with OGMs. The final eligible studies were assessed using the Oxford Center for Evidence Based Medicine for level of evidence. Relevant parameters were extracted to perform descriptive and/or quantitative analyses.Results A total of 42 studies including 1673 patients were included in this systematic review (8 level 3 studies and 34 level 4 studies). Surgeries through transcranial approaches (TCAs) and endoscopic endonasal approach (EEA) were done on 1596 and 77 patients, respectively. Based on a random effects model, rates of gross total resection (GTR) and cerebrospinal fluid (CSF) leak were determined to be 92.4% (CI: 88.6-95.5%) and 5.9% (95% CI: 3.4-9%), respectively. The mortality following surgery was 1.6% (95% CI: 0.9-2.5%) under a fixed effects model. Through subgroup analyses, TCAs were found to be more favorable in GTR and CSF leakage compared to EEA. Besides, anterolateral TCA was associated with better control of CSF leakage than anterior TCA. Conclusion Surgical treatment is capable of achieving GTR in the vast majority of patients with OGMs and postoperative mortality is under well control. Transcranial approach allows a better chance of GTR and better control of CSF leak in comparison to EEA. In comparison to anterior TCA, anterolateral TCA is associated less mortality. However, low evidence level and significant heterogeneity of the included studies prevent the formation of more solid conclusions.

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