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

Author(s):  
Francesco Missale ◽  
Alessandro Ioppi ◽  
Alessandro Ascoli ◽  
Paola Lovino Camerino ◽  
Andrea Luigi Camillo Carobbio ◽  
...  
2010 ◽  
Vol 2 (1) ◽  
pp. 87-94 ◽  
Author(s):  
Joseph Curry ◽  
Zoukaa Sargi

Abstract “Resection of malignancies of the skull base can result in significant functional and cosmetic morbidity as well as mortality. Reconstructive efforts provide not only functional and cosmetic rehabilitation, but also allow for the avoidance of potentially disastrous complications such as cerebrospinal fluid leak or meningitis. The optimal reconstruction is determined both by a patient based approach and a defect based approach. Skull base defects can be addressed by the separate components of the craniofacial skeleton in which they involve, and therefore the individual reconstructive issues which must be addressed. In this article, we describe an approach to skull base reconstruction and the technical aspects of the available reconstructive options.


2019 ◽  
Vol 133 (05) ◽  
pp. 380-385
Author(s):  
C Singh ◽  
N Shah

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.


Author(s):  
Chandra Veer Singh ◽  
Nishit J. Shah

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">To study the clinical outcomes of Hadad-Bassagasteguy flap (HBF) in endonasal reconstruction of anterior skull base defects. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">We prospectively analyzed the demographic data &amp; the outcome results particularly Post-operative CSF leak in 53 patients who underwent HBF in our hospital from February 2013 to June 2014. The early harvested flap was used to reconstruct anterior skull base defects among patients with high-flow on-table CSF leak. Post-operatively the patients were analyzed for CSF leak and bleeding.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Most of the study subjects were between21-50 years of age (73.6%). The mean age of the study subjects was 41.8±13.8 years. Male/female ratio of the study sample was 1.2 with 29 males and 24 females. Of the total 53 patients 46 (86.8%) has macro defects while 7 (13.2%) had micro defects. Non-secretary lesions were present in 60.4% (32/53) patients while secretary were present in 39.6% (21/53) patients. Cerebrospinal fluid leak was present in all the patients undergoing surgery and majority of them were put on lumbar drain, while bleeding was present in 49.1% patients. Of the total 53 patients only 2 had post-operative cerebrospinal fluid leak (2/53; 3.8%). </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Use of HB posterior nasal septal flap for reconstruction of anterior skull base among patients with high-flow intra-operative CSF leak has a remarkable impact in preventing post-operative CSF leak. Its applicability to wide patient-profiles with respect to age, size of defect, diagnosis is making it a versatile choice of reconstruction after endonasal anterior skull base surgeries.</span></p>


2019 ◽  
Vol 133 (10) ◽  
pp. 889-894
Author(s):  
C Carnevale ◽  
M Tomás-Barberán ◽  
G Til-Pérez ◽  
J Ibañez-Domínguez ◽  
D Arancibia-Tagle ◽  
...  

AbstractBackgroundThe indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm.MethodA prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap.ResultsTwenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent).ConclusionThe combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.


2019 ◽  
Vol 84 (1) ◽  
pp. 51
Author(s):  
A. N. Naumenko ◽  
S. S. Gaidukov ◽  
D. A. Gulyaev ◽  
O. I. Konoplev ◽  
I. I. Chernushevich ◽  
...  

2021 ◽  
pp. 014556132110185
Author(s):  
Michela Borrelli ◽  
Kristen A. Echanique ◽  
Jeffrey Koempel ◽  
Elisabeth H. Ference

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.


2019 ◽  
Vol 124 ◽  
pp. 502-512
Author(s):  
Christian P. Soneru ◽  
Charles A. Riley ◽  
Abtin Tabaee ◽  
Ashutosh Kacker ◽  
Vijay K. Anand ◽  
...  

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