External frontal sinusotomy and endoscopic repair of cerebrospinal fluid fistula in the posterior wall: preliminary report of a new technique

2011 ◽  
Vol 125 (8) ◽  
pp. 802-806 ◽  
Author(s):  
P Thulasi Das ◽  
D Balasubramanian
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
Posterior Wall ◽  
Anterior Wall ◽  
New Technique ◽  
Endoscopic Repair ◽  
Tertiary Referral Centre ◽  
Cerebrospinal Fluid Leaks ◽  
A New Technique

AbstractIntroduction:Cerebrospinal fluid rhinorrhoea is the abnormal leakage of cerebrospinal fluid into the nasal cavity. The posterior wall of the frontal sinus can be the site of such leakage. Traditionally, these leaks were repaired via external osteoplastic or neurosurgical approaches. Despite advances in instrumentation, it is difficult to manage superiorly or laterally placed defects endoscopically. We present a new technique of endoscopic repair of frontal sinus posterior wall defects, via access holes drilled in the anterior wall of the frontal sinus.Study design:Preliminary study involving patients presenting with frontal sinus cerebrospinal fluid leaks, with defects in the frontal sinus posterior wall, between 2006 and 2010.Setting:Patients were treated in a tertiary referral centre for nose and sinus diseases. Patient records were reviewed and analysed.Results:Nine patients underwent external frontal sinusotomy under endoscopic vision. Repair was successful in all cases, with no complications. Follow up ranged from three months to three years.Conclusion:External frontal sinusotomy and endoscopic repair is a simple, precise and cosmetically acceptable alternative to osteoplastic and major neurosurgical techniques for management of frontal sinus posterior wall defects. This new, previously undescribed technique enables otolaryngologists to play a role in managing such defects.

Endoscopic modified Lothrop procedure for repair of lateral frontal sinus cerebrospinal fluid leak

2008 ◽  
Vol 123 (1) ◽  
pp. 145-147 ◽  
Author(s):  
J K Anverali ◽  
A A Hassaan ◽  
H A Saleh
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
World Literature ◽  
Cerebrospinal Fluid Leak ◽  
Lumbar Drain ◽  
Alternative Approach ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

AbstractObjective:To describe a previously unreported case of repair of a lateral frontal sinus cerebrospinal fluid leak, using the endoscopic modified Lothrop procedure.Method:Case report of new technique, with reference to the world literature.Results:An effective endoscopic, transnasal repair of a lateral frontal sinus cerebrospinal fluid leak was achieved in a 60-year-old man. The defect was closed with fat, fascia lata and free mucosal grafts. The left nasal cavity was packed and a lumbar drain left in situ post-operatively. The drain and packs were removed one week later and the patient discharged with no complications, and no recurrence at 12 months' follow up.Conclusion:Such cerebrospinal fluid leaks have traditionally been repaired using an external approach with osteoplastic flaps and obliteration of the sinus. We highlight the endoscopic modified Lothrop technique as an effective alternative approach to repair of cerebrospinal fluid leaks in poorly accessible areas of the frontal sinus.

Endonasal Endoscopic Management of Frontal Sinus Cerebrospinal Fluid Leak

2017 ◽  
Vol 31 (6) ◽  
pp. 406-411 ◽  
Author(s):  
Javaneh Jahanshahi ◽  
Mehdi Zeinalizadeh ◽  
Hasan Reza Mohammadi ◽  
Seyed Mousa Sadrehosseini
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Frontal Sinus ◽  
Surgical Approaches ◽  
Endoscopic Management ◽  
Graft Material ◽  
Endoscopic Repair ◽  
Skull Base Reconstruction ◽  
Csf Rhinorrhea

Background A frontal sinus leak is uncommon and is seen in ∼15% of cases of patients with cerebrospinal fluid (CSF) rhinorrhea. Now, endonasal endoscopic techniques have been reported to reconstruct skull base defects in the frontal sinus with a favorable outcome. Objective To review our experience in the repair of frontal sinus CSF leaks through an endonasal endoscopic approach. Methods Twenty-four patients with a frontal sinus leak who underwent endonasal endoscopic repair entered the study. Clinical presentation, location, frontal sinusotomy, graft material, follow-up, and frontal sinus status were evaluated. Results Among >100 cases of surgically repaired CST rhinorrhea, the frontal sinus was the site of the leak in 24 patients (mean age, 28.9 years; mean follow-up, 22 months). The etiology consisted of spontaneous leak and traumatic leak; whereas patients with skull base reconstruction after removal of tumor were excluded. Surgical approaches included Draf IIb, Draf III, Draf IIa in 20, 3, and 1 patients, respectively. Tree autografts as two-layer inlay fat–muscle and onlay fascia lata were used in the majority of patients. A success rate was achieved in 95.83% of the patients. Conclusion Endonasal endoscopic repair of a frontal sinus leak was a successful procedure, with a low failure rate and minimal morbidity.

Endoscopic repair of frontal sinus cerebrospinal fluid leaks

2005 ◽  
Vol 119 (9) ◽  
pp. 709-713 ◽  
Author(s):  
B A Woodworth ◽  
R J Schlosser ◽  
J N Palmer
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
Outflow Tract ◽  
Endoscopic Approach ◽  
Surgical Trauma ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Frontal Recess ◽  
Csf Leaks

Objective: To describe endoscopic management of frontal sinus cerebrospinal fluid (CSF) leaks.Study design: Retrospective.Methods: We reviewed all frontal sinus CSF leaks treated using an endoscopic approach at ourinstitutions from 1998 to 2003. CSF leaks originated immediately adjacent to or within the frontal recess or frontal sinus proper for inclusion in the study. Data collected included demographics, presenting signs and symptoms, site and size of skull-base defect, surgical approach, repair technique, and clinical follow up.Results: Seven frontal sinus CSF leaks in six patients were repaired endoscopically. Average age of presentation was 45 years (range 25–65 years). Aetiology was idiopathic (three), congenital (one), accidental trauma (one), and surgical trauma (two). All patients presented with CSF rhinorrhea; two patients presented with meningitis. Four defects originated in the frontal recess, while two others involved the posterior table and frontal sinus outflow tract. Four patients had associated encephaloceles. We performed endoscopic repair in all six patients withone patient requiring an adjuvant osteoplastic flap without obliteration. All repairs were successful at the first attempt with a mean follow up of 13 months. All frontal sinuses remained patent on both post-operative endoscopic and radiographic exam.Conclusions: Endoscopic repair of frontal sinus CSF leaks and encephaloceles can be an effective method if meticulous attention is directed toward preservation of the frontal sinus outflow tract, thus avoiding an osteoplastic flap and obliteration. The major limiting factor for an endoscopic approach is extreme extension superiorly or laterally within the posterior table beyond the reach of current instrumentation.

scholarly journals Feasibility of a septal mucosal flap for preventing re-stenosis following the Draf III procedure

2017 ◽  
Vol 132 (1) ◽  
pp. 79-82 ◽  
Author(s):  
O Erdur ◽  
K Ozturk ◽  
K Erkan
Keyword(s):  
Revision Surgery ◽  
Frontal Sinus ◽  
New Technique ◽  
Nasoseptal Flap ◽  
Mucosal Flap ◽  
Frontal Recess ◽  
Common Problems ◽  
A New Technique ◽  
Draf Iii

AbstractBackground:Re-stenosis and a consequent need for revision surgery are the most common problems in the follow-up period following endoscopic modification of the Lothrop procedure.Method:This paper reports a new technique for reconstructing and resurfacing of the posterior frontal recess bone for prevention of re-stenosis.Results:A 46-year-old man presented with a frontal sinus osteoma, and treatment featured an endoscopic modification of the Lothrop procedure. A vascularised, posteriorly based, septal mucosal flap was used in reconstruction. There have been no reported issues over 24 months of follow up.Conclusion:The use of a nasoseptal flap seems feasible to reduce scarring and recurrence of (common) frontal recess stenosis after a Draf III operation.

Matrixplasty for the Treatment of Severe Incurved Toenail with Growth Plate Deformity

2012 ◽  
Vol 102 (3) ◽  
pp. 198-204
Author(s):  
J.-Young Kim
Keyword(s):  
Growth Plate ◽  
Clinical Results ◽  
New Technique ◽  
Partial Removal ◽  
Edge Angle ◽  
Results Of Treatment ◽  
The Mean ◽  
A New Technique ◽  
Ingrown Toenails

Background: Severely incurved toenails are accompanied by deformity of the toenail growth plate. In such a condition, partial removal of the nail and nail bed and simple unfolding of the nail itself frequently result in the recurrence of symptoms. We sought to design and develop a new technique for the treatment of incurved toenail with growth plate deformity and to report the results of treating this disease entity. Methods: Forty consecutive patients (52 cases) underwent treatment of symptomatic incurved toenails with a new technique named matrixplasty. The mean ± SD patient age was 40.3 ± 18.9 years. Last follow-up was at a mean ± SD of 18.0 ± 1.3 months. An American Orthopedic Foot and Ankle Society (AOFAS) forefoot hallux score was assigned, and patients were evaluated before treatment and at last follow-up. Patient satisfaction and the recurrence rate of the deformity were evaluated. For evaluation of improvement in toenail shape, the center to edge angle of the toenail was measured before treatment and at last follow-up. The complication rate was also evaluated. Results: All of the ingrown toenails healed, and the nail deformities were corrected within 3 weeks after the procedure. None of the incurved toenails had recurred by last follow-up. The mean pretreatment AOFAS forefoot hallux score was 72.9, and it improved to 99.6 by last follow-up (P < .001). Every patient was very satisfied or satisfied with the results of treatment. The mean ± SD center to edge angle of the toenail improved from 53.3° ± 9.5° to 15.3° ± 5.2° by last follow-up (P < .001). Minor paronychia, which was managed with local wound dressing and oral antibiotics, was identified in four cases. No other complication was identified. Conclusions: Matrixplasty showed excellent clinical results in the treatment of severe incurved toenail, and this newly developed procedure showed improvement of the deformed toenail and its growth plate. (J Am Podiatr Med Assoc 102(3): 198–204, 2012)

Endonasal Endoscopic Repair of Sternberg???s Canal Cerebrospinal Fluid Leaks

2007 ◽  
Vol 117 (2) ◽  
pp. 345-349 ◽  
Author(s):  
Paolo Castelnuovo ◽  
Iacopo Dallan ◽  
Andrea Pistochini ◽  
Paolo Battaglia ◽  
Davide Locatelli ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Repair ◽  
Cerebrospinal Fluid Leaks
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