Endoscopic reconstruction of large anterior skull base defects with opening of the sellar diaphragm. Experience at a tertiary level university hospital

2019 ◽  
Vol 133 (10) ◽  
pp. 889-894
Author(s):  
C Carnevale ◽  
M Tomás-Barberán ◽  
G Til-Pérez ◽  
J Ibañez-Domínguez ◽  
D Arancibia-Tagle ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Middle Turbinate ◽  
Cerebrospinal Fluid Leak ◽  
Lateral Wall ◽  
Anterior Skull Base ◽  
University Hospital ◽  
Endoscopic Reconstruction ◽  
Skull Base Defects ◽  
Fluid Leak

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.

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.

scholarly journals Hadad-Bassagasteguy flap in reconstruction of skull base defects after endonasal skull base surgery

2017 ◽  
Vol 3 (4) ◽  
pp. 1020
Author(s):  
Chandra Veer Singh ◽  
Nishit J. Shah
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Demographic Data ◽  
Cerebrospinal Fluid Leak ◽  
High Flow ◽  
Anterior Skull Base ◽  
Csf Leak ◽  
Female Ratio ◽  
Skull Base Defects ◽  
Fluid Leak

<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>

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

2022 ◽  
Author(s):  
Francesco Missale ◽  
Alessandro Ioppi ◽  
Alessandro Ascoli ◽  
Paola Lovino Camerino ◽  
Andrea Luigi Camillo Carobbio ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Skull Base Defects ◽  
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.

Immunisations and antibiotics in patients with anterior skull base cerebrospinal fluid leaks

2014 ◽  
Vol 128 (7) ◽  
pp. 626-629 ◽  
Author(s):  
J Rimmer ◽  
C Belk ◽  
V J Lund ◽  
A Swift ◽  
P White
Keyword(s):  
Cerebrospinal Fluid ◽  
Streptococcus Pneumoniae ◽  
Antibiotic Prophylaxis ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Prophylactic Antibiotics ◽  
Anterior Skull Base ◽  
Web Based ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

AbstractObjective:There are no UK guidelines for the use of antibiotics and/or immunisations in patients with an active anterior skull base cerebrospinal fluid leak. This study aimed to define current UK practice in this area and inform appropriate guidelines for ENT surgeons.Method:A web-based survey of all members of the British Rhinological Society was carried out and the literature in this area was reviewed.Results:Of those who responded to the survey, 14 per cent routinely give prophylactic antibiotics to patients with cerebrospinal fluid leaks, and 34.9 per cent recommend immunisation against at least one organism, most commonly Streptococcus pneumoniae (86.7 per cent).Conclusion:There is no evidence to support the use of antibiotic prophylaxis in patients with a cerebrospinal fluid leak. We propose that all such patients are advised to seek immunisation against pneumococcus, meningococcus and haemophilus.

scholarly journals Technical nuances of commonly used vascularised flaps for skull base reconstruction

2015 ◽  
Vol 129 (8) ◽  
pp. 752-761 ◽  
Author(s):  
I P Tang ◽  
R L Carrau ◽  
B A Otto ◽  
D M Prevedello ◽  
P Kasemsiri ◽  
...  
Keyword(s):  
Skull Base ◽  
Middle Turbinate ◽  
Cerebrospinal Fluid Leak ◽  
Lateral Wall ◽  
Cranial Base ◽  
Nasoseptal Flap ◽  
Skull Base Reconstruction ◽  
Technical Features ◽  
Fluid Leak ◽  
Temporoparietal Flaps

AbstractBackground and Methods:Reconstruction with a vascularised flap provides the most reliable outcome, with post-operative cerebrospinal fluid leak rates of less than 5 per cent. This article aims to review and summarise the critical technical aspects of the vascularised flaps most commonly used for skull base reconstruction.Results:Vascularised flaps are classified as intranasal or extranasal. The intranasal group includes the Hadad–Bassagaisteguy nasoseptal flap, the Caicedo reverse nasoseptal flap, the nasoseptal rescue flap, the posteriorly or anteriorly based lateral wall flaps, and the middle turbinate flap. Extranasal flaps include the transfrontal pericranial and transpterygoid temporoparietal flaps.Conclusion:The Hadad–Bassagaisteguy nasoseptal flap is overwhelmingly favoured for reconstructing extensive defects of anterior, middle and posterior cranial base. Its pertinent technical features are described. However, it is essential to master the skills required for the various extranasal or regional vascularised flaps because each can offer a reconstructive alternative for specific patients, especially when open approaches are needed and/or intranasal vascularised flaps are not feasible.

scholarly journals Postoperative Cerebrospinal Fluid Leak after Septoplasty: A Potential Complication of Occult Anterior Skull Base Encephalocele

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0043 ◽  
Author(s):  
Resha S. Soni ◽  
Osamah J. Choudhry ◽  
James K. Liu ◽  
Jean Anderson Eloy
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Skull Base ◽  
Intracranial Abscess ◽  
Ethmoid Bone ◽  
Csf Rhinorrhea ◽  
Csf Leakage ◽  
Skull Base Defect ◽  
Fluid Leak

Postoperative cerebrospinal fluid (CSF) rhinorrhea after septoplasty is a known entity resulting from errors in surgical technique and improper handling of the perpendicular plate of the ethmoid bone. When these occur, urgent management is necessary to prevent deleterious sequelae such as meningitis, intracranial abscess, and pneumocephalus. Encephaloceles are rare occurrences characterized by herniation of intracranial contents through a skull base defect that can predispose patients to CSF rhinorrhea. In this report, we present a case of CSF rhinorrhea occurring 2 weeks after septoplasty likely from manipulation of an occult anterior skull base encephalocele. To our knowledge, no previous similar case has been reported in the literature. Otolaryngologists should be aware of the possibility of occult encephaloceles while performing septoplasties because minimal manipulation of these entities may potentially result in postoperative CSF leakage.

Principles of Skull Base Reconstruction After Ablative Head and Neck Cancer Surgery

2010 ◽  
Vol 2 (1) ◽  
pp. 87-94 ◽  
Author(s):  
Joseph Curry ◽  
Zoukaa Sargi
Keyword(s):  
Cerebrospinal Fluid ◽  
Head And Neck Cancer ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Craniofacial Skeleton ◽  
Skull Base Reconstruction ◽  
Technical Aspects ◽  
The Individual ◽  
Skull Base Defects ◽  
Fluid Leak

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.

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