scholarly journals Primary Closure of a Cerebrospinal Fluid Fistula by Nonpenetrating Titanium Clips in Endoscopic Endonasal Transsphenoidal Surgery: Technical Note

Skull Base ◽  
2010 ◽  
Vol 21 (01) ◽  
pp. 047-052 ◽  
Author(s):  
Hiroyuki Kobayashi ◽  
Katsuyuki Asaoka ◽  
Shunsuke Terasaka ◽  
Jun-ich Murata
Keyword(s):  
Cerebrospinal Fluid ◽  
Transsphenoidal Surgery ◽  
Primary Closure ◽  
Technical Note ◽  
Cerebrospinal Fluid Fistula ◽  
Endoscopic Endonasal ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Titanium Clips ◽  
Fluid Fistula

Easy Sellar Reconstruction in Endoscopic Endonasal Transsphenoidal Surgery with Polyester-Silicone Dural Substitute and Fibrin Glue: Technical Note

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 473-476 ◽  
Author(s):  
Paolo Cappabianca ◽  
Luigi Maria Cavallo ◽  
Giuseppe Mariniello ◽  
Oreste de Divitiis ◽  
Alicia Del Carmen Becerra Romero ◽  
...  
Keyword(s):  
Fibrin Glue ◽  
Transsphenoidal Surgery ◽  
Technical Note ◽  
Easy Method ◽  
Endoscopic Endonasal ◽  
Simple Method ◽  
Dural Substitute ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Watertight Closure ◽  
Sellar Reconstruction

Abstract OBJECTIVE To describe a simple method of sellar reconstruction after endoscopic endonasal transsphenoidal surgery that will allow rapid watertight closure of the sellar floor. METHODS A bent sheet of a polyester-silicone dural substitute, fashioned for this purpose with scissors, is introduced into the sella after removal of the lesion. Because of the consistency of the sheet, it opens spontaneously and becomes stuck. Autologous fat tissue or gelatin foam is positioned thereafter, followed by another layer of the dural substitute; a film of fibrin glue completes the sealing. RESULTS Fifteen patients underwent this method and no postoperative cerebrospinal leak or other complication was experienced. CONCLUSION This easy method of sellar reconstruction represents an effective and fast possibility to perform the final step of the endoscopic transsphenoidal procedure, which otherwise may cause maneuverability problems in the limited space of one nostril.

scholarly journals The efficacy of an endoscopic endonasal approach in the repair of cerebrospinal fluid fistula: a clinical analysis

2019 ◽  
Vol 5 (4) ◽  
pp. 90
Author(s):  
Fulya Ozer ◽  
Can Alper Cagici ◽  
Cem Ozer ◽  
Cuneyt Yilmazer
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Approach ◽  
Graft Material ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Cerebrospinal Fluid Fistula ◽  
Endoscopic Repair ◽  
Endoscopic Endonasal ◽  
Csf Leakage ◽  
Fluid Fistula

<p class="abstract"><strong>Background:</strong> Cerebrospinal fluid (CSF) fistula is an abnormal CSF leakage due to bone and/or dural defect of the skull base and usually operated with endonasal endoscopic approach. The aim of this study was to determine the efficacy of an endonasal endoscopic approach in the repair of CSF leakage and to find the reasons of the recurrence of endoscopic procedure.</p><p class="abstract"><strong>Methods:</strong> The medical records of 24 patients that presented with the diagnosis of cerebrospinal fluid fistula and who had undergone endonasal endoscopic repair surgery were reviewed retrospectively.  </p><p class="abstract"><strong>Results:</strong> 13 patients (54.2%) were found to have spontaneous CSF fistulas without any history of trauma, while 11 patients (45.8%) had posttraumatic CSF fistulas. The mean body mass index (BMI) of patients was 31. 3 kg/m² (20.1-49.6). Nasal septal cartilage was used as a graft material in 19 patients (79%) while only fascia was used in 5 patients (21%). The evaluation of long-term results revealed recurrence in 4 patients (16.6%). Two of these patients required a second surgical repair.</p><p class="abstract"><strong>Conclusions:</strong> An endoscopic endonasal approach is a safe method with less morbidity and a reliable outcome in the repair of CSF fistulas. The most important causative factors in the recurrence of endoscopic repair of CSF leak might be to have high BMI and not to use multilayered graft material for closure of fistula.</p><p class="abstract"> </p>

Opiate Use After Endoscopic Endonasal Transsphenoidal Surgery

2021 ◽  
pp. 194589242110619
Author(s):  
Tara J. Wu ◽  
Reza Kianian ◽  
Emmanuel G. Villalpando ◽  
Morcos N. Nakhla ◽  
Christine Wells ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Transsphenoidal Surgery ◽  
Endoscopic Endonasal ◽  
Opiate Use ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Cerebrospinal Fluid Leaks ◽  
Grade 3

Background The literature on opiate use after endoscopic endonasal transsphenoidal surgery (EETS) is limited. Objective To determine the risk factors for higher opiate use following EETS and the quantity of opiates used after discharge. Methods A retrospective review of 144 patients undergoing EETS from July 2018 to July 2020 was conducted. Patient, tumor, and surgical factors were documented. Pain scores and medications used on postoperative days (POD) 0 and 1, and discharge prescriptions, were recorded. Opiate use was quantified using morphine milligram equivalents (MME) dose. Multiple linear regression determined risk factors independently associated with POD0 to 1 opiate use. Results On POD 0 to 1, mean pain score was 4.9/10 (standard deviation [SD] ± 2.0). Mean acetaminophen use was 3.4 tablets (SD ± 1.6; 650 mg per tablet). Mean opiate use was 35.6 MME (SD ± 36.3), equivalent to 4.7 tablets (SD ± 4.8) of oxycodone 5 mg. Multiple linear regression showed that current smokers required an additional 37.1 MME ( P = .011), and patients with grade 3 intraoperative cerebrospinal fluid leaks required an additional 36.7 MME ( P = .046) on POD0 to 1. On discharge, mean opiate prescription was 117.7 MME (SD ± 102.1), equivalent to 15.7 tablets (SD ± 13.6) of oxycodone 5 mg. Thirty-nine patients (27.1%) did not require prescriptions. Only 10 patients (6.9%) required opiate refill(s) within 30 days after surgery. Conclusion Patients undergoing EETS have higher opiate needs compared to those undergoing endoscopic sinus surgery, although the overall requirements are still considered low. Independent risk factors associated with higher opiate use in the immediate postoperative period included current smokers and grade 3 intraoperative cerebrospinal fluid leaks.

Novel Equine Collagen-Only Dural Substitute

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONSE273-ONSE274 ◽  
Author(s):  
Francesco Biroli ◽  
Felice Esposito ◽  
Mario Fusco ◽  
Giorgio G. Bani ◽  
Antonio Signorelli ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Bone Flap ◽  
Neurological Deficits ◽  
Neurosurgical Procedures ◽  
Cerebrospinal Fluid Fistula ◽  
Endoscopic Endonasal ◽  
Systemic Complications ◽  
Dural Substitute ◽  
Dural Closure ◽  
Fluid Fistula

Abstract Objective: A watertight and meticulous dural closure is an essential step after intradural neurosurgical procedures. When such a task cannot be performed, dural replacement materials and other adjunctive measures can provide an effective barrier between the subarachnoid compartment and the extradural space. Methods: We present our experience with a novel collagen-derived dural substitute in a series of 114 patients undergoing a variety of neurosurgical procedures. The patients were clinically or neuroradiologically observed, for immediate and delayed local or systemic complications related to the implant. In three patients who underwent reoperation after decompressive duraplasty and craniectomy for bone flap repositioning, we performed biopsy of the dural implant for histopathological studies. Results: None of the patients experienced local or systemic complications or toxicity related to the dural patch. None of the patients experienced a postoperative cerebrospinal fluid fistula, except one patient who underwent an endoscopic endonasal transsphenoidal marsupialization of a large intrasuprasellar arachnoid cyst; the fistula required reoperation for cerebrospinal fluid fistula repair and intravenous antibiotic therapy for bacterial meningitis. Postoperative magnetic resonance imaging scans showed signs of severe inflammatory response in only one patient who did not present any postoperative clinical symptom or neurological deficits. Three patients underwent reoperation for bone flap repositioning after decompressive craniectomy; in all patients, the dural substitute appeared to have promoted satisfactory dural regeneration, as confirmed by the histological studies. Furthermore, in such patients, no or minimal adherence with the other tissues and the brain cortex was observed. Conclusion: This study demonstrates that the new collagen-only biomatrix is a safe and effective dural substitute for routine neurosurgical procedures. The absence of local and systemic toxicity or complications and the scarce promotion of adherences and inflammation make this material appealing for its use as a dural substitute, even in cases in which the necessity of reoperation is foreseen.

scholarly journals Modified Hemostatic Technique Using Microfibrillar Collagen Hemostat in Endoscopic Endonasal Transsphenoidal Surgery: Technical Note

2014 ◽  
Vol 54 (8) ◽  
pp. 617-621 ◽  
Author(s):  
Yasunori FUJIMOTO ◽  
Taisuke KOBAYASHI ◽  
Masahiro KOMORI ◽  
Pedro MARIANI ◽  
Edson BOR-SENG-SHU ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Technical Note ◽  
Endoscopic Endonasal ◽  
Endoscopic Endonasal Transsphenoidal Surgery
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