Lumbar Drains Decrease the Risk of Post-Operative Cerebrospinal Fluid (CSF) Leak Following Extended Endonasal Endoscopic Surgery for Suprasellar Meningiomas in Patients with High BMI

2016 ◽  
Vol 77 (S 01) ◽  
Author(s):  
Salomon Cohen ◽  
Theodore Schwartz ◽  
Vijay Anand
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Surgery ◽  
Csf Leak ◽  
Endonasal Endoscopic Surgery ◽  
High Bmi

Lumbar Drains Decrease the Risk of Postoperative Cerebrospinal Fluid Leak Following Endonasal Endoscopic Surgery for Suprasellar Meningiomas in Patients With High Body Mass Index

2017 ◽  
Vol 14 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Salomon Cohen ◽  
Samuel H Jones ◽  
Sivashanmugam Dhandapani ◽  
Hazem M Negm ◽  
Vijay K Anand ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cerebrospinal Fluid ◽  
Surgical Resection ◽  
Body Mass ◽  
Endoscopic Surgery ◽  
High Body Mass Index ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Consecutive Series ◽  
Endonasal Endoscopic Surgery

Abstract BACKGROUND Postoperative cerebrospinal fluid (CSF) leak is a persistent, albeit much less prominent, complication following endonasal endoscopic surgery. The pathology with highest risk is suprasellar meningiomas. A postoperative lumbar drain (LD) is used to decrease the risk of CSF leak but is not universally accepted. OBJECTIVE To compare the rates of postoperative CSF leak between patients with and without LD who underwent endonasal endoscopic surgical resection of suprasellar meningiomas. METHODS A consecutive series of newly diagnosed suprasellar meningiomas was drawn from a prospectively acquired database of endonasal endoscopic surgeries at our institution. An intraoperative, preresection LD was placed and left open at 5 cc/h for ∼48 h. In a subset of patients, the LD could not be placed. Rates of postoperative CSF leak were compared between patients with and without an LD. RESULTS Twenty-five patients underwent endonasal endoscopic surgical resection of suprasellar meningiomas. An LD could not be placed in 2 patients. There were 2 postoperative CSF leaks (8%), both of which occurred in the patients who did not have an LD (P = .0033). The average body mass index (BMI) of the patients in whom the LD could not be placed was 39.1 kg/m2, compared with 27.6 kg/m2 for those in whom the LD could be placed (P = .009). In the subgroup of obese patients (BMI > 30 kg/m2), LD placement was protective against postoperative CSF leak (P = .022). CONCLUSION The inability to place an LD in patients with obesity is a risk factor for postoperative CSF leak. An LD may be useful to prevent postoperative CSF leak, particularly in patients with elevated BMI.

scholarly journals Oropharyngeal CSF Leak Secondary to Anterior Cervical Discectomy and Fusion

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Wyatt J. Weinheimer ◽  
Justin G. Rowley ◽  
Randal Otto ◽  
John Floyd ◽  
Philip G. Chen
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Endoscopic Surgery ◽  
Fusion Imaging ◽  
Anterior Cervical Discectomy ◽  
Csf Leak ◽  
Cervical Discectomy ◽  
Csf Fistula ◽  
Second Procedure ◽  
Csf Leaks

We present a case of an oropharyngeal cerebrospinal fluid (CSF) fistula in a patient that presented with headache, rhinorrhea, and pneumocephalus years after an anterior cervical discectomy and fusion. Imaging suggested a defect in the fovea ethmoidalis, but endoscopic surgery revealed the defect in the oropharynx. A second procedure was performed to remove the spinal hardware and repair the leak. This case is not only unique in the literature but also highlights the importance of maintaining a broad differential diagnosis to include rare complications and shows that despite dramatic improvements in imaging, locating CSF leaks still presents a challenge.

scholarly journals Reoperative endoscopic endonasal surgery for residual or recurrent pituitary adenomas

2017 ◽  
Vol 127 (2) ◽  
pp. 397-408 ◽  
Author(s):  
Hazem M. Negm ◽  
Rafid Al-Mahfoudh ◽  
Manish Pai ◽  
Harminder Singh ◽  
Salomon Cohen ◽  
...  
Keyword(s):  
Endoscopic Surgery ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Residual Tumor ◽  
Csf Leak ◽  
Categorical Variables ◽  
Recurrent Tumor ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Endonasal Endoscopic Surgery

OBJECTIVERegrowth of the lesion after surgical removal of pituitary adenomas is uncommon unless subtotal resection was originally achieved in the first surgery. Treatment for recurrent tumor can involve surgery or radiotherapy. Locations of residual tumor may vary based on the original approach. The authors evaluated the specific sites of residual or recurrent tumor after different transsphenoidal approaches and describe the surgical outcome of endoscopic endonasal transsphenoidal reoperation.METHODSThe authors analyzed a prospectively collected database of a consecutive series of patients who had undergone endoscopic endonasal surgeries for residual or recurrent pituitary adenomas after an original transsphenoidal microscopic or endoscopic surgery. The site of the recurrent tumor and outcome after reoperation were noted and correlated with the primary surgical approach. The chi-square or Fisher exact test was used to compare categorical variables, and the Mann-Whitney U-test was used to compare continuous variables between surgical groups.RESULTSForty-one patients underwent surgery for residual/recurrent pituitary adenoma from 2004 to 2015 at Weill Cornell Medical College. The previous treatment was a transsphenoidal microscopic (n = 22) and endoscopic endonasal (n = 19) surgery. In 83.3% patients (n = 30/36) there was postoperative residual tumor after the initial surgery. A residual tumor following endonasal endoscopic surgery was less common in the sphenoid sinus (10.5%; 2/19) than it was after microscopic transsphenoidal surgery (72.7%; n =16/22; p = 0.004). Gross-total resection (GTR) was achieved in 58.5%, and either GTR or near-total resection was achieved in 92.7%. Across all cases, the average extent of resection was 93.7%. The rate of GTR was lower in patients with Knosp-Steiner Grade 3–4 invasion (p < 0.0005). Postoperative CSF leak was seen in only one case (2.4%), which stopped with lumbar drainage. Visual fields improved in 52.9% (n = 9/17) of patients and were stable in 47% (n = 8/17). Endocrine remission was achieved in 77.8% (n = 14/18) of cases, 12 by surgery alone and 2 by adjuvant medical (n = 1) and radiation (n = 1) therapy. New diabetes insipidus occurred in 4.9% (n = 2/41) of patients—in one of whom an additional single anterior hormonal axis was compromised—and 9.7% (n = 4/41) of patients had a new anterior pituitary hormonal insufficiency.CONCLUSIONSEndonasal endoscopic reoperation is extremely effective at removing recurrent or residual pituitary adenomas that remain after a prior surgery, and it may be preferable to radiation therapy particularly in symptomatic patients. Achievement of GTR is less common when lateral cavernous sinus invasion is present. The locations of residual/recurrent tumor were more likely sphenoidal and parasellar following a prior microscopic transsphenoidal surgery and sellar following a prior endonasal endoscopic surgery.

scholarly journals Cerebrospinal fluid rhinorrhoea: an overview of endoscopic multilayer repair

2016 ◽  
Vol 2 (4) ◽  
pp. 180
Author(s):  
Mohammed Shoeb ◽  
Shashikant Mhashal ◽  
Vinod Gite ◽  
Samir Bhargava
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Surgery ◽  
Septal Cartilage ◽  
Graft Material ◽  
Endoscopic Repair ◽  
Intracranial Surgery ◽  
Endonasal Endoscopic Surgery ◽  
Csf Leakage ◽  
Csf Rhinorrhoea ◽  
Ct And Mri

<p class="abstract"><strong>Background:</strong> A cerebrospinal fluid (CSF) rhinorrhoea occurs when there is communication between the subarachnoid space and the nasal cavity. CSF rhinorrhoea commonly occurs following head trauma (fronto-basal skull fractures), as a result of intracranial surgery or spontaneously. The aim of our article was to emphasize the importance of endonasal endoscopic surgery using multilayer autograft technique.</p><p class="abstract"><strong>Methods:</strong> A total of 08 cases of CSF rhinorrhoea were treated. A retrospective study was undertaken to analyze the characteristics of 08 patients. After detailed otorhinolaryngoscopic examination, diagnostic nasal endoscopy and radiological evaluation by CT and MRI, all underwent endonasal endoscopic surgery. This article reviews the causes, diagnosis and treatment of CSF leakage of cases done with a 0 degree 4 mm sinoscope using fascia lata septal cartilage and fat as a graft material.  </p><p class="abstract"><strong>Results:</strong> The defects as large as 1.5 cm could be safely treated with this technique. The overall success rate of endoscopic repair for CSF rhinorrhoea has been 100%.</p><p><strong>Conclusions:</strong> Endonasal approach is less morbid compared with external approach. Endoscopic surgery gives better visualization.</p>

The Use of Methylene Blue Staining Test in Determining the CSF Leaks Location of the Anterior Skull Base

2018 ◽  
Vol 69 (6) ◽  
pp. 1376-1377
Author(s):  
Razvan Hainarosie ◽  
Teodora Ghindea ◽  
Irina Gabriela Ionita ◽  
Mura Hainarosie ◽  
Cristian Dragos Stefanescu ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Cerebrospinal Fluid ◽  
Intrathecal Injection ◽  
Diagnostic Procedures ◽  
Blue Staining ◽  
Csf Leak ◽  
Glucose Content ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage

Cerebrospinal fluid rhinorrhea represents drainage of cerebrospinal fluid into the nasal cavity. The first steps in diagnosing CSF rhinorrhea are a thorough history and physical examination of the patient. Other diagnostic procedures are the double ring sign, glucose content of the nasal fluid, Beta-trace protein test or beta 2-transferrin. To establish the exact location of the defect imagistic examinations are necessary. However, the gold standard CSF leakage diagnostic method is an intrathecal injection of fluorescein with the endoscopic identification of the defect. In this paper we analyze a staining test, using Methylene Blue solution, to identify the CSF leak�s location.

scholarly journals Cerebrospinal fluid leakage after cranial surgery in the pediatric population—a systematic review and meta-analysis

2021 ◽  
Author(s):  
Emma M. H. Slot ◽  
Kirsten M. van Baarsen ◽  
Eelco W. Hoving ◽  
Nicolaas P. A. Zuithoff ◽  
Tristan P. C van Doormaal
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Pediatric Population ◽  
Meta Analysis ◽  
Leakage Rate ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Cranial Surgery ◽  
Csf Leakage

Abstract Background Cerebrospinal fluid (CSF) leakage is a common complication after neurosurgical intervention. It is associated with substantial morbidity and increased healthcare costs. The current systematic review and meta-analysis aim to quantify the incidence of cerebrospinal fluid leakage in the pediatric population and identify its risk factors. Methods The authors followed the PRISMA guidelines. The Embase, PubMed, and Cochrane database were searched for studies reporting CSF leakage after intradural cranial surgery in patients up to 18 years old. Meta-analysis of incidences was performed using a generalized linear mixed model. Results Twenty-six articles were included in this systematic review. Data were retrieved of 2929 patients who underwent a total of 3034 intradural cranial surgeries. Surprisingly, only four of the included articles reported their definition of CSF leakage. The overall CSF leakage rate was 4.4% (95% CI 2.6 to 7.3%). The odds of CSF leakage were significantly greater for craniectomy as opposed to craniotomy (OR 4.7, 95% CI 1.7 to 13.4) and infratentorial as opposed to supratentorial surgery (OR 5.9, 95% CI 1.7 to 20.6). The odds of CSF leakage were significantly lower for duraplasty use versus no duraplasty (OR 0.41 95% CI 0.2 to 0.9). Conclusion The overall CSF leakage rate after intradural cranial surgery in the pediatric population is 4.4%. Risk factors are craniectomy and infratentorial surgery. Duraplasty use is negatively associated with CSF leak. We suggest defining a CSF leak as “leakage of CSF through the skin,” as an unambiguous definition is fundamental for future research.

Simulation of Cerebrospinal Fluid Leak Repair Using a 3-Dimensional Printed Model

2021 ◽  
pp. 194589242110035
Author(s):  
Muhamed A. Masalha ◽  
Kyle K. VanKoevering ◽  
Omar S. Latif ◽  
Allison R. Powell ◽  
Ashley Zhang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Great Part ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Clinical Environment ◽  
Training Tool ◽  
3 Dimensional ◽  
Clinical Scenarios ◽  
Before And After ◽  
3D Printed

Background Acquiring proficiency for the repair of a cerebrospinal fluid (CSF) leak is challenging in great part due to its relative rarity, which offers a finite number of training opportunities. Objective The purpose of this study was to evaluates the use of a 3-dimensional (3D) printed, anatomically accurate model to simulate CSF leak closure. Methods Volunteer participants completed two simulation sessions. Questionnaires to assess their professional qualifications and a standardized 5-point Likert scale to estimate the level of confidence, were completed before and after each session. Participants were also queried on the overall educational utility of the simulation. Results Thirteen otolaryngologists and 11 neurosurgeons, met the inclusion criteria. A successful repair of the CSF leak was achieved by 20/24 (83.33%), and 24/24 (100%) during the first and second simulation sessions respectively (average time 04:04 ± 1.39 and 02:10 ± 01:11). Time-to-close-the-CSF-leak during the second session was significantly shorter than the first (p < 0.001). Confidence scores increased across the training sessions (3.3 ± 1.0, before the simulation, 3.7 ± 0.6 after the first simulation, and 4.2 ± 0.4 after the second simulation; p < 0.001). All participants reported an increase in confidence and believed that the model represented a valuable training tool. Conclusions Despite significant differences with varying clinical scenarios, 3D printed models for cerebrospinal leak repair offer a feasible simulation for the training of residents and novice surgeons outside the constrictions of a clinical environment.

scholarly journals Symptom assessment after nasal irrigation with xylitol in the postoperative period of endonasal endoscopic surgery

2020 ◽  
Author(s):  
Caroline Feliz Fonseca Sepeda da Silva ◽  
Flávia Emilly Rodrigues da Silva ◽  
Henrique Furlan Pauna ◽  
Johann Gustavo Guilhermo Melcherts Hurtado ◽  
Marco Cesar Santos
Keyword(s):  
Endoscopic Surgery ◽  
Postoperative Period ◽  
Symptom Assessment ◽  
Nasal Irrigation ◽  
Endonasal Endoscopic Surgery
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