scholarly journals Primary Dural Closure for Retrosigmoid Approaches

2017 ◽  
Vol 79 (04) ◽  
pp. 330-334 ◽  
Author(s):  
Garrett Venable ◽  
Mallory Roberts ◽  
Ryan Lee ◽  
L. Michael
Keyword(s):  
Posterior Fossa ◽  
Primary Closure ◽  
Chart Review ◽  
Tumor Resection ◽  
Retrospective Chart Review ◽  
Csf Leak ◽  
Dural Defect ◽  
Dural Closure ◽  
Lesion Type ◽  
Csf Leaks

Object Primary closure of posterior fossa dura can be challenging, and postoperative cerebrospinal fluid (CSF) leaks continue to represent a common complication of the retrosigmoid approach. We describe a simple technique to allow for primary closure of the dura following retrosigmoid approaches. The incidence of CSF leaks using this method is reported. Methods A retrospective chart review was conducted on all cases of retrosigmoid craniotomies performed by the senior surgeon from February 2009 to February 2015. The primary outcome was development of postoperative CSF leak or pseudomeningocele. Length of stay, lesion type, and other surgical complications were also reported. Results Eighty-six patients underwent a retrosigmoid craniotomy during the study period. The most common indications for retrosigmoid craniotomy were microvascular decompression (58%) and tumor resection (36%). No allo- or autografts to repair the dural defect were needed, and no lumbar drains were used. No patients developed CSF otorrhea, rhinorrhea, or incisional leak postoperatively. Conclusion Primary dural closure is possible in retrosigmoid approaches without the use of allo- or autografts and may prevent postoperative CSF leaks when combined with other posterior fossa closure techniques. Careful attention to the handling of the dural flap is necessary to achieve this.

Graft dural closure is associated with a reduction in CSF leak and hydrocephalus in pediatric patients undergoing posterior fossa brain tumor resection

2020 ◽  
Vol 25 (3) ◽  
pp. 228-234
Author(s):  
Andrew T. Hale ◽  
Stephen R. Gannon ◽  
Shilin Zhao ◽  
Michael C. Dewan ◽  
Ritwik Bhatia ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Wound Infection ◽  
Posterior Fossa ◽  
Pediatric Patients ◽  
Tumor Resection ◽  
Csf Leak ◽  
Multivariate Logistic Regression ◽  
Dural Closure ◽  
Csf Diversion ◽  
Persistent Hydrocephalus

OBJECTIVEThe authors aimed to evaluate clinical, radiological, and surgical factors associated with posterior fossa tumor resection (PFTR)–related outcomes, including postoperative complications related to dural augmentation (CSF leak and wound infection), persistent hydrocephalus ultimately requiring permanent CSF diversion after PFTR, and 90-day readmission rate.METHODSPediatric patients (0–17 years old) undergoing PFTR between 2000 and 2016 at Monroe Carell Jr. Children’s Hospital of Vanderbilt University were retrospectively reviewed. Descriptive statistics included the Wilcoxon signed-rank test to compare means that were nonnormally distributed and the chi-square test for categorical variables. Variables that were nominally associated (p < 0.05) with each outcome by univariate analysis were included as covariates in multivariate linear regression models. Statistical significance was set a priori at p < 0.05.RESULTSThe cohort consisted of 186 patients with a median age at surgery of 6.62 years (range 3.37–11.78 years), 55% male, 83% Caucasian, and average length of follow-up of 3.87 ± 0.25 years. By multivariate logistic regression, the variables primary dural closure (PDC; odds ratio [OR] 8.33, 95% confidence interval [CI] 1.07–100, p = 0.04), pseudomeningocele (OR 7.43, 95% CI 2.23–23.76, p = 0.0007), and hydrocephalus ultimately requiring permanent CSF diversion within 90 days of PFTR (OR 9.25, 95% CI 2.74–31.2, p = 0.0003) were independently associated with CSF leak. PDC versus graft dural closure (GDC; 35% vs 7%, OR 5.88, 95% CI 2.94–50.0, p = 0.03) and hydrocephalus ultimately requiring permanent CSF diversion (OR 3.30, 95% CI 1.07–10.19, p = 0.0007) were associated with wound infection requiring surgical debridement. By multivariate logistic regression, GDC versus PDC (23% vs 37%, OR 0.13, 95% CI 0.02–0.87, p = 0.04) was associated with persistent hydrocephalus ultimately requiring permanent CSF diversion, whereas pre- or post-PFTR ventricular size, placement of peri- or intraoperative extraventricular drain (EVD), and radiation therapy were not. Furthermore, the addition of perioperative EVD placement and dural closure method to a previously validated predictive model of post-PFTR hydrocephalus improved its performance from area under the receiver operating characteristic curve of 0.69 to 0.74. Lastly, the authors found that autologous (vs synthetic) grafts may be protective against persistent hydrocephalus (p = 0.02), but not CSF leak, pseudomeningocele, or wound infection.CONCLUSIONSThese results suggest that GDC, independent of potential confounding factors, may be protective against CSF leak, wound infection, and hydrocephalus in patients undergoing PFTR. Additional studies are warranted to further evaluate clinical and surgical factors impacting PFTR-associated complications.

scholarly journals Circumferential Watertight Dural Repair Using Nitinol U-Clips in Expanded Endonasal and Sublabial Approaches to the Cranial Base

2010 ◽  
Vol 67 (suppl_2) ◽  
pp. ons448-ons456 ◽  
Author(s):  
Francesco Acerbi ◽  
Eric Genden ◽  
Joshua Bederson
Keyword(s):  
Vascular Diseases ◽  
Cranial Base ◽  
Csf Leak ◽  
Melanoma Metastasis ◽  
Dural Repair ◽  
Dural Closure ◽  
Tuberculum Sellae ◽  
Planum Sphenoidale ◽  
Sublabial Approach ◽  
Csf Leaks

ABSTRACT BACKGROUND: In recent years, significant advances have been made in the field of expanded endonasal approaches that permit treatment of different cranial base intradural lesions. OBJECTIVE: To report our technique of cranial base dural repair by the application of nitinol U-Clips in endoscope-assisted extended endonasal or sublabial approaches. Closure techniques and postoperative cerebrospinal (CSF) leaks are reported. METHODS: We reviewed 11 patients with different kinds of cranial base tumors or vascular diseases (2 tuberculum sellae meningiomas, 1 planum sphenoidale meningioma, 4 craniopharyngiomas, 1 recurrent clival chordoma, 1 esthesioneuroblastoma, 1 ethmoidal melanoma metastasis, 1 basilar trunk aneurysm) who underwent an endoscope-assisted extended endonasal or sublabial approach. Dural repair was performed using nitinol U-Clips to circumferentially suture AlloDerm or fascia lata directly to the existing dural borders. Lumbar drainage was not used in 9 patients and was used in 2 patients for 5 days. Patients were evaluated for the appearance of CSF leaks. RESULTS: Postoperative CSF leak was observed in 1 patient (9%). This required a second transnasal repair. CONCLUSION: Circumferential dural closure with U-Clips is a useful adjunct to prevent CSF leaks after expanded endonasal or sublabial approaches to the cranial base for treatment of intracranial pathology.

Endoscopic temporal ventriculocisternostomy: an option for the treatment of trapped temporal horns

2013 ◽  
Vol 11 (5) ◽  
pp. 568-574 ◽  
Author(s):  
Anna K. Krähenbühl ◽  
Jörg Baldauf ◽  
Michael R. Gaab ◽  
Henry W. S. Schroeder
Keyword(s):  
Chart Review ◽  
Standard Treatment ◽  
Tumor Resection ◽  
Retrospective Chart Review ◽  
Septum Pellucidum ◽  
The Other ◽  
Rare Form ◽  
Temporal Horn ◽  
Multiloculated Hydrocephalus ◽  
Postoperative Meningitis

Entrapment of the temporal horn is a rare form of isolated hydrocephalus. Standard treatment has not yet been established for this condition, and only a few cases have been reported in the literature. The authors reviewed their prospectively maintained database to report their experience with endoscopic temporal ventriculocisternostomy. All endoscopic operations performed in the Department of Neurosurgery at Ernst Moritz Arndt University between March 1993 and August 2012 were reviewed, and a retrospective chart review of all patients with temporal ventriculocisternostomy was performed. Four patients were identified (3 children and 1 adult). In 3 patients, the condition developed after tumor resection, and in 1 patient it developed due to postmeningitic multiloculated hydrocephalus. In 2 patients, a recurrent trapped temporal horn developed. Refenestration was successful in one of these patients, and dilation in the trigone area with a subsequent stomy of the septum pellucidum was successful in the other. In 1 patient, postoperative meningitis developed, which was treated with antibiotics. Endoscopic temporal ventriculocisternostomy is an option in the treatment of trapped temporal horns. However, more experience is required to recommend it as the treatment of choice.

Petrous Apex Pneumatization: Influence on Postoperative Cerebellopontine Angle Tumor Cerebrospinal Fluid Fistula

2018 ◽  
Vol 127 (9) ◽  
pp. 604-607
Author(s):  
Matthew Shew ◽  
Thomas Muelleman ◽  
Michael Harris ◽  
Michael Li ◽  
Kevin Sykes ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Risk Factor ◽  
Cerebellopontine Angle ◽  
Tumor Resection ◽  
Retrospective Chart Review ◽  
Csf Leak ◽  
Petrous Apex ◽  
Csf Rhinorrhea ◽  
Csf Fistula ◽  
Communication Pathway

Objective: Multiple investigators have sought to identify risk factors for cerebrospinal fluid (CSF) leak following cerebellopontine angle (CPA) tumor resection. We evaluated whether pneumatization of the petrous apex (PA) is a risk factor for CSF fistula. Method: We conducted a retrospective chart review at 2 major tertiary academic institutions undergoing CPA tumor resection and analyzed their respective head or temporal computed tomography (CT) scans if available. Results: A total of 91 cases were identified; 51 (64%) demonstrated PA pneumatization, and a total of 17 CSF leaks were identified. We discovered higher rates of CSF leak (25.0% vs 13.7%; P = .273) and CSF rhinorrhea (15.0% vs 5.9%; P = .174) in patients with PA pneumatization compared to those without PA pneumatization. Conclusions: Isolated PA pneumatization may be a risk factor and communication pathway for CSF fistula. Further studies will need to be broadened across multiple institutions to draw any additional and stronger conclusions.

Closure of large skull base defects after endoscopic transnasal craniotomy

2009 ◽  
Vol 111 (2) ◽  
pp. 371-379 ◽  
Author(s):  
Richard J. Harvey ◽  
João F. Nogueira ◽  
Rodney J. Schlosser ◽  
Sunil J. Patel ◽  
Eduardo Vellutini ◽  
...  
Keyword(s):  
Skull Base ◽  
Csf Leak ◽  
Dural Defect ◽  
Medical Centers ◽  
Dural Defects ◽  
Ventral Skull Base ◽  
Skull Base Defects ◽  
Reconstructive Techniques ◽  
Csf Leaks

Object The authors describe the utility of and outcomes after endoscopic transnasal craniotomy and skull reconstruction in the management of skull base pathologies. Methods The authors conducted a observational study of patients undergoing totally endoscopic, transnasal, transdural surgery. The patients included in the study underwent treatment over a 12-month period at 2 tertiary medical centers. The pathological entity, region of the ventral skull base resected, and size of the dural defect were recorded. Approach-related complications were documented, as well as CSF leaks, infections, bleeding-related complications, and any minor complications. Results Thirty consecutive patients were assessed during the study period. The patients had a mean age of 45.5 ± 20.2 years and a mean follow-up period of 182.4 ± 97.5 days. The dural defects reconstructed were as large as 5.5 cm (mean 2.49 ± 1.36 cm). One patient (3.3%) had a CSF leak that was managed endoscopically. Two patients had epistaxis that required further care, but there were no complications related to intracranial infections or bleeding. Some minor sinonasal complications occurred. Conclusions Skull base endoscopic reconstructive techniques have significantly advanced in the past decade. The use of pedicled mucosal flaps in the reconstruction of large dural defects resulting from an endoscopic transnasal craniotomy permits a robust repair. The CSF leak rate in this study is comparable to that achieved in open approaches. The ability to manage the skull base defects successfully with this approach greatly increases the utility of transnasal endoscopic surgery.

The Effect of Neural Lesion Type on Botulinum Toxin Dosage: A Retrospective Chart Review

PM&R ◽  
2013 ◽  
Vol 6 (5) ◽  
pp. 406-411 ◽  
Author(s):  
Chetan P. Phadke ◽  
Caitlin Davidson ◽  
Farooq Ismail ◽  
Chris Boulias
Keyword(s):  
Botulinum Toxin ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Lesion Type

scholarly journals Augmentation of dural closure following cerebro-spinal surgeries using Evicel- an experience of 105 patients in India

2021 ◽  
Vol 8 (4) ◽  
pp. 1211
Author(s):  
Batuk D. Diyora ◽  
Nilesh More ◽  
Gagan Dhali
Keyword(s):  
Fibrin Sealant ◽  
Tissue Adhesive ◽  
Dural Defect ◽  
Dural Closure ◽  
Csf Leakage ◽  
Fluid Collections ◽  
Incidental Durotomy ◽  
Dural Suture ◽  
Neurological Surgery ◽  
Csf Leaks

Background: For the neurosurgeon, CSF leaks are a frustrating post-operative complication, and for the patient, it can result in unanticipated morbidity and mortality. Immediate intra-operative recognition of incidental durotomy and dural closure may avoid it. Fibrin sealant is a two-component topical hemostat, dura sealant, and tissue adhesive consisting of fibrinogen and thrombin. We conducted this study to evaluate the efficacy of fibrin sealant Evicel in the management of postoperative CSF leaks as an adjunct to dural suture in patients undergoing a variety of neurosurgical procedures.Methods: This was a retrospective, single-center clinical study conducted on 105 patients who underwent elective neurological surgery from August 2015 to May 2016 at Sion Hospital, India. The efficacy endpoint was the prevention of clinically evident and verified postoperative CSF leak.Results: In all patients, the dural defect was effectively repaired intraoperatively, indicated by the absence of CSF leakage. The success rate of using Evicel was 100% in our cohort for the durasealant efficacy. No adverse effects were reported.Conclusions: We conclude that the use of fibrin sealant Evicel was successful to manage CSF leaks and achieve predictable watertight dural closure resulting in a reduction of intraoperative and postoperative fluid collections. It possesses an acceptable safety profile, consistent with previous findings from other similar studies and studies evaluating the role of Evicel in other surgical indications.

Polyethylene Glycol Hydrogel Dural Sealant May Reduce Incisional Cerebrospinal Fluid Leak after Posterior Fossa Surgery

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS182-ONS187 ◽  
Author(s):  
Khoi D. Than ◽  
Clinton J. Baird ◽  
Alessandro Olivi
Keyword(s):  
Cerebrospinal Fluid ◽  
Polyethylene Glycol ◽  
Fibrin Glue ◽  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
P Value ◽  
Posterior Fossa Surgery ◽  
Dural Closure ◽  
Fluid Leak

Abstract Objective: Incisional cerebrospinal fluid (CSF) leak remains a significant cause of morbidity, particularly after posterior fossa surgery, with ranges between 4 and 17% in most series. We aimed to determine whether the use of a new polyethylene glycol (PEG) dural sealant product (DuraSeal; Confluent Surgical, Waltham, MA) is effective at preventing incisional CSF leak after posterior fossa surgery. Methods: One hundred cases of posterior fossa surgery with the PEG dural sealant applied at the time of dural closure were prospectively observed from May 2005 to April 2006. All patients underwent posterior fossa craniotomy or craniectomy. Clinical histories were followed to document cases of incisional CSF leak, pseudomeningocele, meningitis, wound infection, and interventions required to treat a CSF leak or pseudomeningocele. A retrospective cohort of 100 patients treated in a similar fashion but with fibrin glue augmented dural closure served as controls. Results: In the PEG group, two of 100 (2%) patients developed an incisional CSF leak postoperatively. By comparison, 10 of 100 (10%) patients in whom fibrin glue was used developed an incisional CSF leak. This difference was statistically significant, with a P value of 0.03. There were no significant differences in the rates of pseudomeningocele, meningitis, or other postoperative interventions. Conclusion: The application of PEG dural sealant to the closed dural edges may be effective at reducing incisional CSF leak after posterior fossa surgery.

Surgical Anatomy Of Dural Defects In Spontaneous Spinal Cerebrospinal Fluid Leaks

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-238-ONS-245 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Bahram Mokri ◽  
David G. Piepgras ◽  
Fredric B. Meyer ◽  
John L.D. Atkinson
Keyword(s):  
Cerebrospinal Fluid ◽  
Primary Closure ◽  
Surgical Anatomy ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Imaging Studies ◽  
Surgical Exploration ◽  
Csf Leakage ◽  
Dural Defects ◽  
Csf Leaks

Abstract Objective: Spontaneous intracranial hypotension is typically caused by a spontaneous spinal cerebrospinal fluid (CSF) leak. The configuration of the related dural defects can be complex. We describe our experience with the surgical anatomy of these defects. Methods: Thirteen consecutive patients with spontaneous spinal CSF leaks who underwent surgical exploration at Mayo Clinic between 1994 and 2003 were studied. All patients' records, imaging studies, detailed intraoperative findings, and outcomes were reviewed. Results: There were four men and nine women with an average age of 40 years (range, 12–62 yr). Preoperative imaging studies revealed a single site of CSF leak in eight patients, two sites in three patients, and multiple sites in two patients. Intraoperatively, the exact site of leakage could not be found in four patients. Among the other nine patients, primary closure of a meningeal diverticulum was achieved in one patient. Significant regional attenuation of the dura prevented primary repair of the leak site in eight patients. Muscle, fibrin glue, and Gelfoam (Upjohn Co., Kalamazoo, MI) soaked in patient's own blood were commonly used to pack the epidural space in an attempt to seal the site of the leak. Ligation of two nonappendicular nerve roots allowed closure of the leak in one of these patients. Postoperatively, resolution of symptoms occurred in eight patients, significant improvement was noted in three patients, and only transient resolution in two. The mean duration of follow-up was 20.5 months. Conclusion: Surgery for closure of spontaneous spinal CSF leaks may not be straightforward. Even when extradural CSF leakage is discovered preoperatively by imaging studies, it may not always be possible to identify the exact site of the leakage intraoperatively. Furthermore, the anatomy of the dural defects may be complex and not amenable to primary closure. In such cases, the use of adjuvant techniques during surgical exploration may be effective.

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