scholarly journals Transmastoid Repair of Spontaneous Cerebrospinal Fluid Leaks

2018 ◽  
Vol 79 (05) ◽  
pp. 451-457 ◽  
Author(s):  
Enrique Perez ◽  
Daniel Carlton ◽  
Matthew Alfarano ◽  
Eric Smouha

Objective Determine the efficacy of using a purely transmastoid approach for the repair of spontaneous cerebrospinal fluid (CSF) leaks and further elucidate the relationship of elevated body mass index (BMI) and skull base thickness in our patient population. Method We conducted a retrospective chart review of patients treated for spontaneous temporal bone CSF leaks at our tertiary care institution from the years 2006 to 2015. Cases were categorized as primary or secondary. We analyzed success rates, length of stay, use of lumbar drains, BMIs, and rates of meningitis. Skull base thickness was compared with BMI in each case. Results We identified 26 primary operations for spontaneous CSF leaks and 7 secondary operations. Twenty-three of 33 repairs were performed via the transmastoid approach alone with an 87% success rate (20/23). Of the10 repairs including a middle cranial fossa (MCF) or combined MCF-transmastoid approach, 2 failed for an 80% success rate (8/10). Five transmastoid repairs underwent placement of a lumbar drain versus all 10 repairs employing an intracranial exposure. Average length of stay for those undergoing a transmastoid approach (1.7 days) was significantly shorter than for patients undergoing a MCF repair (6.3 days). Four patients presented with meningitis. Average BMI was 35.3. No correlation was established between BMI and skull base thickness (R 2 = 0.00011). Conclusion The transmastoid approach is effective in the majority of cases and prevents the need for an intracranial operation, resulting in lower morbidity and a shorter length of stay. We believe that this is the preferred primary approach in most patients with spontaneous CSF leaks.

Author(s):  
Peter A. Benedict ◽  
Joseph R. Connors ◽  
Micah R. Timen ◽  
Nupur Bhatt ◽  
Richard Lebowitz ◽  
...  

Objective: Diagnosis of cerebrospinal fluid (CSF) leaks is sometimes challenging in the postoperative period following pituitary and ventral skull base surgery. Intrathecal fluorescein (ITF) may be useful in this setting. Design: Retrospective chart review Setting: Tertiary care center Methods and Participants: All patients who underwent pituitary and ventral skull base surgery performed by a single rhinologist between January 2017–March 2020 were included. There were 103 patients identified. Eighteen patients received 20 ITF injections due to clinical suspicion for CSF leak during the postoperative period without florid CSF rhinorrhea on clinical exam. Computed tomography scans with new or increasing intracranial air and intra-operative findings were used to confirm CSF leaks. Clinical courses were reviewed for at least 6 months after initial concern for leak as the final determinate of CSF leak. Main Outcome Measures: Specificity and safety of ITF Results: Eleven (61%) ITF patients were female and 7 (39%) were male. Average patient age was 52.50±11.89. There were 6 patients with confirmed postoperative CSF leaks, 3 of whom had evaluations with ITF. ITF use resulted in 2 true positives, 1 false negative, 17 true negatives and 0 false positives. ITF sensitivity was 67%, specificity was 100%, and positive and negative predictive values were 100% and 94.4%, respectively. There were no adverse effects from ITF use. Conclusions: Existing modalities for detecting postoperative CSF leaks suffer from suboptimal sensitivity and specificity, delayed result reporting, or limited availability. Intrathecal fluorescein represents a specific and safe test with potential utility in the postoperative setting.


2010 ◽  
Vol 124 (12) ◽  
pp. 1294-1297 ◽  
Author(s):  
P Thulasi Das ◽  
D Balasubramanian

AbstractObjective:To present our experience in managing cerebrospinal fluid rhinorrhoea using the cartilage inlay (underlay) technique to repair skull base defects larger than 4 mm.Study design:Retrospective study involving patients presenting with cerebrospinal fluid rhinorrhoea between 1994 and 2008.Setting:Patients were treated in a tertiary referral centre for nose and sinus diseases. Patients' medical records were reviewed and analysed.Results:A total of 62 patients were operated upon using a cartilage inlay technique to repair bony skull base defects ranging in size from 4 to 20 mm (widest diameter). Of these 62 patients, 16 constituted revisions of earlier procedures undertaken elsewhere. The success rate of the technique was 100 per cent. Patient follow up ranged from six months to 16 years, with a median follow up of 15 months. Three patients had minor post-operative sinus infections; no serious complications were encountered.Conclusion:Extradural cartilage inlay appears to be an effective technique in the management of cerebrospinal fluid rhinorrhoea, especially for large defects and revision procedures. To our knowledge, the described patients represent the largest reported series of cerebrospinal fluid rhinorrhoea cases managed using the cartilage inlay technique. We believe that the crucial factors in our high success rate for cerebrospinal fluid fistula repair are: precise identification of the bony defect; meticulous preparation of the graft bed; careful elevation of the dura; judicious use of just enough graft tissue; and adequate graft support.


2019 ◽  
Vol 81 (06) ◽  
pp. 645-650
Author(s):  
Roshni V. Khatiwala ◽  
Karthik S. Shastri ◽  
Maria Peris-Celda ◽  
Tyler Kenning ◽  
Carlos D. Pinheiro-Neto

Abstract Background The endoscopic endonasal approach (EEA) has become increasingly used for resection of skull base tumors in the sellar and suprasellar regions. A nasoseptal flap (NSF) is routinely used for anterior skull base reconstruction; however, there are numerous additional allografts and autografts being used in conjunction with the NSF. The role of perioperative cerebrospinal fluid (CSF) diversion is also unclear. Objective This study was aimed to analyze success of high-flow CSF leak repair during EEA procedures without use of CSF diversion through lumbar drainage. Methods A retrospective chart review of patients who had intraoperative high-flow CSF leak during EEA procedures at our institution between January 2013 and December 2017 was performed. CSF leaks were repaired with use of a fascia lata button graft and nasoseptal flap, without use of perioperative lumbar drains. Results A total of 38 patients were identified (10 male, 28 female). Patient BMIs ranged from 19.7 to 49 kg/m2 (median = 31 kg/m2), with 18 patients meeting criteria for obesity (BMI > 30 kg/m2) and 12 patients overweight (25 kg/m2 < BMI < 29.9 kg/m2). There was no incidence of postoperative CSF leak. Conclusion In our experience, the nasoseptal flap used in conjunction with the fascia lata button graft is a safe, effective and robust combination for cranial base reconstruction with high-flow intraoperative CSF leaks, without need for lumbar drains.


2018 ◽  
Vol 32 (4) ◽  
pp. 310-317 ◽  
Author(s):  
Kent Lam ◽  
Amber U. Luong ◽  
William C. Yao ◽  
Martin J. Citardi

Background The use of abdominal free fat is a traditional surgical method for the repair and reconstruction of the anterior skull base. Our objective is to assess the outcomes associated with the autologous fat graft to endoscopically repair anterior skull base defects at a single tertiary care center. Methods All patients, who underwent endoscopic skull base repair utilizing abdominal free fat from September 2009 to June 2016, were included for retrospective chart review. Evaluated outcome measurements included (1) the successful closure of preoperative and intraoperative cerebrospinal fluid (CSF) leaks and (2) complications at both donor and recipient graft sites during the postoperative periods. Four representative clinical cases have additionally been selected to highlight the common indications for which the fat graft may be effective in skull base reconstruction. Results Of the 27 patients who were identified for inclusion in this review, 25 (92.6%) demonstrated successful repair of preoperative or intraoperative CSF leaks following primary skull base repair. Two patients developed recurrent CSF leaks occurring about 1 week after their primary closures, and a secondary closure rate of 96.3% was achieved with use of fat grafts. Other complications included seroma and hematoma formation at the abdominal donor sites, each occurring in 1 patient. Conclusions The use of autologous fat remains a viable option for grafting material during endoscopic skull base reconstruction. Despite the wide variety of closure techniques in skull base surgery, autologous fat provides safe and easily accessible material to repair CSF leaks.


2013 ◽  
Vol 71 (3) ◽  
pp. 165-170 ◽  
Author(s):  
Luciano Lopes Furlanetti ◽  
Marcelo Volpon Santos ◽  
Ricardo Santos de Oliveira

ObjectiveNeuroendoscopic surgery in children has particular features and is associated with different success rates (SR). The aim of this study was to identify putative factors that could influence the outcome in pediatric patients.MethodsClinical data of 177 patients under 18 years of age submitted to 200 consecutive neuroendoscopic procedures from January 2000 to January 2010 were reviewed.ResultsThe overall success rate was 77%. Out of the patients with successful outcomes, 46% were under six months, 68% were between six months and one year of age, and 85% older than one year. Neuroendoscopic techniques provide very good results for a wide number of indications in children. Tumor-related cerebrospinal fluid (CSF) circulation problems and aqueductal stenosis seem to be particularly well suited to neuroendoscopic treatment regardless of the patient's age.ConclusionPatients' age and etiology of hydrocephalus were associated with a different outcome. In all cases, surgical experience is extremely important to reduce complications.


2011 ◽  
Vol 3 (1) ◽  
pp. 31-41 ◽  
Author(s):  
Werner Garavello ◽  
Lorenzo Gaini ◽  
Diego Zanetti

ABSTRACT This paper reviews the diagnosis and treatment of temporal bone meningoencephaloceles, defined as the herniation of meninges or brain tissue into empty spaces within the temporal bone, i.e. tympanic or mastoid cavity, through the tegmen tympani or antri respectively. It also describes the current methods of control of cerebrospinal fluid (CSF) leaks, which commonly present as serous otorrhea or rhinorrhea in addition to a variety of symptoms, such as conductive hearing loss. Imaging is the mainstay of the diagnostic process. Management of the condition is surgical, and this review outlines the surgical options with special emphasis on the transmastoid approach and the materials applicable for repair of the bony dehiscences.


2019 ◽  
Vol 57 (220) ◽  
Author(s):  
Robin Joshi

Introduction: Renal stone disease has been affecting people for centuries. Percutaneous nephrolithotomy is one of the five interventions offered to a patient with renal stone. With the continuous development of noninvasive or minimally invasive techniques, these surgical procedures have been refined over time. This study was conducted to find the success rate of percutaneous nephrolithotomy in renal stone using Guy’s score and complication by Modified Clavien score. Methods: This descriptive cross-sectional study was done among 114 patients who underwent percutaneous nephrolithotomy in a tertiary care hospital, from September 2016 to December 2018 after receiving ethical approval from the Institutional Review Committee. Convenient sampling was done. All patients were informed about the potential benefits and risks of the percutaneous nephrolithotomy procedure and patients signed an informed written consent form. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion. Statistical analysis was done by using Statistical Package for Social Sciences version 22.2. Results: Forty-six (40.3%) patients had Guy’s stone score I, 43 (37.71%) patients had a score of II, 15 (13.6%) patients had a score of III and 10 (8.77%) patients had a score of IV. The success rates of stone clearance were 97.8 %, 95.3%, 80% and 50% for Guy’s stone score 1, 2, 3 and 4 respectively. A total of 114 patients were enrolled in the study out of which 66 were male and 48 were female. Eighteen patients experienced some form of complications out of which 3 patients needed surgical intervention with Modified Clavien score of III. Conclusions: Using Guy’s scoring system for percutaneous nephrolithotomy we evaluated the success rate. It is reproducible, easy and proves to be a useful tool to counsel patients about stonefree rate and prognosis for the surgical procedure. Modified Clavien score was helpful in evaluating complication rate.


2017 ◽  
Vol 4 (10) ◽  
pp. 3190
Author(s):  
Nazim Agaoglu ◽  
Mehmet Ulusahin

Background: Surgical approach for acute appendicitis (AA) is a standard live saving treatment method. The purpose of this study was to assess the feasibility, initial safety and success rate of non-operative treatment of AA in selected patients.Methods: Selected AA patients were enrolled in this prospective study (non-operative treatment). This was based on IV antibiotic therapy and followed up with oral antibiotic. Patients who declined to participate or excluded were managed with appendectomy and considered as controls. The primary goal of the study was to determine the feasibility, initial safety, early and late success rates of non-operative management. Secondary outcomes include hospital length of stay and charge, days of missed works and return to normal activity at home of patients treated non-operatively in comparison to appendectomy group.Results: In non-operative group (36 patients), 7 patients failed to response and managed by appendectomy with early success rate of 80.5%. Three patients experienced recurrent attacks of AA were managed with appendectomy. Late success rate was 72.2%. In appendectomy group (53 patients) one patient with adenocarcinoma of the colon detected during surgery and in ten patients the appendix was perforated. One patient died due to generalized peritonitis. In non-operative group length of stay and hospital charge were lower but only days to resume home activities and days of missed work were shorter and statistically significant as compared to appendectomy group.Conclusions: This study confirms the feasibility, safety and optimum success rate of non-operative treatment of early AA in selected patients.


2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ayalew Zewdie ◽  
Dejene Tagesse ◽  
Selam Alemayehu ◽  
Tesfaye Getachew ◽  
Menbeu Sultan

Background. Emergency medical care starts with airway assessment and intervention management. Endotracheal intubation is the definitive airway management in the emergency department (ED) for patients requiring a definitive airway. Successful first pass is recommended as the main objective of emergency intubation. There exists no published research regarding the success rates or complications that occur within Ethiopian hospitals emergency department intubation practice. Objective. This study aimed to assess the success rate of emergency intubations in a tertiary hospital, Addis Ababa, Ethiopia. Methodology. This was a single institute retrospective documentation review on intubated patients from November 2017 to November 2018 in the emergency department of Addis Ababa Burn Emergency and Trauma Hospital. All intubations during the study period were included. Data were collected by trained data collectors from an intubation documentation sheet. Result. Of 15,933 patients seen in the department, 256 (1.6%) patients were intubated. Of these, 194 (74.9%) were male, 123 (47.5%) sustained trauma, 65 (25.1%) were medical cases, and 13(5%) had poisoning. The primary indications for intubation were for airway protection (160 (61.8%)), followed by respiratory failure (72(27.8%)). One hundred and twenty-nine (49.8%) had sedative-only intubation, 110 (42.5%) had rapid sequence intubation, and 16 (6.2%) had intubation without medication. The first-pass success rate in this sample was 70.3% (180/256), second-pass 21.4% (55/256), and third-pass 7.4% (19/256), while the overall success rate was 99.2% (254/256). Hypoxia was the most common complication. Conclusion. The intubation first-pass success rate was lower than existing studies, but the overall intubation success rate was satisfactory.


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