scholarly journals Revascularization of AlloDerm Used during Endoscopic Skull Base Surgery

2018 ◽  
Vol 80 (01) ◽  
pp. 046-050 ◽  
Author(s):  
Zahrah Taufique ◽  
Nupur Bhatt ◽  
David Zagzag ◽  
Richard Lebowitz ◽  
Seth Lieberman
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Case Reports ◽  
Tertiary Care ◽  
Abdominal Wall Reconstruction ◽  
The Body ◽  
Skull Base Reconstruction ◽  
Endoscopic Skull Base Surgery ◽  
Care Institution ◽  
Tertiary Care Institution

Objectives AlloDerm is an acellular dermal matrix often used for reconstruction throughout the body. AlloDerm has been shown to undergo revascularization when used to reconstruct soft tissue such as in abdominal wall reconstruction. In this study, the authors review the literature on revascularization of AlloDerm and demonstrate the histologic findings of AlloDerm after implantation during skull base reconstruction. Study Design Literature review and case reports. Setting Tertiary Care Institution Participants Patients from a tertiary care institution Main Outcome Measures Histologic slides are evaluated and compared with nonimplanted AlloDerm. Methods The authors review a case of explanted AlloDerm that had been used for skull base reconstruction after endoscopic skull base surgery. Results Upon reviewing the histologic slides of explanted AlloDerm to nonimplanted AlloDerm, we demonstrate revascularization of AlloDerm when used in skull base reconstruction. Representative slides will be included. Conclusions AlloDerm undergoes revascularization when used for skull base reconstruction.

Outcomes In Pediatric Endoscopic Skull Base Surgery: A Systematic Review

2021 ◽  
Author(s):  
Erin Mamuyac Lopez ◽  
Zainab Farzal ◽  
Kelly Marie Dean ◽  
Craig Miller ◽  
Justin Cates Morse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Skull Base ◽  
Pediatric Patients ◽  
Skull Base Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Csf Leak ◽  
Inclusion Criteria ◽  
Endoscopic Skull Base Surgery ◽  
Tertiary Care Medical Center

Objectives: The frequency of endoscopic skull base surgery in pediatric patients is increasing. This study’s aim is to systematically review the literature for endoscopic skull base surgery outcomes in children/adolescents ages 0-18 years. Design: A systematic review of the literature was performed in PubMed and SCOPUS databases querying studies from 2000-2020 using PRISMA guidelines. Final inclusion criteria included: case series with 10+ patients with pediatric patients age ≤18 years, endoscopic or endoscopic-assisted skull base surgery, and outcomes reported. Setting: Tertiary care medical center Participants: Children/adolescents ages 0-18 years who underwent endoscopic skull base surgery Main Outcome Measures: Patient demographics, pathology, reconstructive technique, intra-operative findings, intra-operative and post-operative surgical complications. Results: Systematic literature search yielded 287 publications. Of these, 12 studies discussing a total of 399 patients age 0-18 years met inclusion criteria for final analysis. 7 of 12 studies discussed a single pathology. The most common pathology was a skull base defect causing CSF leak. The majority of skull base repairs were made with free tissue grafts. The most common post-operative complication was CSF leak (n=40). Twelve cases of meningitis occurred post-operatively with two of these episodes resulting in death. Conclusions: Endoscopic skull base surgery has been performed recently in the pediatric population in a variety of disease states. Inconsistent individual-level data and reporting standards are present in existing studies posing challenges for comparative analysis. Standardized reporting will aid future reviews and meta-analysis for rare skull base pathology.

Neurotoxicity of Lorazepam in a Premature Infant

PEDIATRICS ◽  
1992 ◽  
Vol 89 (6) ◽  
pp. 1129-1130
Author(s):  
CATHERINE M. G. CRONIN
Keyword(s):  
Premature Infant ◽  
Premature Infants ◽  
Case Reports ◽  
Tertiary Care ◽  
Apgar Scores ◽  
Care Institution ◽  
Peripheral Hospital ◽  
Tertiary Care Institution ◽  
Male Neonate

To the Editor.— Recently, I have observed several cases of stereotypic movements following injection of lorazepam in premature infants and wish to alert my colleagues to a potential cause of neurotoxicity. Case 1 CASE REPORTS A male neonate was born in a peripheral hospital at 24 weeks gestation. Apgar scores were 2 at 1 minute and 6 at 5 minutes. He weighed 680 g and was transferred to a tertiary care institution at 20 hours of life.

scholarly journals Hybrid Robotics for Endoscopic Transnasal Skull Base Surgery: Single-Centre Case Series

2021 ◽  
Author(s):  
Francesca Zappa ◽  
Alba Madoglio ◽  
Marco Ferrari ◽  
Davide Mattavelli ◽  
Alberto Schreiber ◽  
...  
Keyword(s):  
Skull Base ◽  
Transsphenoidal Surgery ◽  
Skull Base Surgery ◽  
Case Reports ◽  
Case Series ◽  
Cushing Disease ◽  
Skull Base Reconstruction ◽  
Robotic Assisted Surgery ◽  
Endoscope Holder ◽  
Robotic Endoscope

Abstract BACKGROUND Only preclinical studies and case reports have described robotic surgery for endoscopic transnasal skull base surgery. OBJECTIVE To evaluate the role of a novel robotic endoscope holder, developed for transsphenoidal surgery. METHODS Patients were prospectively enrolled for 3 mo at the Neurosurgery Unit of Brescia. Endoscope Robot® was used to assist during the sphenoidal phase of the approach, tumor removal, and skull base reconstruction. A Likert scale questionnaire was given to all surgeons after each procedure. Patients who underwent robotic-assisted surgery were matched with nonrobotic ones for pathology and type of procedure. All surgical videos were evaluated during bimanual phases. RESULTS Twenty-one patients underwent robot-assisted, endoscopic transsphenoidal surgery for different pathologies (16 pituitary adenomas, 3 chordomas, 1 craniopharyngioma, 1 pituitary exploration for Cushing disease) for a total of 23 procedures (1 patient underwent 2 endoscopic revisions of a skull base reconstruction). Subjective advantages reported by surgeons included smoothness of movement, image steadiness, and improvement of maneuvers in narrow spaces and with angled endoscopes; as the main limitation, Endoscope Robot® appeared to be relatively heavy during the initial endoscope positioning. A comparative analysis with a historical matched cohort documented similar clinical outcomes, while endoscope lens cleaning and position readjustments were significantly less frequent in robotic procedures. CONCLUSION Although confirmation in larger studies is needed, Endoscope Robot® was a safe and effective tool, especially advantageous in lengthy interventions through deep and narrow corridors.

scholarly journals Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull Base Surgery

2019 ◽  
Vol 81 (03) ◽  
pp. 301-307
Author(s):  
Sarek A. Shen ◽  
Aria Jafari ◽  
Jesse R. Qualliotine ◽  
Adam S. DeConde
Keyword(s):  
Pain Management ◽  
Skull Base ◽  
Pain Control ◽  
Evaluation System ◽  
Skull Base Surgery ◽  
Utilization Review ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Skull Base Reconstruction ◽  
Endoscopic Skull Base Surgery

Introduction Postoperative pain management and opioid use following endoscopic skull base surgery (ESBS) is not well understood. A subset of patients requires additional opioid prescription (AOP) in the postoperative period. The objective of this study is to describe the incidence of AOP, as well as evaluate patient and surgical characteristics that may predict additional pain management requirements following ESBS. Methods A retrospective review of cases undergoing ESBS between November 2016 and August 2018 was performed. We reviewed patients' sociodemographic and clinical data, and Controlled Substance Utilization Review and Evaluation System (CURES) records. Stepwise multivariable logistic regressions were performed to evaluate the factors associated with AOP within 60 days following surgery. Results A total of 42 patients were identified. Indications for ESBS included intracranial mass (64.2%), sinonasal malignancy (23.8%), and skull base reconstruction (9.5%). AOP were recorded in nine patients (21.4%). There were no significant differences in operative factors, including approach, lesion location, or perioperative analgesia between the two cohorts. On multivariable logistic regression, we found that younger age (odds ratio [OR]: 0.891, 95% confidence interval [CI]: 0.79–1.00, p = 0.050), comorbid depression (OR: 86.48, 95% CI: 1.40–5,379.07, p = 0.034), and preoperative opioid use (OR: 104.45, 95% CI: 1.41–7,751.10, p = 0.034) were associated with additional prescriptions postoperatively. Conclusion The requirement for extended postoperative opioid pain control is common after ESBS. Patient demographics including age and psychosocial factors, such as depression may predict the need for AOP after ESBS. These results suggest that patient-driven factors, rather than surgical characteristics, may determine the need for prolonged pain control requirements after ESBS.

Intrathecal Fluorescein in Endoscopic Skull Base Surgery

2007 ◽  
Vol 137 (2) ◽  
pp. 316-320 ◽  
Author(s):  
Abtin Tabaee ◽  
Dimitris G. Placantonakis ◽  
Theodore H. Schwartz ◽  
Vijay K. Anand
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Skull Base ◽  
Retrospective Review ◽  
Skull Base Surgery ◽  
Csf Leak ◽  
Skull Base Reconstruction ◽  
Endoscopic Skull Base Surgery ◽  
High Degree ◽  
The Impact

OBJECTIVES: Reconstruction following endoscopic skull base surgery requires a high degree of success to avoid the morbidity of postoperative cerebrospinal fluid (CSF) leak. The impact on outcomes of CSF visualization with intrathecal fluorescein, however, is unknown. STUDY DESIGN: A retrospective review of patients undergoing endoscopic skull base surgery with intrathecal fluorescein. A possible correlation between intraoperative fluorescein identification and postoperative CSF leak was analyzed. RESULTS: 61 patients underwent surgery for a variety of lesions including pituitary adenoma (55.7%), encephalocele (14.8%), and meningioma (9.8%). Seven (19.4%) of the 37 patients with intraoperative fluorescein leak experienced postoperative CSF leak compared to 0 of the 24 patients who did not have intraoperative fluorescein leak ( P = 0.02). All cases of CSF leak resolved with lumbar drainage alone. CONCLUSIONS: The lack of intraoperative fluorescein leak-age correlates strongly with a low risk for postoperative CSF leak. This can be used to stratify the extent of skull base reconstruction required during endoscopic skull base surgeries.

Nasoseptal Flap Takedown in Endoscopic Skull Base Surgery

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P79-P79
Author(s):  
Adam Mikial Zanation ◽  
Carl H Snyderman ◽  
Ricardo L Carrau ◽  
Kassam Amin
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Fat Graft ◽  
Csf Leak ◽  
Great Promise ◽  
Nasoseptal Flap ◽  
Skull Base Reconstruction ◽  
Second Stage ◽  
Endoscopic Skull Base Surgery ◽  
Intradural Tumor

Objective 1) Understand the importance of the nasoseptal flap in endoscopic skull base reconstruction. 2) Learn the techniques and limitations of nasoseptal flap takedowns and reuse during second stage and revision endoscopic skull base surgery. Methods Prospective consecutive analysis of CSF leak outcomes with nasoseptal flap takedown and reuse during endoscopic skull base surgery at a tertiary care skull base center. Results 16 consecutive cases of nasoseptal flap takedown and reuse for endoscopic endonasal intradural tumor surgery were collected prospectively and evaluated for CSF leak outcomes. 10 of these cases were planned second-stage surgeries and 6 were for revision or recurrent tumors. All 16 cases had intradural tumor extension and intra operative CSF leak. 15 of 16 had successful skull base reconstruction without postoperative CSF leak. One patient required revision endoscopic CSF leak repair and bolstering of the defect with a fat graft on post operative day 3. No flap deaths occurred. Endoscopic skull base reconstructive techniques and limitations of flap takedowns are discussed. Conclusions As the limits of endoscopic skull base surgery increases, the limits of endoscopic skull base reconstruction must also increase. The pedicled nasoseptal flap has shown great promise (4% leak rate in over 300 nasoseptal flap skull base reconstructions) at the time of the initial resection. This report illustrates the ability to takedown and reuses the nasoseptal flap in revision cases with great success (94%) and minimal additional nasal morbidity.

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