scholarly journals Cerebrospinal Fluid Leak Rate after Vestibular Schwannoma Surgery via Middle Cranial Fossa Approach

2018 ◽  
Vol 80 (04) ◽  
pp. 437-440 ◽  
Author(s):  
Noga Lipschitz ◽  
Gavriel D. Kohlberg ◽  
Kareem O. Tawfik ◽  
Zoe A. Walters ◽  
Joseph T. Breen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Vestibular Schwannoma ◽  
Middle Cranial Fossa ◽  
Leak Rate ◽  
Gross Total Resection ◽  
Csf Leak ◽  
Tumor Diameter ◽  
Total Resection ◽  
Csf Leakage ◽  
Cranial Fossa

Objective Evaluate the cerebrospinal fluid (CSF) leak rate after the middle cranial fossa (MCF) approach to vestibular schwannoma (VS) resection. Design Retrospective case series. Setting Quaternary referral academic center. Participants Of 161 patients undergoing the MCF approach for a variety of skull base pathologies, 66 patients underwent this approach for VS resection between 2007 and 2017. Main Outcome Measure Postoperative CSF leak rate. Results There were two instances of postoperative CSF leak (3.0%). Age, gender, and BMI were not significantly associated with CSF leak. In the two cases with CSF leakage, tumors were isolated to the internal auditory canal (IAC) and both underwent gross total resection. Both CSF leaks were successfully treated with lumbar drain diversion. For the 64 cases that did not have a CSF leak, 51 were isolated to the IAC, 1 was located only in the cerebellopontine angle (CPA), and 12 were located in both the IAC and CPA. 62 patients underwent gross total resection and 2 underwent near-total resection. Mean maximal tumor diameter in the CSF leak group was 4.5 mm (range: 3–6 mm) versus 10.2 mm (range: 3–19 mm) in patients with no CSF leak (p = 0.03). Conclusions The MCF approach for VS resection is a valuable technique that allows for hearing preservation and total tumor resection and can be performed with a low CSF leakage rate. This rate of CSF leak is less than the reported rates in the literature in regard to both translabyrinthine and retrosigmoid approaches.

scholarly journals 795 Trends in Cerebrospinal Fluid Leak Rates Following the Extended Endoscopic Endonasal Approach for Anterior Skull Base Meningioma: A Meta-Analysis Over the Last 20 Years

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A H Zamanipoor Najafabadi ◽  
D Z Khan ◽  
I S Muskens ◽  
M L D Broekman ◽  
N L Dorward ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Arterial Injury ◽  
Gross Total Resection ◽  
Csf Leak ◽  
Total Resection ◽  
Visual Improvement ◽  
The Impact ◽  
Reconstructive Techniques ◽  
Over Time

Abstract Introduction The extended endoscopic approach (EEA) provides direct access for resection of tuberculum sellae (TSM) and olfactory groove meningiomas (OGM) but is associated with cerebrospinal fluid (CSF) leak in up to 25% of patients. To evaluate the impact of improved skull base reconstructive techniques, we assessed published CSF leak percentages in EEA over the last two decades. Method Random-effects meta-analyses were performed for studies published between 2004-2020. Outcomes assessed were CSF leak, gross total resection, visual improvement, intraoperative arterial injury and 30-day mortality. For the main analyses, publications were pragmatically grouped based on publication year in three categories: 2004-2010, 2011-2015, and 2016-2020. Results We included 29 studies describing 540 TSM and 115 OGM patients. CSF leak incidence dropped over time from 22% (95% CI: 6-43%) in studies published between 2004 and 2010, to 16% (95% CI: 11-23%) between 2011 and 2015, and 4% (95% CI: 1-9%) between 2016 and 2020. Outcomes of gross total resection, visual improvement, intraoperative arterial injury, and 30-day mortality remained stable over time Conclusions We report a noticeable decrease in CSF leak over time, which might be attributed to the development of reconstructive techniques (e.g., hadad bassagasteguy flap, and gasket seal), refined multilayer repair protocols, and selected lumbar drain usage.

scholarly journals Clinical, surgical and postoperative outcome analysis of tumors occupying both posterior and middle cranial fossa

2021 ◽  
Vol 18 (2) ◽  
pp. 36-44
Author(s):  
Rahul Singh ◽  
Ravi Shankar Prasad ◽  
Ramit Chandra Singh ◽  
Kulwant Singh ◽  
Anurag Sahu
Keyword(s):  
Postoperative Outcome ◽  
Middle Cranial Fossa ◽  
Posterior Cranial Fossa ◽  
Gross Total Resection ◽  
Outcome Analysis ◽  
Subtotal Resection ◽  
Combined Approach ◽  
Total Resection ◽  
Trigeminal Schwannoma ◽  
Cranial Fossa

Objectives: To analyse clinical, surgical and postoperative outcome perspectives of tumors occupying both middle and posterior cranial fossa. Materials and Methods: This retrospective cohort study includes 23 patients operated for tumors involving both middle and posterior cranial fossa in our department between August 2016 and August 2020. Each patient was evaluated for age, sex, co morbidities, tumour histopathology, clinical presentation, radiological characteristics, surgical and outcome characteristics. Unpaired t- test and chi-square test was used for statistical analysis. P < 0.05 was considered statistically significant. Results: The mean age was 46 years (range 40–57 years), with the majority of patients being female (56.5%). Most tumors (65.3%) were trigeminal schwannoma, with the remaining being vestibular schwannoma (21.7%), facial schwannoma (8.7%) and epidermoid (4.3%). The most commonly used surgical approach was the retrosigmoid approach (30.4%) and combined approach (30.4%).  Gross total resection (GTR) was done in 14 patients while subtotal resection (STR) was done in 9 patients. STR was significantly associated (p<0.05) with persisting cranial nerve deficit and tumour progression.  Midbrain compression, internal carotid artery and cavernous sinus involvement were significantly (p<0.05) associated with STR. Conclusions: Trigeminal schwannoma is the most common tumour involving both middle and posterior cranial fossa. Combined approach for such tumours is required in tumours having significant size in both middle cranial fossa and posterior cranial fossa. The intent of surgery is to achieve a gross total resection (GTR) but adhesions and involvement of critical brain structures results in STR.

scholarly journals Middle Cranial Fossa Encephalocele and Cerebrospinal Fluid Leakage: Etiology, Approach, Outcomes

2019 ◽  
Vol 81 (03) ◽  
pp. 268-274
Author(s):  
Beth McNulty ◽  
Christopher A. Schutt ◽  
Dennis Bojrab ◽  
Seilesh Babu
Keyword(s):  
Cerebrospinal Fluid ◽  
Middle Cranial Fossa ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Cerebrospinal Fluid Leakage ◽  
Combined Approach ◽  
Common Location ◽  
Significant Difference ◽  
Cranial Fossa ◽  
Transmastoid Approach

Objective To compare outcome data for surgical approaches in the management of a middle cranial fossa encephalocele or cerebrospinal fluid (CSF) leak and, secondarily, to evaluate the role of obesity and the etiology of the defect. Design Retrospective Setting Quaternary referral center Participants The study included 73 patients who underwent surgical repair of middle cranial fossa tegmen defects, two of which underwent bilateral repair. Outcome Measures Demographic characteristics, clinical presentation, etiology, imaging, audiometry, surgical findings, method and material for repair, and postoperative course. Results Fifty cases were spontaneous in origin, 2 were iatrogenic, and 23 were because of chronic otitis media. Of the 50, 18 underwent middle fossa craniotomy, 29 underwent a transmastoid approach, and 28 underwent a combined approach for repair. A postoperative CSF leak was seen in five patients: one who had undergone a transmastoid approach and four after a combined approach. There was no significant difference between the three approaches and risk of postoperative CSF fistulae. Two of the CSF fistulae resolved after a lumbar drain, and the remaining three patients required revision surgery. Conclusions Middle cranial fossa tegmen defects are most commonly seen in obese females and are spontaneous in origin. The most common location was the tegmen mastoideum, and these defects were most commonly repaired through the transmastoid approach, with no greater risk of recurrence.

Acquired Middle Cranial Fossa Fistulas

Neurosurgery ◽  
1979 ◽  
Vol 5 (4) ◽  
pp. 466-472 ◽  
Author(s):  
Benjamin Kaufman ◽  
Howard Yonas ◽  
Robert J. White ◽  
Clinton F. Miller
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Population ◽  
Normal Pressure ◽  
Middle Cranial Fossa ◽  
Csf Leak ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Cranial Fossa ◽  
Definition Of ◽  
Base Of The Skull

Abstract To the accepted classification of three types of normal pressure, nontraumatic cerebrospinal fluid (CSF) fistulas, we would add “acquired.” This type of CSF fistula tends to occur from the middle cranial fossa because of the enlargement of “pitholes” that are normally present in its anterior medial aspect. The enlargement of these bony defects is due to normal intracranial pressure variations that, not uncommonly, create meningoceles and meningoencephaloceles. A portion of the floor of this area is aerated in up to 10% of the normal population by the lateral recess of the sphenoid sinus, the pterygoid recess. Thus, this area has the potential to act as a pathway between the middle fossa and the paranasal sinuses, allowing cerebrospinal fluid to pass into the sinuses. Isotope and computerized tomographic studies are helpful in the localization of such a CSF leak. Tomography of the base of the skull, however, is essential for the ideal definition of possible routes of fistulization. If there is any question of the presence of a middle fossa fistula, these studies can show whether the floor of this area is pneumatized and whether there are any defects in the floor. The treatment of such a fistula should include generalized reinforcement of the floor of the anterior middle fossa by a middle fossa approach. If any doubt exists as to the site of leakage (anterior or middle fossa), the minimal surgical procedure should include exploration of both areas via a frontotemporal craniotomy.

Outcomes of Transzygomatic Middle Cranial Fossa Approach for Skull Base Tumors—A Single Institutional Experience

2020 ◽  
Author(s):  
Nauman F. Manzoor ◽  
Peter Morone ◽  
Patrick D. Kelly ◽  
Silky Chotai ◽  
Robert J. Yawn ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Middle Cranial Fossa ◽  
Csf Leak ◽  
Tumor Control ◽  
Skull Base Tumors ◽  
Total Resection ◽  
Neurological Morbidity ◽  
Cranial Fossa ◽  
The Mean

Abstract Objectives To evaluate surgical outcomes after transzygomatic middle cranial fossa (MCF) (TZ-MCF) approach for tumor control in patients with large skull base lesions involving the MCF and adjacent sites. Setting This study was done at the tertiary skull base center. Design This is a retrospective case series. Main Outcome Measures The main outcome measures were tumor control (recurrence), new-onset cranial neuropathies, facial nerve and audiometric outcomes, cerebrospinal fluid (CSF) leak, and wound complications. Results Sixteen patients were identified with a median age of 45 years (range: 20–72). The mean maximum tumor dimension was 5.49 cm (standard deviation [SD]: 1.2, range: 3.1–7.3) and the mean tumor volume was 28.5 cm3 (SD: 18.8, range: 2.9–63.8). Ten (62.5%) tumors were left sided. The most common pathology encountered was meningioma (n = 7) followed by chondrosarcoma (n = 4). Mean follow-up was 36.3 (SD: 26.9) months. Gross total resection or near total resection was achieved in nine (56.2%) and planned subtotal resection was used in seven (43.7%). Postoperative additional new cranial nerve (CN) deficits included CN V (n = 1), CN III (n = 2), CN VI (n = 1), and CN X (n = 1). Major neurological morbidity (hemiplegia) was encountered in two patients with resolution. There were no cases of CSF leak, meningitis, hemorrhage, seizures, aphasia, or death. There was no recurrence or regrowth of residual tumor. Facial nerve function was preserved in all but one patient (House–Brackmann grade 2). Conclusion Various skull base tumors involving MCF with extension to adjacent sites can be successfully resected using the TZ-MCF approach in a multidisciplinary fashion. This approach yields optimal exposure and permits excellent tumor control with acceptable CN and neurological morbidity.

Risk Factors for Readmission with Cerebrospinal Fluid Leakage Within 30 Days of Vestibular Schwannoma Surgery

Neurosurgery ◽  
2017 ◽  
Vol 82 (5) ◽  
pp. 630-637 ◽  
Author(s):  
Ali A Alattar ◽  
Brian R Hirshman ◽  
Brandon A McCutcheon ◽  
Clark C Chen ◽  
Thomas Alexander ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Surgical Resection ◽  
Vestibular Schwannoma ◽  
Health Planning ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Case Volume ◽  
Csf Leakage ◽  
First Admission

Abstract BACKGROUND Cerebrospinal fluid (CSF) leak is a well-recognized complication after surgical resection of vestibular schwannomas and is associated with a number of secondary complications, including readmission and meningitis. OBJECTIVE To identify risk factors for and timing of 30-d readmission with CSF leak. METHODS Patients who had undergone surgical resection of a vestibular schwannoma from 1995 to 2010 were identified in the California Office of Statewide Health Planning and Development database. The most common admission diagnoses were identified by International Classification of Disease, ninth Revision, diagnosis codes, and predictors of readmission with CSF leak were determined using logistic regression. RESULTS A total of 6820 patients were identified. CSF leak, though a relatively uncommon cause of admission after discharge (3.52% of all patients), was implicated in nearly half of 490 readmissions (48.98%). Significant independent predictors of readmission with CSF leak were male sex (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.32-2.25), first admission at a teaching hospital (OR 3.32, 95% CI 1.06-10.39), CSF leak during first admission (OR 1.84, 95% CI 1.33-2.55), obesity during first admission (OR 2.10, 95% CI 1.20-3.66), and case volume of first admission hospital (OR of log case volume 0.82, 95% CI 0.70-0.95). Median time to readmission was 6 d from hospital discharge. CONCLUSION This study has quantified CSF leak as an important contributor to nearly half of all readmissions following vestibular schwannoma surgery. We propose that surgeons should focus on technical factors that may reduce CSF leakage and take advantage of potential screening strategies for the detection of CSF leakage prior to first admission discharge.

Fat Implant is Superior to Muscle Implant in Vestibular Schwannoma Surgery for the Prevention of Cerebrospinal Fluid Fistulae

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS38-ONS43 ◽  
Author(s):  
Wolf O. Lüdemann ◽  
Lennart H. Stieglitz ◽  
Venelin Gerganov ◽  
Amir Samii ◽  
Madjid Samii
Keyword(s):  
Cerebrospinal Fluid ◽  
Vestibular Schwannoma ◽  
Inverse Correlation ◽  
Tumor Grade ◽  
Petrous Bone ◽  
Csf Leak ◽  
Fat Tissue ◽  
Csf Leakage ◽  
Cranial Base Surgery ◽  
Air Cells

Abstract Objective: Meticulous sealing of opened air cells in the petrous bone is necessary for the prevention of cerebrospinal fluid (CSF) fistulae after vestibular schwannoma surgery. We performed a retrospective analysis to determine whether muscle or fat tissue is superior for this purpose. Methods: Between January 2001 and December 2006, 420 patients underwent retrosigmoidal microsurgical removal by a standardized procedure. The opened air cells at the inner auditory canal and the mastoid bone were sealed with muscle in 283 patients and with fat tissue in 137 patients. Analysis was performed regarding the incidence of postoperative CSF fistulae and correlation with the patient's sex and tumor grade. Results: The rate of postoperative CSF leak after application of fat tissue was lower (2.2%) than after use of muscle (5.7%). Women had less postoperative CSF leakage (3.4%) than men (5.6%). There was an inverse correlation with tumor grade. Patients with smaller tumors seemed to have a higher rate of CSF leakage than those with large tumors without hydrocephalus. Only large tumors with severe dislocation of the brainstem causing hydrocephalus showed a higher incidence of CSF leaks. Conclusion: Fat implantation is superior to muscle implantation for the prevention of CSF leakage after vestibular schwannoma surgery and should, therefore, be used for the sealing of opened air cells in cranial base surgery.

Management of CSF leakage after microsurgery for vestibular schwannoma via the middle cranial fossa approach

2016 ◽  
Vol 273 (10) ◽  
pp. 2975-2981 ◽  
Author(s):  
Matthias Scheich ◽  
Christian Ginzkey ◽  
Desiree Ehrmann-Müller ◽  
Wafaa Shehata-Dieler ◽  
Rudolf Hagen
Keyword(s):  
Vestibular Schwannoma ◽  
Middle Cranial Fossa ◽  
Middle Cranial Fossa Approach ◽  
Csf Leakage ◽  
Cranial Fossa

scholarly journals Management of Spontaneous Cerebrospinal Fluid Leaks in the Middle Cranial Fossa and Bone Tegmen Tympani Defect in Patients with Meningitis and Rhinorrhea

2020 ◽  
pp. 1-5
Author(s):  
Francesco Paglia ◽  
Altamura C.F ◽  
D'Angelo L ◽  
Francesco Paglia ◽  
Marzetti F ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Middle Cranial Fossa ◽  
Occurrence Rate ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Csf Rhinorrhea ◽  
Tegmen Tympani ◽  
Cranial Fossa ◽  
Dural Defects ◽  
Csf Leaks

The pathogenetic process of spontaneous CerebroSpinal Fluid (CSF) leaks in the middle cranial fossa has not been clearly identified yet. It is related to a tegmen defect associated to the presence of a simultaneous encephalocele or meningoencephalocele. The main complication of a CSF leak is meningitis, whose occurrence rate ranges from 4% to 50% according to different causes and conditions of the leak [1]. Surgical approaches to temporal bone reconstruction include middle cranial fossa (MCF) craniotomy, transmastoid (TM), or a combined (MCF/TM) approach. In our experience, we describe 2 cases of patients who presented with CSF rhinorrhea and meningoencephaloceles correlated with conductive hearing loss and meningitis. The MCF approach is a considerable way to successful repair CSF leaks and encephaloceles due to tegmen tympani and dural defects.

Vascularized temporoparietal fascial flap for the treatment of a traumatic cerebrospinal fluid fistula in the middle cranial fossa

2009 ◽  
Vol 111 (2) ◽  
pp. 393-395 ◽  
Author(s):  
Mahmoud Taha ◽  
Thomas Carroll ◽  
Jeremy McMahon
Keyword(s):  
Cerebrospinal Fluid ◽  
Middle Cranial Fossa ◽  
Cerebrospinal Fluid Fistula ◽  
Pedicle Flap ◽  
Csf Fistula ◽  
Fascial Flap ◽  
Csf Leakage ◽  
Cranial Fossa ◽  
Fluid Fistula

The temporoparietal fascial flap (TPFF) is a vascularized pedicle flap commonly used in head and neck reconstructions. The authors describe the use of a TPFF in repairing a large traumatic middle cranial fossa CSF fistula via a middle cranial fossa approach. During the 18-month follow-up, the patient had no further CSF leakage or meningitis. The use of a TPFF for the repair of a traumatic CSF fistula has not been described in the literature. The authors recommend the use of a TPFF in treating recurrent or large middle cranial fossa CSF fistulas. The flap provides a well-vascularized thin layer that can be ideal in middle cranial fossa repair, and its proximity to the operation site is perfect as well.

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