Surgical Outcomes of the Endonasal Endoscopic Approach within a Standardized Management Protocol for Repair of Spontaneous CSF Leaks: A Retrospective Review of 46 Patients

2020 ◽  
Author(s):  
Daniel Kreatsoulas ◽  
Varun Shah ◽  
Douglas Hardesty
Keyword(s):  
Retrospective Review ◽  
Surgical Outcomes ◽  
Endoscopic Approach ◽  
Management Protocol ◽  
Csf Leaks

scholarly journals Surgical outcomes of the endonasal endoscopic approach within a standardized management protocol for repair of spontaneous cerebrospinal fluid rhinorrhea

2020 ◽  
pp. 1-7 ◽  
Author(s):  
Daniel C. Kreatsoulas ◽  
Varun S. Shah ◽  
Bradley A. Otto ◽  
Ricardo L. Carrau ◽  
Daniel M. Prevedello ◽  
...  
Keyword(s):  
Significant Risk ◽  
Endoscopic Approach ◽  
Csf Leak ◽  
Fungal Sinusitis ◽  
Opening Pressure ◽  
Surgical Morbidity ◽  
Csf Rhinorrhea ◽  
Management Protocol ◽  
Csf Diversion ◽  
Csf Leaks

OBJECTIVESpontaneous CSF leaks are rare, their diagnosis is often delayed, and they can precipitate meningitis. Craniotomy is the historical “gold standard” repair for these leaks. An endonasal endoscopic approach (EEA) offers potentially less invasiveness and lower surgical morbidity than a traditional craniotomy but must yield the same surgical success. A paucity of data exists studying EEA as the primary management for spontaneous CSF leaks.METHODSThe authors retrospectively reviewed patients undergoing spontaneous CSF rhinorrhea repair at their institution from July 2010 to August 2018. Standardized management includes EEA as first-line treatment, and lumbar puncture (LP) performed 24–48 hours postoperatively. If opening pressure on LP is elevated, CSF diversion or acetazolamide therapy is used as needed. Perioperative lumbar drains are not used.RESULTSOf 46 patients identified, the most common CSF rhinorrhea etiology was encephalocele (28/46, 60.9%), and the most common location was cribriform/ethmoid (26/46, 56.5%). Forty-three patients underwent EEA alone, and 3 underwent a simultaneous EEA/craniotomy. The most common repair strategy was nasoseptal or other pedicled flaps (18/46, 39.1%). Postoperatively, 15 patients (32.6%) received CSF diversion due to elevated ICP, with BMI > 40 kg/m2 being a significant risk factor (odds ratio 4.35, p = 0.033) for postrepair shunt placement. Twelve patients received acetazolamide therapy for treatment of mildly elevated pressures. The average opening pressure of the shunted group was 36 cm H2O and the average for the acetazolamide-only group was 26 cm H2O. Two patients underwent CSF leak repair revision, one because of progressive fungal sinusitis and the other because of recurrent CSF leak. The mean follow-up duration was 15 months.CONCLUSIONSThe paradigm of EEA repair of spontaneous CSF rhinorrhea with postoperative LP to identify undiagnosed idiopathic intracranial hypertension appears to be safe and effective. In the authors’ cohort, morbid obesity was statistically associated with the need for postoperative CSF diversion. This has implications for future surgical treatment as obesity levels continue to rise worldwide.

scholarly journals Robotic-Assisted Hysterectomy for the Management of Severe Endometriosis: A Retrospective Review of Short-Term Surgical Outcomes

2013 ◽  
Vol 17 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Mohamed A. Bedaiwy ◽  
Mohamed Y. Abdel Rahman ◽  
Mark Chapman ◽  
Heidi Frasure ◽  
Sangeeta Mahajan ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Surgical Outcomes ◽  
Short Term ◽  
Robotic Assisted

scholarly journals The Effectiveness of Partial Lid Margin Excision Including Hair Follicles in Diffuse Trichiasis and Distichiasis

2021 ◽  
Vol 62 (9) ◽  
pp. 1167-1171
Author(s):  
In Choel Shin ◽  
Sang Duck Kim
Keyword(s):  
Retrospective Review ◽  
Surgical Outcomes ◽  
Medical Records ◽  
Complete Resolution ◽  
Telephone Survey ◽  
Skin Pigmentation ◽  
Hair Follicles ◽  
Eyelid Margin ◽  
Surgical Success ◽  
Abnormal Cilia

Purpose: In the present study, we introduced and evaluated the effectiveness of partial lid margin excision including hair follicles in diffuse trichiasis and distichiasis. Methods: A retrospective review of medical records was performed on 21 eyelids of 14 patients with diffuse trichiasis and distichiasis. The patients had trichiasis of more than 1/3 of the eyelid margin and received lid margin excision including hair follicles at our hospital. The patients were followed up for more than 3 months after surgical correction. A telephone survey of the surgical outcomes, including recurrence and cosmetic satisfaction, was conducted for patients who were unable to visit the clinic. Success was defined as complete resolution of symptoms, no recurrence of abnormal cilia, and acceptable cosmesis. Results: The patients included five males (6 eyes) and nine females (15 eyes) with an average age of 61.9 years (range, 39.8-82.4 years). The surgical success rate was 90.5%. Two eyelids showed a recurrence of trichiasis requiring additional electrolysis treatment, and one eyelid exhibited skin pigmentation. Conclusions: For patients with diffuse trichiasis and distichiasis, partial lid margin excision including hair follicles showed excellent results with respect to resolving irritating symptoms, with minimal complications, low recurrence, and an easy procedure.

scholarly journals MP52-20 KIDNEY ALLOGRAFT NEPHRECTOMY – A RETROSPECTIVE REVIEW OF INDICATIONS AND SURGICAL OUTCOMES

2020 ◽  
Vol 203 ◽  
pp. e780
Author(s):  
Vincent Khor* ◽  
Edwin Jonathan Aslim ◽  
Jin Yong ◽  
Kenneth Chen ◽  
Valerie Huei Li Gan
Keyword(s):  
Retrospective Review ◽  
Surgical Outcomes ◽  
Kidney Allograft ◽  
Allograft Nephrectomy

Surgical outcomes of endoscopic transsphenoidal pituitary adenoma resection in elderly versus younger patients

2021 ◽  
Author(s):  
Tyler D Alexander ◽  
Chandala Chitguppi ◽  
Sarah Collopy ◽  
Kira Murphy ◽  
Pascal Lavergne ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Surgical Outcomes ◽  
Extent Of Resection ◽  
Common Type ◽  
Tumor Characteristics ◽  
Endoscopic Transsphenoidal Surgery ◽  
Younger Patients ◽  
Patient Variables ◽  
Intracranial Neoplasm ◽  
Csf Leaks

Introduction Pituitary adenomas (PAs) are one of the most common type of intracranial neoplasm with increased incidence in elderly patients. The outcomes of endoscopic transsphenoidal surgery (ETS) specifically on elderly patients remains unclear. Methods We performed a retrospective cohort study to compare elderly patients (age 65 years) with non-elderly patients (age <65 years) who underwent ETS for PA from January 2005 to December 2021. Surgical outcomes, including extent of resection, complication profile, length of stay, and endocrinopathy rates, were compared between elderly and non-elderly patients. Results A total of 690 patients were included with 197 (29%) being elderly. Elderly patients showed higher rates of hypertension (p<0.05), myocardial infarction (p<0.01), and atrial fibrillation (p=0.01) but not other comorbidities. Elderly patients also had more frequent optic nerve involvement (72% of cases vs. 61%, p=0.01). Tumor characteristics and other patient variables were otherwise similar between younger and elderly patients. Postoperative CSF leaks (2% vs. 2%, p=0.8), 30-day readmission, reoperation, postoperative complications, and postoperative endocrinopathies were similar between younger and older patients. Subdividing patients into age <65, 65-79, and >80 also did not demonstrate a worsening of surgical outcomes with age. Conclusion For well selected elderly patients in experienced endoscopic skull base centers, good surgical outcomes similarly to younger patients may be achieved.

MRI-negative PET-negative epilepsy long-term surgical outcomes: A single-institution retrospective review

2020 ◽  
Vol 167 ◽  
pp. 106481
Author(s):  
Jacob Pellinen ◽  
Ruben Kuzniecky ◽  
Werner Doyle ◽  
Orrin Devinsky ◽  
Patricia Dugan
Keyword(s):  
Retrospective Review ◽  
Surgical Outcomes ◽  
Single Institution
Sign in / Sign up

Export Citation Format

Share Document