Skull Base Paragangliomas: From the Operating Room to the Bench

Background Spontaneous cerebrospinal fluid (CSF) leaks are largely attributed to idiopathic intracranial hypertension and typically present as skull base defects with or without prolapse of intracranial contents. However, in our practice, we have encountered a distinct type of spontaneous CSF leak that presents in a different manner. Objective To discuss a newly-classified, difficult to treat, subset of spontaneous CSF leaks that present as excavation of the bone of the skull base in a tunnel- or canal-like fashion by a meningocele or meningoencephalocele instead of as a localized area of bony dehiscence. Methods A retrospective review was performed at a tertiary care rhinology practice to identify a subset of CSF leak patients with an excavating/canal-like skull base defect visualized radiographically on computed tomography (CT) scan or magnetic resonance imaging and/or endoscopically in the operating room. Results The cohort of patients consisted of 7 females and 1 male with an average age of 53.6 years and a self-reported race of 4:3:1 African-American: Caucasian-Indian. All patients presented with CSF rhinorrhea. The most common leak site was the cribriform and upper septum. Six of the 8 patients had multiple defects and/or progression of their skull base defects, and 5 patients required multiple and/or repeat repairs in the operating room. Seven of the 8 patients underwent a cisternogram because the excavating nature of the leaks made it difficult to identify the specific leak site on high-resolution CT scan alone. Conclusion In spontaneous CSF leaks that are difficult to identify or recur soon after a proper repair, an excavating pattern should be considered. Failure to recognize this type of leak and all of its tributaries, to fully unroof the excavated bone to completely resect the meningocele, and to visualize and close the site of origin will likely result in failure and recurrence of CSF leak.

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Operating Room Setup in Skull Base Surgery

Atlas of Surgical Approaches to Paranasal Sinuses and the Skull Base ◽

10.1007/978-3-662-48632-0_3 ◽

2016 ◽

pp. 103-107

Author(s):

Dan M. Fliss ◽

Ziv Gil

Keyword(s):

Skull Base ◽

Operating Room ◽

Skull Base Surgery

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History of Neuroendoscopy

Sinir Sistemi Cerrahisi Dergisi ◽

10.5222/sscd.2021.96641 ◽

2021 ◽

Author(s):

Osman Boyalı ◽

Mourat Chasan ◽

Furkan Diren ◽

Erdinç Civelek ◽

Serdar Kabataş

Keyword(s):

Skull Base ◽

Operating Room ◽

Spinal Surgery ◽

Skull Base Surgery ◽

Surgical Interventions ◽

The Future ◽

History Of

two hundred years of design, endoscopy is widely used today in neurosurgical interventions for intraventricular surgery, skull base surgery, spinal surgery and various other applications. Neuroendoscope, which had fallen off the agenda in the early 1900s due to unsuccessful surgical interventions, was re-used to assist microsurgery in the future. It has become an indispensable equipment of the neurosurgery operating room itself, rather than the complementary feature of the neuroendoscopy, which has increased effectiveness in the development of technology. In this article, our aim is to tell the history of neuroendoscopy used in current neurosurgical field to physicians.

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Biomedical applications: Pitfalls in the practice

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100169626 ◽

1994 ◽

Vol 52 ◽

pp. 378-379

Author(s):

J. D. Shelburne ◽

Peter Ingram ◽

Victor L. Roggli ◽

Ann LeFurgey

Keyword(s):

Operating Room ◽

Liquid Nitrogen ◽

Lung Tissue ◽

Biomedical Applications ◽

Microprobe Analysis ◽

Tissue Sample ◽

Cellular Level ◽

Tissue Samples ◽

Asbestos Fibers

At present most medical microprobe analysis is conducted on insoluble particulates such as asbestos fibers in lung tissue. Cryotechniques are not necessary for this type of specimen. Insoluble particulates can be processed conventionally. Nevertheless, it is important to emphasize that conventional processing is unacceptable for specimens in which electrolyte distributions in tissues are sought. It is necessary to flash-freeze in order to preserve the integrity of electrolyte distributions at the subcellular and cellular level. Ideally, biopsies should be flash-frozen in the operating room rather than being frozen several minutes later in a histology laboratory. Electrolytes will move during such a long delay. While flammable cryogens such as propane obviously cannot be used in an operating room, liquid nitrogen-cooled slam-freezing devices or guns may be permitted, and are the best way to achieve an artifact-free, accurate tissue sample which truly reflects the in vivo state. Unfortunately, the importance of cryofixation is often not understood. Investigators bring tissue samples fixed in glutaraldehyde to a microprobe laboratory with a request for microprobe analysis for electrolytes.

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