926 CSF Rhinorrhoea After Endonasal Intervention to The Skull Base (CRANIAL): Multicentre Pilot Study

Abstract Introduction CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective, multicentre observational study seeking to determine: the scope of skull base repair methods used, and the corresponding rates of postoperative CSF rhinorrhoea in endonasal transsphenoidal (TSA) expanded endonasal approaches (EEA) for skull base tumours. Method A prospective, observational cohort pilot study was carried out at eleven neurosurgical units, via NANSIG and BNTRC collaboratives. Results 192 cases were included – 167 TSA (87%), 25 EEA (13%). The most common (MC) pathologies included: pituitary adenomas (n = 150/192), craniopharyngiomas (n = 7/192) and meningiomas (n = 4/192). The MC skull base repair techniques used were tissue glues (n = 135/192, MC Tisseel®), grafts (n = 94/192, MC fat or Spongostan™) and vascularised flap (52/192, MC nasoseptal). These repairs were most frequently supported by nasal packs (n = 127/192) and lumbar drains (n = 23/197). Biochemically confirmed CSF rhinorrhoea occurred in 10/167 (6%) TSA and 4/25 (16%) EEA. 5 cases required operative management for CSF rhinorrhoea (CSF diversion or direct repair). Qualitative feedback was largely positive (e.g., user-friendly data collection), demonstrating acceptability. Conclusions Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is clear precedent for multicentre dissemination of this project, in order to establish a benchmark of contemporary skull base neurosurgery practice.

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CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL). Part 1: Multicenter Pilot Study

World Neurosurgery ◽

10.1016/j.wneu.2020.12.171 ◽

2021 ◽

Author(s):

Danyal Z. Khan ◽

Hani J. Marcus ◽

Hugo Layard Horsfall ◽

Soham Bandyopadhyay ◽

Benjamin E. Schroeder ◽

...

Keyword(s):

Pilot Study ◽

Skull Base ◽

Csf Rhinorrhoea

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CSF rhinorrhoea after endonasal intervention to the anterior skull base (CRANIAL): proposal for a prospective multicentre observational cohort study

British Journal of Neurosurgery ◽

10.1080/02688697.2020.1795622 ◽

2020 ◽

pp. 1-10

Author(s):

Danyal Z. Khan ◽

Soham Bandyopadhyay ◽

Vikesh Patel ◽

Benjamin E. Schroeder ◽

Ivan Cabrilo ◽

...

Keyword(s):

Cohort Study ◽

Skull Base ◽

Observational Cohort Study ◽

Anterior Skull Base ◽

Observational Cohort ◽

Csf Rhinorrhoea

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Malignant Pleural Effusions Impact on Fatigue (IMPE-F): A Prospective Observational Cohort Pilot Study

Journal of Respiration ◽

10.3390/jor1020011 ◽

2021 ◽

Vol 1 (2) ◽

pp. 98-104

Author(s):

Avinash Aujayeb ◽

Donna Wakefield

Keyword(s):

Pilot Study ◽

Health Research ◽

Patient Reported Outcome ◽

Pleural Effusions ◽

Inclusion Criteria ◽

Malignant Pleural Effusions ◽

Cancer Related Fatigue ◽

Patient Reported ◽

Observational Cohort ◽

Respondent Fatigue

Introduction: Cancer-related fatigue is well described. Fatigue in patients with a malignant pleural effusion (MPE) has not been directly studied. Methods: A prospective observational cohort pilot study ‘Do Interventions for Malignant Pleural Effusions (MPE) impact on patient reported fatigue levels (IMPE-F study)’ is planned to determine whether pleural interventions reduce fatigue in MPE. Fatigue will be assessed with a validated patient reported outcome measure, FACIT-F. Discussion: MPE-F has funding from Rocket Medical Plc, and is part of a Masters in Clinical Research at Newcastle University. Respondent fatigue will be addressed by the investigators going through the questionnaire with the participants. Inclusion criteria are all patients above 18 years of age with a presumed MPE undergoing a procedure and able to consent. The expected number of participants is 50. Trial registration: The IMPE-F study has Research Ethics Committee (REC) [20/YH/0224] and Health Research Authority (HRA) and Health and Care Research Wales (HCRW) approvals [IRAS project ID: 276451]. The study has been adopted on National Institute for Health Research portfolio [CPMS ID 46430].

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Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles

Neurosurgical FOCUS ◽

10.3171/2012.3.focus1267 ◽

2012 ◽

Vol 32 (6) ◽

pp. E5 ◽

Cited By ~ 30

Author(s):

Richard F. Schmidt ◽

Osamah J. Choudhry ◽

Joseph Raviv ◽

Soly Baredes ◽

Roy R. Casiano ◽

...

Keyword(s):

Skull Base ◽

Sphenoid Sinus ◽

Skull Base Surgery ◽

Surgical Anatomy ◽

Endoscopic Endonasal ◽

Csf Rhinorrhea ◽

Lateral Recess ◽

Sternberg Canal ◽

Deep Location ◽

Repair Techniques

Lateral sphenoid encephaloceles of the Sternberg canal are rare entities and usually present with spontaneous CSF rhinorrhea. Traditionally, these were treated via transcranial approaches, which can be challenging given the deep location of these lesions. However, with advancements in endoscopic skull base surgery, including improved surgical exposures, angled endoscopes and instruments, and novel repair techniques, these encephaloceles can be resected and successfully repaired with purely endoscopic endonasal approaches. In this report, the authors review the endoscopic endonasal transpterygoid approach to the lateral recess of the sphenoid sinus for repair of temporal lobe encephaloceles, including an overview of the surgical anatomy from an endoscopic perspective, and describe the technical operative nuances and surgical pearls for these cases. The authors also present 4 new cases of lateral sphenoid recess encephaloceles that were successfully treated using this approach.

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The evaluation of risk prediction models in predicting outcomes after bariatric surgery: a prospective observational cohort pilot study

Perioperative Medicine ◽

10.1186/s13741-018-0088-5 ◽

2018 ◽

Vol 7 (1) ◽

Cited By ~ 2

Author(s):

David Andrew Gilhooly ◽

Michelle Cole ◽

Suneetha Ramani Moonesinghe

Keyword(s):

Bariatric Surgery ◽

Pilot Study ◽

Risk Prediction ◽

Prediction Models ◽

Risk Prediction Models ◽

Observational Cohort

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Assessment of fracture risk tools in care home residents: a multi-centre observational pilot study

European Geriatric Medicine ◽

10.1007/s41999-020-00383-2 ◽

2020 ◽

Author(s):

F. Ihama ◽

A. Pandyan ◽

C. Roffe

Keyword(s):

Pilot Study ◽

Care Home ◽

Fragility Fractures ◽

Care Homes ◽

Regression Analyses ◽

Observational Cohort ◽

Comorbidity Index ◽

Participant Outcomes ◽

Study Setting

Abstract Background Fragility fractures are common in care home residents but established tools have not been tested in this population. Aim:To identify the most practicable tool for use. Methods Design Multicentre prospective observational cohort pilot study. Setting: 18 care homes in Boston, UK. Assessments: fragility risk score at baseline with FRAX, QFractureScore, Garvan nomogram, body mass index and TUGT for each participant. Outcomes: falls, fractures, combined falls & fractures. Follow-up; 12 months. Results 217/618 (35%) residents in the 18 care homes were enrolled. 147 (68%) had mental capacity,70 (32%) did not. There were 325 falls and 10 fractures in participants during the study. At the same time there were 1671 falls and 103 fractures in residents not participating in the study. Multiple regression analyses showed that only age had a statistically significant association with falls (χ2(1) = 5.7775, p = 0.0162), fractures (χ2(1) = 4.7269, p = 0.0297) and combined falls & fractures (χ2(1) = 4.7269, p = 0.0297). C-statistics were: falls; FRAX 0.544, BMI 0.610, QFractureScore 0.554, Garvan nomogram 0.579, TUGT 0.656, fractures; FRAX 0.655, BMI 0.708, QFractureScore 0.736, Garvan nomogram 0.712, TUGT 0.590, combined falls and fractures, c-statistics were same as for fractures. Fifty-four participants (25%) died during follow-up. Charlson comorbidity index predicted mortality, R2 = 0.021 (p = 0.034). Conclusions QFractureScore, BMI and Garvan nomogram were good predictors of fractures and combined falls and fractures Only age had statistically significant association with the outcomes. No tool was good predictor of falls.

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Endoscopic Endonasal Reconstruction of High-Flow Cerebrospinal Fluid Leak with Fascia Lata “Button” Graft and Nasoseptal Flap: Surgical Technique and Case Series

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1693124 ◽

2019 ◽

Vol 81 (06) ◽

pp. 645-650

Author(s):

Roshni V. Khatiwala ◽

Karthik S. Shastri ◽

Maria Peris-Celda ◽

Tyler Kenning ◽

Carlos D. Pinheiro-Neto

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Fascia Lata ◽

High Flow ◽

Csf Leak ◽

Nasoseptal Flap ◽

Endoscopic Endonasal ◽

Skull Base Reconstruction ◽

Csf Diversion ◽

Csf Leaks

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.

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17 Improving Frailty Identification and Comprehensive Geriatric Assessment (CGA) Completion on the Wards

Age and Ageing ◽

10.1093/ageing/afz183.17 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i1-i8

Author(s):

D Verma ◽

F Bonora ◽

R Walker ◽

M Kaneshamoorthy ◽

L Bafadhel

Keyword(s):

Older People ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Elderly Care ◽

Frail Older People ◽

Clinical Frailty Scale ◽

Improvement Project ◽

Qualitative Feedback ◽

Complicated Course ◽

User Friendly

Abstract Introduction The Comprehensive Geriatric Assessment (CGA) is known to deliver substantial and measurable health improvements to frail older people, including increased independence and a reduction in mortality.1 The Clinical Frailty Scale (CFS) can detect older adults at higher risk of complicated course and longer hospital stay.2 Despite the known benefits, previous audits has shown poor documentation on geriatric wards at Southend Hospital. Therefore, we devised a Quality Improvement Project to improve the uptake of both these. Methods A total of two Plan Do Study Act (PDSA) cycles were completed where CGA completion and CFS documentation was audited. Each cycle lasted two weeks (25 patients). Qualitative feedback was obtained from the members of multidisciplinary team to aid improvements. The baseline audit was based on the introduction of a 2-page ward proforma for all new patients. The first intervention was an improved 2-page ward-proforma. The second intervention was a single page ward-proforma. Results Originally, 40% of new patients admitted onto the ward had a CGA assessment and CFS score. After the first intervention, 79% (19) patients had a CFS score and a CGA assessment. 21% had a full CGA completed and 58% had partial CGA. Feedback included wanting a single page proforma to increase uptake. Questions needed to be more unambiguous and more tick boxes. After the second intervention 100% (25) patients had a CFS score and a CGA assessment. 40% (10) had a full CGA completed and 60% (15) had a partial CGA. Feedback include incorporating the ward round documentation to avoid repetition. Conclusions The results show that by using a focused, concise and user-friendly proforma, uptake of the Comprehensive Geriatric Assessment and Clinical Frailty Scale can be significantly increased, bringing substantial and measurable health improvements to frail older people admitted to elderly care wards. References 1. Welsh TJ, Gordon AL, Gladman JR. Int J Clin Pract. 2014;68(3):290–293. 2. Juma S, Taabazuing MM, Montero-Odasso M. Can Geriatr J. 2016;19(2):34–39.

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Isolated rectal buttonhole tears in obstetrics: case series and review of the literature

International Urogynecology Journal ◽

10.1007/s00192-020-04502-2 ◽

2020 ◽

Cited By ~ 2

Author(s):

Joanna C. Roper ◽

Ranee Thakar ◽

Abdul H. Sultan

Keyword(s):

Case Reports ◽

Case Series ◽

Operative Management ◽

The Other ◽

Uneventful Recovery ◽

Repair Technique ◽

Vaginal Deliveries ◽

Colorectal Surgeon ◽

Colorectal Surgeons ◽

Repair Techniques

Abstract Introduction and hypothesis The management of isolated rectal buttonhole tears is not standardised and can be challenging in an acute obstetric setting. Our aim was to review the published literature and describe management and repair techniques in a case series. Methods A literature search was carried out. All results were screened and reviewed. Rectal buttonhole tears following vaginal delivery between April 2012 and January 2020 in our institution were identified. Repair technique and post-operative management were recorded. Results There were nine published case reports (four instrumental deliveries, two vaginal breech and three normal vaginal deliveries). Four case reports described a two-layer closure and five described a three-layer closure. Two cases were repaired in collaboration with colorectal surgeons. All nine cases made an uneventful recovery. We identified three patients with buttonhole tears all of whom had instrumental deliveries. A colorectal surgeon repaired the tear in two layers in one case, and an obstetrician performed the repair in the other two cases, one in three layers and the other in two layers. One patient had a de-functioning stoma at a later date due to a second breakdown of the recto-vaginal fistula repair. Conclusion Buttonhole tears are rare but techniques of repair vary. Most cases reviewed had an uneventful recovery after repair. We provide standardised steps for repair and management of isolated rectal buttonhole tears along with a video demonstrating the repair technique in an animal tissue (pig) model.

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