Comprehensive Algorithm for Skull Base Dural Lesion and Cerebrospinal Fluid Fistula Diagnosis

AbstractObjective:To present our experience in managing cerebrospinal fluid rhinorrhoea using the cartilage inlay (underlay) technique to repair skull base defects larger than 4 mm.Study design:Retrospective study involving patients presenting with cerebrospinal fluid rhinorrhoea between 1994 and 2008.Setting:Patients were treated in a tertiary referral centre for nose and sinus diseases. Patients' medical records were reviewed and analysed.Results:A total of 62 patients were operated upon using a cartilage inlay technique to repair bony skull base defects ranging in size from 4 to 20 mm (widest diameter). Of these 62 patients, 16 constituted revisions of earlier procedures undertaken elsewhere. The success rate of the technique was 100 per cent. Patient follow up ranged from six months to 16 years, with a median follow up of 15 months. Three patients had minor post-operative sinus infections; no serious complications were encountered.Conclusion:Extradural cartilage inlay appears to be an effective technique in the management of cerebrospinal fluid rhinorrhoea, especially for large defects and revision procedures. To our knowledge, the described patients represent the largest reported series of cerebrospinal fluid rhinorrhoea cases managed using the cartilage inlay technique. We believe that the crucial factors in our high success rate for cerebrospinal fluid fistula repair are: precise identification of the bony defect; meticulous preparation of the graft bed; careful elevation of the dura; judicious use of just enough graft tissue; and adequate graft support.

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32 Cerebrospinal Fluid Fistula in Skull Base Surgery

Handbook of Skull Base Surgery ◽

10.1055/b-0036-131034 ◽

2016 ◽

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Skull Base Surgery ◽

Cerebrospinal Fluid Fistula ◽

Fluid Fistula

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The use of platelet gel for repair of a cerebrospinal fluid fistula of the skull base (a case report and literature review)

Voprosy neirokhirurgii imeni N N Burdenko ◽

10.17116/neiro201882186-92 ◽

2018 ◽

Vol 82 (1) ◽

pp. 86

Author(s):

O. I. Sharipov ◽

M. A. Kutin ◽

A. V. Bayuklin ◽

A. A. Imaev ◽

A. A. Abdilatipov ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Case Report ◽

Literature Review ◽

Skull Base ◽

Cerebrospinal Fluid Fistula ◽

Platelet Gel ◽

Fluid Fistula

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Skull base cerebrospinal fluid fistula

Neurosurgical FOCUS ◽

10.3171/2012.5.focus12164 ◽

2012 ◽

Vol 32 (6) ◽

pp. Introduction ◽

Cited By ~ 1

Author(s):

John Diaz Day ◽

Anil Nanda

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Cerebrospinal Fluid Fistula ◽

Fluid Fistula

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Repair of Cerebrospinal Fluid Fistula from an Invasive Skull Base Prolactinoma Using a Septal Mucosal Vascularized Flap: Technical Case Report

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0032-1331386 ◽

2013 ◽

Vol 74 (S 01) ◽

pp. e50-e53

Author(s):

Andrew Little

Keyword(s):

Cerebrospinal Fluid ◽

Case Report ◽

Skull Base ◽

Cerebrospinal Fluid Fistula ◽

Fluid Fistula

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Resolution of Chronic Aspiration Pneumonitis following Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Fistula of the Skull Base: A Case Series

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1633648 ◽

2018 ◽

Vol 79 (S 01) ◽

pp. S1-S188

Author(s):

Maya Or ◽

Samridhi Amba ◽

Justin Seltzer ◽

Roozera Khan ◽

Bozena Wrobel ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Case Series ◽

Aspiration Pneumonitis ◽

Cerebrospinal Fluid Fistula ◽

Endoscopic Endonasal ◽

Fluid Fistula

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The advantages of using auto-fat tissue in the reconstruction of defects of the skull base in patients with CSF leak

OTORHINOLARYNGOLOGY 2-3(2) 2019 - OTORHINOLARYNGOLOGY ◽

10.37219/2528-8253-2018-2-18 ◽

2018 ◽

pp. 18-23

Author(s):

Dmitry Zabolotny ◽

Diana Zabolotnaya ◽

Eldar Ismagilov

Keyword(s):

Cerebrospinal Fluid ◽

Surgical Treatment ◽

Skull Base ◽

Csf Leak ◽

Fat Tissue ◽

Cerebrospinal Fluid Fistula ◽

Overlay Technique ◽

Skull Base Defect ◽

Group 2 ◽

Fluid Fistula

Relevance: At present, the method of repair of the cerebrospinal fluid fistula using mucous flaps according to the “overlay” technique is widely used in the reconstruction of the skull base and is generally accepted. We have developed an original method for reconstructing defects of the skull base in the presence of a cerebrospinal fluid fistula, using an auto-fat tissue and placing it in two layers. Objectives: To conduct a comparative assessment of methods for the reconstruction of the skull base defect in patients with CSF leak using endoscopic endonasal approach. Materials and methods: Under our supervision there were 46 patients with CSF leak. Depending on the technique of cerebrospinal fluid fistula repair, all patients were divided into 2 groups. The first group of 20 patients consisted of patients who underwent surgery with auto-fat tissue according to our proposed technique. The second group - 26 patients were patients who underwent repair of the skull base defect using the standard overlay technique - a mucous flap on the feeding vascular pedicle. The criterion for evaluating the effectiveness of surgical treatment was patient complaints and data from objective research methods (endoscopic examination of the nasal cavity). Results: After 3 months after surgical treatment, a patient of group 1 had a recurrence of liquorrhea, patients of group 2 after 3 months had a recurrence of liquorrhea in 3 patients, after 6 months in 2 patients of group 2 there was a recurrence of liquorrhea. Findings: When the size of the bone defect of the base of the skull is up to 0.6 cm, the original technique proposed by us for plastics of the cerebrospinal fluid fistula with an auto-fat tissue in two layers provides a tight closure of the bone defect and the defect of the dura mater. When using this method of plastics, the risk of the development of a recurrence of CSF leak is significantly reduced in comparison with the plastics of the cerebrospinal fluid fistula with the use of overlay grafts.

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