Nasal Floor Free Mucosal Graft for Skull Base Reconstruction and Cerebrospinal Fluid Leak Repair

AbstractBackground:Multi-layer reconstruction has become standard in endoscopic skull base surgery. The inlay component used can vary among autografts, allografts, xenografts and synthetics, primarily based on surgeon preference. The short- and long-term outcomes of collagen matrix in skull base reconstruction are described.Methods:A case series of patients who underwent endoscopic skull base reconstruction with collagen matrix inlay were assessed. Immediate peri-operative outcomes (cerebrospinal fluid leak, meningitis, ventriculitis, intracranial bleeding, epistaxis, seizures) and delayed complications (delayed healing, meningoencephalocele, prolapse of reconstruction, delayed cerebrospinal fluid leak, ascending meningitis) were examined.Results:Of 120 patients (51.0 ± 17.5 years, 41.7 per cent female), peri-operative complications totalled 12.7 per cent (cerebrospinal fluid leak, 3.3 per cent; meningitis, 3.3 per cent; other intracranial infections, 2.5 per cent; intracranial bleeding, 1.7 per cent; epistaxis, 1.7 per cent; and seizures, 0 per cent). Delayed complications did not occur in any patients.Conclusion:Collagen matrix is an effective inlay material. It provides robust long-term separation between sinus and cranial cavities, and avoids donor site morbidity, but carries additional cost.

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Principles of Skull Base Reconstruction After Ablative Head and Neck Cancer Surgery

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1021 ◽

2010 ◽

Vol 2 (1) ◽

pp. 87-94 ◽

Cited By ~ 1

Author(s):

Joseph Curry ◽

Zoukaa Sargi

Keyword(s):

Cerebrospinal Fluid ◽

Head And Neck Cancer ◽

Skull Base ◽

Cerebrospinal Fluid Leak ◽

Craniofacial Skeleton ◽

Skull Base Reconstruction ◽

Technical Aspects ◽

The Individual ◽

Skull Base Defects ◽

Fluid Leak

Abstract “Resection of malignancies of the skull base can result in significant functional and cosmetic morbidity as well as mortality. Reconstructive efforts provide not only functional and cosmetic rehabilitation, but also allow for the avoidance of potentially disastrous complications such as cerebrospinal fluid leak or meningitis. The optimal reconstruction is determined both by a patient based approach and a defect based approach. Skull base defects can be addressed by the separate components of the craniofacial skeleton in which they involve, and therefore the individual reconstructive issues which must be addressed. In this article, we describe an approach to skull base reconstruction and the technical aspects of the available reconstructive options.

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Cerebrospinal Fluid Leak Repair Simulation Model: Face, Content, and Construct Validation

American Journal of Rhinology and Allergy ◽

10.1177/1945892420952262 ◽

2020 ◽

pp. 194589242095226

Author(s):

Abdulaziz AlQahtani ◽

Abeer Albathi ◽

Paolo Castelnuovo ◽

Fahad Alfawwaz

Keyword(s):

Cerebrospinal Fluid ◽

Construct Validity ◽

Simulation Model ◽

Skull Base ◽

Cerebrospinal Fluid Leak ◽

Skull Base Reconstruction ◽

Reconstruction Surgery ◽

Item Questionnaire ◽

The Face ◽

Fluid Leak

Background Cerebrospinal fluid leak (CSFL) repair simulation models are scarce; however, these models are valuable tools for skull base reconstruction surgery training. Objectives This study aims to assess the face, content, and construct validity of a CSFL repair simulation model. Method Eight novices (residents- PGY3) and eight experts have performed skull base reconstruction in multiple sites in twelve human cadaveric heads in simulated surgical environment. The experts completed a post-study 21-item questionnaire to assess the face and content validity. The performances of the participants were recorded and scored by two independent investigators who were blinded to the participant's level. Global Rating Scale of Operative Performance (GRSOP) and a Specific Skull Base Reconstruction Checklist (SBRC) were used to score the performances. Results The responses from the expert group for the 21-item questionnaire were high for all items (4.13–4.88 out of 5). The internal consistency reliability of the questionnaire and the intraclass correlation, which was derived by Cronbach’s Alpha, were 0.913 and 0.941 respectively. Differences in construct validity between the two groups were statistically significant for both the GRSOP and SBRS (P-value < 0.001). Conclusion We demonstrated the face, content, and construct validity of the CSFL repair simulation model, which facilitates the acquisition of technical skills necessary for skull base reconstruction surgery. The model includes realistic features that make it useful in educational courses.

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Cerebrospinal Fluid Leak Risk Factors in Pediatric Patients undergoing Endoscopic Endonasal Skull Base Surgery

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0035-1546527 ◽

2015 ◽

Vol 76 (S 01) ◽

Author(s):

Amanda Stapleton ◽

Elizabeth Tyler-Kabara ◽

Paul Gardner ◽

Snyderman Carl ◽

Wang Eric

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Skull Base ◽

Pediatric Patients ◽

Skull Base Surgery ◽

Cerebrospinal Fluid Leak ◽

Endoscopic Endonasal ◽

Fluid Leak

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Risk factor for cerebrospinal fluid leak after endoscopic endonasal skull base surgery: a single-center experience

Acta Oto-Laryngologica ◽

10.1080/00016489.2021.1900600 ◽

2021 ◽

pp. 1-5

Author(s):

Hiroyuki Ozawa ◽

Mariko Sekimizu ◽

Shin Saito ◽

Shintaro Nakamura ◽

Takuya Mikoshiba ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Risk Factor ◽

Skull Base ◽

Skull Base Surgery ◽

Cerebrospinal Fluid Leak ◽

Single Center ◽

Endoscopic Endonasal ◽

Single Center Experience ◽

Fluid Leak

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Crayon in the Orbit and Sinuses in a Pediatric Patient

Ear Nose & Throat Journal ◽

10.1177/01455613211018582 ◽

2021 ◽

pp. 014556132110185

Author(s):

Michela Borrelli ◽

Kristen A. Echanique ◽

Jeffrey Koempel ◽

Elisabeth H. Ference

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Pediatric Patient ◽

Cerebrospinal Fluid Leak ◽

Ethmoid Sinus ◽

Rare Occurrence ◽

Lamina Papyracea ◽

The Right ◽

Fluid Leak ◽

Type Of Injury

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.

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The Challenge of Skull Base Closure: Methods for Reducing Postoperative Cerebrospinal Fluid Leak

World Neurosurgery ◽

10.1016/j.wneu.2019.01.121 ◽

2019 ◽

Vol 124 ◽

pp. 502-512

Author(s):

Christian P. Soneru ◽

Charles A. Riley ◽

Abtin Tabaee ◽

Ashutosh Kacker ◽

Vijay K. Anand ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Cerebrospinal Fluid Leak ◽

Base Closure ◽

Fluid Leak

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Pediatric skull base reconstruction: case report of a tunneled temporoparietal fascia flap

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.6.peds1588 ◽

2016 ◽

Vol 17 (3) ◽

pp. 371-377 ◽

Cited By ~ 11

Author(s):

Jeffrey C. Rastatter ◽

Patrick C. Walz ◽

Tord D. Alden

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Cerebrospinal Fluid Leak ◽

Nasoseptal Flap ◽

Pediatric Case ◽

Clival Chordoma ◽

Temporoparietal Fascia ◽

Temporoparietal Fascia Flap ◽

Fluid Leak ◽

Fascia Flap

The authors of this report present a pediatric case involving the use of a tunneled temporoparietal fascia flap to reconstruct a skull base defect for a multiply recurrent clival chordoma and cerebrospinal fluid leak, demonstrate the surgical technique through illustrations and intraoperative photos, and review the pertinent literature. A 9-year-old female patient underwent extensive clival chordoma resection via both the endoscopic and open approaches, which ultimately exhausted the bilateral nasoseptal flaps and other intranasal reconstructive options. Following proton beam radiation and initiation of chemotherapy, tumor recurrence was managed with further endoscopic resection, which was complicated by a recalcitrant cerebrospinal fluid leak. A tunneled temporoparietal fascia flap was used to provide vascular tissue to augment an endoscopic repair of the leak and reconstruction of the skull base. While the nasoseptal flap remains the workhorse for many pediatric and adult endoscopic skull base reconstructions, the tunneled temporoparietal fascia flap has a demonstrated efficacy in adults when the nasoseptal flap and other intranasal flaps are unavailable. This report documents a pediatric case, serving as a step toward establishing this technique in the pediatric population.

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