Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea and Skull Base Defects: A Review of Twenty-Nine Cases

1994 ◽  
Vol 111 (5) ◽  
pp. 600-605 ◽  
Author(s):  
Edward E. Dodson ◽  
Charles W. Gross ◽  
Jason L. Swerdloff ◽  
L. Mark Gustafson
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Sinus Surgery ◽  
Neurosurgical Procedures ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Endoscopic Techniques ◽  
Time Period ◽  
Transnasal Endoscopic Repair ◽  
Skull Base Defects ◽  
Tissue Grafts

The management of cerebrospinal fluid rhinorrhea has historically plagued the neurosurgeon and the otolaryngologist—head and neck surgeon. Intracranial repair is still favored at many institutions, despite its inherent morbidity. Extracranial nonendoscopic techniques have been previously described but have not gained wide acceptance. More recently, several reports have been published describing a variety of endoscopic techniques in limited patient series used to manage cerebrospinal fluid rhinorrhea. We present our series of 29 patients with cerebrospinal fluid rhinorrhea, treated with endoscopic techniques between December 1989 and June 1993, with follow-up ranging from 3 to 43 months. This represents the largest reported series to date of patients treated with this technique. Our technique has evolved during this time period but centers around the use of free tissue grafts from various donor sites. The causes of the skull base defects in this series included neurosurgical procedures (9), functional endoscopic sinus surgery (8), and trauma (3). Defects occurred spontaneously in 9 cases. The fovea ethmoidalis and sphenoid sinus were the site in 11 and 12 cases, respectively, and the cribriform plate was involved in 6 cases. Cerebrospinal fluid rhinorrhea was documented by nasal endoscopy with or without intrathecal fluorescein, laboratory studies, computed tomography with or without contrast cisternography, and radioisotope cisternography in various combinations. Resolution of cerebrospinal fluid rhinorrhea was achieved in 22 of 29 patients (75.9%) with one endoscopic procedure and 25 of 29 patients (86.2%) after a second attempt. Four patients required neurosurgical intervention for recurrent cerebrospinal fluid rhinorrhea. Complications were minimal and were related primarily to the original pathology or procedure. Cerebrospinal fluid rhinorrhea can be managed safely and effectively with endoscopic techniques in a majority of cases, and the morbidity of open procedures can be avoided.

Endoscopic Repair of Large Skull Base Defects after Powered Sinus Surgery

2003 ◽  
Vol 129 (3) ◽  
pp. 204-209 ◽  
Author(s):  
Christopher A. Church ◽  
Alexander G. Chiu ◽  
Winston C. Vaughan
Keyword(s):  
Skull Base ◽  
Sinus Surgery ◽  
Intracranial Injury ◽  
Endoscopic Repair ◽  
Endoscopic Techniques ◽  
Tissue Removal ◽  
Cerebrospinal Fluid Leaks ◽  
Pathology Reports ◽  
Skull Base Defects

OBJECTIVES: To evaluate the management of patients with large skull base defects (> 2 cm) and intracranial injury caused by powered endoscopic sinus surgery. STUDY DESIGN AND SETTING: All patients treated for postendoscopic sinus surgery skull base injury over a 4-year period were reviewed. RESULTS: Three patients with skull base defects greater than 2 cm in size and associated intracranial injury from powered ESS were identified. All patients presented with active cerebrospinal fluid leaks. CT scans showed intracranial injury and pathology reports revealed brain tissue removal. Using image-guided endoscopic techniques, all defects were addressed with multilayer repair. Closure was achieved in all patients on the first attempt, with an average follow-up of 27 months. CONCLUSIONS: The use of powered instrumentation along the skull base can be dangerous and can result in extensive skull base defects with associated loss of dura and gray matter. Large ethmoid roof defects and significant intracranial injury, however, are not absolute contraindications to endoscopic repair.

Cranial Bone Grafts in Cerebrospinal Fluid Leak and Encephalocele Repair: A Preliminary Report

2003 ◽  
Vol 17 (3) ◽  
pp. 153-158 ◽  
Author(s):  
William E. Bolger ◽  
Kevin Mclaughlin
Keyword(s):  
Cerebrospinal Fluid ◽  
Bone Graft ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Bone Grafts ◽  
Cranial Bone ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Graft Harvest ◽  
Skull Base Defects

Background With the introduction and subsequent widespread acceptance of endoscopic surgery, otolaryngologists are increasingly being called on to care for patients with cerebrospinal fluid rhinorrhea and meningoencephaloceles. Patients with large encephaloceles and skull base defects present a special challenge. We present our experience with cranial bone grafts in treating this important entity. Methods Our clinical experience was reviewed from 1998 to 2001. Review parameters included defect size, cranial bone graft harvest site and size, and graft appearance on postoperative follow-up. Results Results revealed that 20 patients underwent defect repair with cranial bone graft. The average defect was ∼0.92 x 0.7 cm; nine defects were located in the ethmoid roof, eight defects were in the sphenoid, and three defects were in the posterior table of the frontal sinus. Donor sites included 2 parietal, 3 frontal, and 15 temporal (mastoid). Grafts healed well and all defects remained closed on endoscopic and computerized tomographic follow-up. All donor sites healed well. Conclusion Our experience indicates that cranial bone graft is an excellent material for endoscopic reconstruction of skull base defects. It confers special advantages in large defects, in defects with complex three-dimensional characteristics, and in patients with cerebrospinal fluid leaks associated with an elevated intracranial pressure.

Anterior Skull Base Tumors and Surgery

2021 ◽  
Author(s):  
Judd H. Fastenberg ◽  
Gurston G. Nyquist ◽  
Blair M. Barton
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Sinus Surgery ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Dural Repair ◽  
Endoscopic Techniques ◽  
Anterior Cranial Base ◽  
Tissue Flaps ◽  
Skull Base Defects

Anterior skull base surgery requires intimate knowledge of a highly complex anatomic region containing critical neurovascular structures. A wide array of pathologies can occur along the anterior cranial base, including meningiomas, esthesioneuroblastomas, pituitary adenomas, craniopharyngiomas, chondrosarcomas, and chordomas. Advancements in endoscopic sinus surgery have allowed many of these tumors to be effectively treated via an endoscopic endonasal technique. This approach obviates the need for large incisions causing cosmetic deformity, improves magnification of the surgical field, and offers a direct path to lesions thus avoiding retraction of structures such as the brain and nerves. Surgeons must understand the limitations of endoscopic techniques and consider open or combined open and endoscopic approaches when appropriate. Reconstructive anterior skull base techniques vary depending on the size and location of defects, along with factors such as intracranial pressure and patient co-morbidities. Large skull base defects require multilayer reconstruction that include a watertight primary dural repair with either synthetic or autologous tissue, followed by local vascularized tissue flaps. This review contains 8 figures, 2 videos, 4 tables and 33 references Key words: Anterior skull base, meningioma, esthesioneuroblastoma, chordoma, pituitary, CSF leak, nasosptal flap, dural repair, expanded endonasal approaches, endoscopic surgery

Is posttraumatic cerebrospinal fluid fistula a predictor of posttraumatic meningitis? A US Nationwide Inpatient Sample database study

2012 ◽  
Vol 32 (6) ◽  
pp. E4 ◽  
Author(s):  
Ashish Sonig ◽  
Jai Deep Thakur ◽  
Prashant Chittiboina ◽  
Imad Saeed Khan ◽  
Anil Nanda
Keyword(s):  
Cerebrospinal Fluid ◽  
Head Injury ◽  
Skull Base ◽  
Nationwide Inpatient Sample ◽  
Neurosurgical Procedures ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Factors Associated ◽  
Hospitalization Cost ◽  
Neurosurgical Intervention

Object Various factors have been reported in literature to be associated with the development of posttraumatic meningitis. There is a paucity of data regarding skull fractures and facial fractures leading to CSF leaks and their association with the development of meningitis. The primary objective of this study was to analyze the US Nationwide Inpatient Sample (NIS) database to elucidate the factors associated with the development of posttraumatic meningitis. A secondary goal was to analyze the overall hospitalization cost related to posttraumatic meningitis and factors associated with that cost. Methods The NIS database was analyzed to identify patients admitted to hospitals with a diagnosis of head injury from 2005 through 2009. This data set was analyzed to assess the relationship of various clinical parameters that may affect the development of posttraumatic meningitis using binary logistic regression models. Additionally, the overall hospitalization cost for the head injury patients who did not undergo any neurosurgical intervention was further categorized into quartile groups, and a regression model was created to analyze various factors responsible for escalating the overall cost of the hospital stay. Results A total of 382,267 inpatient admissions for head injury were analyzed for the 2005–2009 period. Meningitis was reported in 0.2% of these cases (708 cases). Closed skull base fractures, open skull base fractures, cranial vault fractures, and maxillofacial fractures were reported in 20,524 (5.4%), 1089 (0.3%), 5064 (1.3%), and 88,649 (23.2%) patients, respectively. Among these patients with fractures, meningitis was noted in 0.17%, 0.18%, 0.05%, and 0.10% admissions, respectively. Cerebrospinal fluid rhinorrhea was reported in 453 head injury patients (0.1%) and CSF otorrhea in 582 (0.2%). Of the patients reported to have CSF rhinorrhea, 35 (7.7%) developed meningitis, whereas in the cohort with CSF otorrhea, 15 patients (2.6%) developed meningitis. Cerebrospinal fluid rhinorrhea (p < 0.001, OR 22.8, 95% CI 15.6–33.3), CSF otorrhea (p < 0.001, OR 9.2, 95% CI 5.2–16.09), and major neurosurgical procedures (p < 0.001, OR 5.6, 95% CI 4.8–6.5) were independent predictors of meningitis. Further, CSF rhinorrhea (p < 0.001, OR 2.0, 95% CI 1.6–2.7), CSF otorrhea (p < 0.001, OR 2.3, 95% CI 1.9–2.7), and posttraumatic meningitis (p < 0.001, OR 3.1, 95% CI 2.5–3.8) were independent factors responsible for escalating the cost of head injury in cases not requiring any major neurosurgical intervention. Conclusions Cerebrospinal fluid rhinorrhea and CSF otorrhea are independent predictors of posttraumatic meningitis. Furthermore, meningitis and CSF fistulas may independently lead to significantly increased cost of hospitalization in head injury patients not undergoing any major neurosurgical intervention.

scholarly journals Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea

2017 ◽  
Vol 10 (2) ◽  
pp. 45-48
Author(s):  
Devang P Gupta ◽  
SK Dinesh ◽  
Ashil D Manavadaria
Keyword(s):  
Cerebrospinal Fluid ◽  
Conservative Management ◽  
Sinus Surgery ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Medical College ◽  
Primary Surgery ◽  
Transnasal Endoscopic Repair

ABSTRACT Introduction Cerebrospinal fluid (CSF) leak can arise as a complication of trauma, hydrocephalus, endoscopic sinus surgery, or it may occur spontaneously without any identifiable cause. Surgical repair is recommended in patients who do not respond to the conservative management. In recent years, transnasal endoscopic approach has become the preferred method for repairing CSF leaks, and better outcomes have been reported as compared with the intracranial approaches that were previously used. The objective of this study was to analyze the outcome of transnasal endoscopic repair of CSF rhinorrhea. Materials and methods This prospective study was conducted in the Department of ENT, B.J. Medical College, Ahmedabad, India, from April 2013 to July 2016. Twenty-five patients with CSF rhinorrhea were included in the study. They were diagnosed based on the clinical evaluation, computed tomography, and magnetic resonance imaging. These patients did not respond to conservative management and were operated transnasally using rigid endoscope. Patients were followed up for a mean duration of 9 months, and the outcome was analyzed. Results The patients included in the study ranged in the age group of 12 to 55 years. Among the patients, 15 were females and 10 were males. The cause of CSF rhinorrhea was traumatic in 18, idiopathic or spontaneous in 7. In 12 patients, the site of leak was cribriform plate, 6 from ethmoid, 5 from sphenoid sinus, and in 2 frontal sinuses were affected. Primary surgery was successful in 23 of cases. In two cases, reexploration had to be performed. Overall success rate was 100%. Conclusion Transnasal endoscopic repair of CSF rhinorrhea is highly successful, safe, and less traumatic. How to cite this article Gupta DP, Dinesh SK, Manavadaria AD. Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea. Clin Rhinol An Int J 2017;10(2):45-48.

Sign in / Sign up

Export Citation Format

Share Document