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.

Extradural cartilage inlay graft in cerebrospinal fluid fistula repair

2010 ◽  
Vol 124 (12) ◽  
pp. 1294-1297 ◽  
Author(s):  
P Thulasi Das ◽  
D Balasubramanian
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Success Rate ◽  
Bony Defect ◽  
Cerebrospinal Fluid Fistula ◽  
Fistula Repair ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Skull Base Defects ◽  
Fluid Fistula

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.

Cerebrospinal fluid leak repair: utility of intrathecal fluorescein for correct topographic identification of the skull base defects

2022 ◽  
Author(s):  
Francesco Missale ◽  
Alessandro Ioppi ◽  
Alessandro Ascoli ◽  
Paola Lovino Camerino ◽  
Andrea Luigi Camillo Carobbio ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Skull Base Defects ◽  
Fluid Leak

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.

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

2010 ◽  
Vol 2 (1) ◽  
pp. 87-94 ◽  
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.

scholarly journals Vascularized middle turbinate mucoperiosteal flap in skull base defects: follow-up analysis of 20 cases

2016 ◽  
Vol 3 (1) ◽  
pp. 71 ◽  
Author(s):  
Shibu George ◽  
Sandeep Suresh
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Middle Turbinate ◽  
Benign Intracranial Hypertension ◽  
Nasoseptal Flap ◽  
Csf Rhinorrhea ◽  
Endoscopic Closure ◽  
Mucoperiosteal Flap ◽  
Skull Base Defects

<p class="abstract"><strong>Background:</strong> Vascularized flaps are preferred in repair of skull base defects since they provide quality tissue volume and allow rapid healing. Though nasoseptal flap is the gold standard it may not be available always and has its own share of pitfalls; this makes the middle turbinate flap a viable alternative. This descriptive study was designed to analyze the efficacy of middle turbinate flap in endoscopic closure of skull base defects and to define indications and limitations of the flap.</p><p class="abstract"><strong>Methods:</strong> 20 patients who underwent endoscopic closure of small and medium sized skull base defects using middle turbinate mucoperiosteal flap were analyzed and followed up. Etiology, presentation, site and co-morbidities associated with such defects were studied. Effectiveness of closure was analyzed by the ability to cover fully, graft uptake and complications.  </p><p class="abstract"><strong>Results:</strong> Successful flap take up was noted in all 20 cases (100%) on long term follow up; transient cerebrospinal fluid leak was observed in 1case (5%) during the immediate post-operative period which subsided fully. Spontaneous CSF rhinorrhea (n=11 [55%]) was the most common indication for closure and unilateral watery rhinorrhea was the commonest presentation (n=13 [65%]). Benign intracranial hypertension was found to have significant association with cerebrospinal fluid rhinorrhea. Most common site of leak was the medial lamella of cribriform plate (n=11 [55%]).</p><p><strong>Conclusions:</strong> Middle turbinate flap is an effective alternative to nasoseptal flap for small and medium sized anterior skull base defects; efficacy in larger defects and posterior sellar defects cannot be substantiated. </p>

A management algorithm for cerebrospinal fluid leak associated with anterior skull base fractures: detailed clinical and radiological follow-up

2011 ◽  
Vol 35 (2) ◽  
pp. 227-238 ◽  
Author(s):  
Camillo Sherif ◽  
Antonio Di Ieva ◽  
Daniel Gibson ◽  
Bita Pakrah-Bodingbauer ◽  
Georg Widhalm ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Skull Base ◽  
Management Algorithm ◽  
Fluid Leak

Presentation, Workup, and Management of Penetrating Transorbital and Transnasal Injuries: A Case Report and Systematic Review

2017 ◽  
Vol 31 (2) ◽  
pp. e29-e34 ◽  
Author(s):  
Saied Ghadersohi ◽  
Elisabeth H. Ference ◽  
Kara Detwiller ◽  
Robert C. Kern
Keyword(s):  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Case Report ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Interdisciplinary Management ◽  
Endoscopic Removal ◽  
Low Velocity ◽  
Surgical Interventions ◽  
Skull Base Defects

Background A foreign body (FB) penetrating intracranially after passing transorbitally or transnasally is a rare occurrence. However, otolaryngologists are increasingly being asked to participate in the care of these patients for both endoscopic removal of the object and repair of any skull base defects. Objective To assess the presentation, workup, and management of transnasal or transorbital penetrating FB injury. Methods Systematic review of the presentation, workup, and management of transnasal or transorbital penetrating FB injury; plus, a case report of a 53-year-old woman with a transorbital penetrating rose bush branch. We searched medical literature data bases, which resulted in 215 total titles, which were then narrowed based on inclusion and exclusion criteria. Results Thirty-five cases of transorbital or transnasal low-velocity trauma that involved the paranasal sinuses were reviewed from 33 articles. The average age was 30 years, 40% of the objects were made of wood. Fifty-seven percent of the cases were transorbital, whereas 43% were transnasal. Forty-six percent of the surgical interventions were completed endoscopically or with endoscopic assistance. Complications of injury were common, with 66% of patients experiencing cerebrospinal fluid leaks; 23%, permanent blindness; 17%, meningitis; 14%, ophthalmoplegia; 9%, decreased visual acuity; and 3%, brain abscess. Our patient presented with a traumatic cerebrospinal fluid leak, and recovered well after transorbital and endoscopic removal of the branch, skull base repair, and a prolonged course of antibiotics and antifungal medications. Conclusions Transnasal and transorbital penetrating FB injuries are a relatively uncommon occurrence but when they do occur require rapid workup and interdisciplinary management to prevent acute and delayed complications.

Posterior nasoseptal flap in the reconstruction of skull base defects following endonasal surgery

2019 ◽  
Vol 133 (05) ◽  
pp. 380-385
Author(s):  
C Singh ◽  
N Shah
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
High Flow ◽  
Anterior Skull Base ◽  
Nasoseptal Flap ◽  
Lumbar Drain ◽  
Endonasal Reconstruction ◽  
Skull Base Defects ◽  
Fluid Leak

AbstractObjectiveTo study the clinical outcomes of a posterior nasoseptal flap used in the endonasal reconstruction of anterior skull base defects.MethodsThe early harvested flap was used to reconstruct anterior skull base defects in patients with high-flow on-table cerebrospinal fluid leak. Post-operatively, the patients were analysed for cerebrospinal fluid leak and bleeding.ResultsOf the 100 patients, 87 had macro defects while 13 had micro defects. Non-secretary lesions were present in 60 patients, while secretary lesions were present in 40 patients. Cerebrospinal fluid leak was present in all the patients undergoing surgery, and the majority of them had a lumbar drain fitted. Post-operatively, two patients experienced bleeding and only two patients had a cerebrospinal fluid leak.ConclusionThe use of a posterior nasoseptal flap for reconstruction of the anterior skull base amongst patients with a high-flow intra-operative cerebrospinal fluid leak can help prevent post-operative cerebrospinal fluid leak. Its applicability to wide patient profiles, with respect to age, size of defect and diagnosis, make it a versatile choice for reconstruction after endonasal anterior skull base surgical procedures.

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