GRADED REPAIR OF CRANIAL BASE DEFECTS AND CEREBROSPINAL FLUID LEAKS IN TRANSSPHENOIDAL SURGERY

Abstract Objective: Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented. Methods: To achieve watertight closure of the anterior cranial base, autologous fascia lata was used to create a “gasket seal” around a bone buttress, followed by application of a tissue sealant such as DuraSeal (Confluent Surgical, Inc., Waltham, MA). The gasket-seal closure was used to seal the anterior cranial base in a series of 10 patients with intradural surgery for suprasellar craniopharyngiomas (n = 5), planum meningiomas (n = 3), clival chordoma (n = 1), and recurrent iatrogenic cerebrospinal fluid leak (n = 1). Lumbar drains were placed intraoperatively in five patients and remained in place for 3 days postoperatively. Results: After a mean follow-up period of 12 months, there were no cerebrospinal fluid leaks. Conclusion: The gasket-seal closure is an effective method for achieving watertight closure of the anterior cranial base after endoscopic intradural surgery.

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Opiate Use After Endoscopic Endonasal Transsphenoidal Surgery

American Journal of Rhinology and Allergy ◽

10.1177/19458924211061990 ◽

2021 ◽

pp. 194589242110619

Author(s):

Tara J. Wu ◽

Reza Kianian ◽

Emmanuel G. Villalpando ◽

Morcos N. Nakhla ◽

Christine Wells ◽

...

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Linear Regression ◽

Multiple Linear Regression ◽

Transsphenoidal Surgery ◽

Endoscopic Endonasal ◽

Opiate Use ◽

Endoscopic Endonasal Transsphenoidal Surgery ◽

Cerebrospinal Fluid Leaks ◽

Grade 3

Background The literature on opiate use after endoscopic endonasal transsphenoidal surgery (EETS) is limited. Objective To determine the risk factors for higher opiate use following EETS and the quantity of opiates used after discharge. Methods A retrospective review of 144 patients undergoing EETS from July 2018 to July 2020 was conducted. Patient, tumor, and surgical factors were documented. Pain scores and medications used on postoperative days (POD) 0 and 1, and discharge prescriptions, were recorded. Opiate use was quantified using morphine milligram equivalents (MME) dose. Multiple linear regression determined risk factors independently associated with POD0 to 1 opiate use. Results On POD 0 to 1, mean pain score was 4.9/10 (standard deviation [SD] ± 2.0). Mean acetaminophen use was 3.4 tablets (SD ± 1.6; 650 mg per tablet). Mean opiate use was 35.6 MME (SD ± 36.3), equivalent to 4.7 tablets (SD ± 4.8) of oxycodone 5 mg. Multiple linear regression showed that current smokers required an additional 37.1 MME ( P = .011), and patients with grade 3 intraoperative cerebrospinal fluid leaks required an additional 36.7 MME ( P = .046) on POD0 to 1. On discharge, mean opiate prescription was 117.7 MME (SD ± 102.1), equivalent to 15.7 tablets (SD ± 13.6) of oxycodone 5 mg. Thirty-nine patients (27.1%) did not require prescriptions. Only 10 patients (6.9%) required opiate refill(s) within 30 days after surgery. Conclusion Patients undergoing EETS have higher opiate needs compared to those undergoing endoscopic sinus surgery, although the overall requirements are still considered low. Independent risk factors associated with higher opiate use in the immediate postoperative period included current smokers and grade 3 intraoperative cerebrospinal fluid leaks.

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BioGlue® for prevention of postoperative cerebrospinal fluid leaks in transsphenoidal surgery: a case series

Surgical Neurology ◽

10.1016/j.surneu.2006.06.043 ◽

2006 ◽

Vol 66 (4) ◽

pp. 371-376 ◽

Cited By ~ 52

Author(s):

Joshua R. Dusick ◽

Carlos A. Mattozo ◽

Felice Esposito ◽

Daniel F. Kelly

Keyword(s):

Cerebrospinal Fluid ◽

Transsphenoidal Surgery ◽

Case Series ◽

Cerebrospinal Fluid Leaks

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Endoscopic Endonasal Approaches For Repair Of Cerebrospinal Fluid Leaks: Nine-Year Experience

Operative Neurosurgery ◽

10.1227/01.neu.0000193924.65297.3f ◽

2006 ◽

Vol 58 (suppl_4) ◽

pp. ONS-246-ONS-257 ◽

Cited By ~ 29

Author(s):

Davide Locatelli ◽

Federico Rampa ◽

Ilaria Acchiardi ◽

Maurizio Bignami ◽

Francesca De Bernardi ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Multidisciplinary Approach ◽

Surgical Repair ◽

Correct Diagnosis ◽

Cranial Base ◽

Successful Outcome ◽

Surgical Approaches ◽

Endoscopic Endonasal ◽

Invasive Approach ◽

Cerebrospinal Fluid Leaks

Abstract Objective: To describe surgical endoscopic experience in the repair of cerebrospinal fluid leaks treated by transnasal approaches. Methods: Different surgical approaches and techniques in the repair of cranial base defects are reviewed in a series of 135 patients. Results: Success rate at first attempt was 93.3%. Only 9 patients (6.7%) needed a second surgical repair, and in one patient, a coronal approach with frontal craniotomy was necessary. In the other eight cases, an endoscopic procedure was chosen. Two patients needed a third endonasal endoscopic surgical repair, with successful outcome. Conclusion: The target of endoscopic endonasal technique in the repair of cerebrospinal fluid leaks is to ensure a stable duraplasty with the least invasive approach avoiding craniotomy. A correct diagnosis surely allows the choice of the best treatment, surgical approach, graft, and technique. Our multidisciplinary approach to this pathology during these years has been essential to gain our challenging results.

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