“Gasket-seal” Watertight Closure in Minimal-access Endoscopic Cranial Base Surgery

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS342-ONS343 ◽  
Author(s):  
Lewis Z. Leng ◽  
Seth Brown ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Cranial Base ◽  
Minimal Access ◽  
Anterior Cranial Base ◽  
Tissue Sealant ◽  
Cerebrospinal Fluid Leaks ◽  
Cranial Base Surgery ◽  
Watertight Closure ◽  
Fluid Leak

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.

Extrapolating the Limits of the Nasoseptal Flap With Pedicle Dissection to the Internal Maxillary Artery

2018 ◽  
Vol 16 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Carlos D Pinheiro-Neto ◽  
Maria Peris-Celda ◽  
Tyler Kenning
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
Cerebrospinal Fluid Leak ◽  
Cranial Base ◽  
Pedicled Flap ◽  
Maxillary Artery ◽  
Internal Maxillary Artery ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Anterior Cranial Base

Abstract BACKGROUND The nasoseptal flap is the main pedicled flap used for endoscopic cranial base reconstruction. For large anterior cranial base defects, the anterior edge is a concern for the nasoseptal flap reach. OBJECTIVE To present a surgical technique that completely releases the vascular pedicle of the nasoseptal flap from the sphenopalatine artery (SPA) foramen improving considerably the reach of the flap. METHODS A patient with left anterior cranial base fracture involving the posterior table of the frontal sinus, who presented with cerebrospinal fluid leak and contused brain herniation to the ethmoid and frontal sinuses. Unilateral endoscopic endonasal anterior cranial base reconstruction was performed with left sided nasoseptal flap. The nasoseptal flap pedicle was dissected and completely released from the SPA foramen. The flap was left attached only to the internal maxillary artery (IMAX) vascular bundle. RESULTS The flap covered the entire left anterior cranial base, from the planum sphenoidale to the posterior table of the frontal sinus. There was complete obliteration of the cerebrospinal fluid fistula postoperatively with resolution of the radiographic pneumocephalus and the patient's rhinorrhea. CONCLUSION The complete release of the nasoseptal flap pedicle from the SPA foramen is feasible and remarkably improves the reach of the flap. It also increases the reconstructive area of the flap since the entire septal mucosa can be used for reconstruction and the pedicle length is based exclusively upon the SPA/IMAX.

Combined Anterior and Anterolateral Approaches to the Cranial Base:Complication Analysis, Avoidance, and Management

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-327-ONS-337 ◽  
Author(s):  
Thomas C. Origitano ◽  
Guy J. Petruzzelli ◽  
John P. Leonetti ◽  
Darl Vandevender
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Cranial Base ◽  
Complication Management ◽  
Tension Pneumocephalus ◽  
The Past ◽  
Benign Pathology ◽  
Cerebrovascular Events ◽  
Cranial Base Surgery ◽  
Neurological Surgery ◽  
Fluid Leak

Abstract Objective: During the past decade, applications of anterior and anterolateral cranial approaches for both benign and malignant pathologies have expanded in frequency and application. Complications associated with these procedures impact significantly on patient outcome. The primary aim of this study is to detail the strategies for complication management and avoidance developed from experience with 120 patients who underwent anterior and anterolateral cranial base procedures during the past 14 years. Methods: Between July 1990 and February 2004, 62 male and 58 female patients underwent 120 combined (neurological surgery and otolaryngology joint participation) anterior and anterolateral cranial base procedures. Fifty-four percent had malignant pathology, and 46% had benign pathology. The approaches taken were transfacial (10%), extended subfrontal (33%), lateral craniofacial (23%), and anterior craniofacial (35%). Thirty-day morbidity and mortality were analyzed. Results: Twenty (17%) patients experienced at least one complication. Malignancy and reoperation, regardless of histology, appeared to affect the complication rate. A decline in complications occurred with experience, in part because of changes in management that reflected the complication experience (25% in Patients 0–31, 18% in Patients 32–70, 10% in Patients 71–120). Methodology is detailed for avoidance and management of retraction injury, infection, tension pneumocephalus, cerebrospinal fluid leak, pericranial flap failure, free flap sizing, dural banding, intracranial hypotension, and cerebrovascular events. Individual patient analysis, complications timing, and strategy for management are discussed. Conclusion: Improved patient outcomes for anterior and anterolateral cranial base surgery are, in part, directly related to the ability to avoid and manage associated complications. Experience, avoidance, and interdiction are key factors in complication management.

Immunisations and antibiotics in patients with anterior skull base cerebrospinal fluid leaks

2014 ◽  
Vol 128 (7) ◽  
pp. 626-629 ◽  
Author(s):  
J Rimmer ◽  
C Belk ◽  
V J Lund ◽  
A Swift ◽  
P White
Keyword(s):  
Cerebrospinal Fluid ◽  
Streptococcus Pneumoniae ◽  
Antibiotic Prophylaxis ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Prophylactic Antibiotics ◽  
Anterior Skull Base ◽  
Web Based ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

AbstractObjective:There are no UK guidelines for the use of antibiotics and/or immunisations in patients with an active anterior skull base cerebrospinal fluid leak. This study aimed to define current UK practice in this area and inform appropriate guidelines for ENT surgeons.Method:A web-based survey of all members of the British Rhinological Society was carried out and the literature in this area was reviewed.Results:Of those who responded to the survey, 14 per cent routinely give prophylactic antibiotics to patients with cerebrospinal fluid leaks, and 34.9 per cent recommend immunisation against at least one organism, most commonly Streptococcus pneumoniae (86.7 per cent).Conclusion:There is no evidence to support the use of antibiotic prophylaxis in patients with a cerebrospinal fluid leak. We propose that all such patients are advised to seek immunisation against pneumococcus, meningococcus and haemophilus.

Endoscopic modified Lothrop procedure for repair of lateral frontal sinus cerebrospinal fluid leak

2008 ◽  
Vol 123 (1) ◽  
pp. 145-147 ◽  
Author(s):  
J K Anverali ◽  
A A Hassaan ◽  
H A Saleh
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
World Literature ◽  
Cerebrospinal Fluid Leak ◽  
Lumbar Drain ◽  
Alternative Approach ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

AbstractObjective:To describe a previously unreported case of repair of a lateral frontal sinus cerebrospinal fluid leak, using the endoscopic modified Lothrop procedure.Method:Case report of new technique, with reference to the world literature.Results:An effective endoscopic, transnasal repair of a lateral frontal sinus cerebrospinal fluid leak was achieved in a 60-year-old man. The defect was closed with fat, fascia lata and free mucosal grafts. The left nasal cavity was packed and a lumbar drain left in situ post-operatively. The drain and packs were removed one week later and the patient discharged with no complications, and no recurrence at 12 months' follow up.Conclusion:Such cerebrospinal fluid leaks have traditionally been repaired using an external approach with osteoplastic flaps and obliteration of the sinus. We highlight the endoscopic modified Lothrop technique as an effective alternative approach to repair of cerebrospinal fluid leaks in poorly accessible areas of the frontal sinus.

Delayed cerebrospinal fluid leak after penetrating cervical trauma

Trauma ◽  
2016 ◽  
Vol 19 (1) ◽  
pp. 63-65 ◽  
Author(s):  
Charles Fredericks ◽  
James R Yon ◽  
John Kubasiak ◽  
Anupam Basu ◽  
Kimberly Nagy ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Stab Wound ◽  
Cervical Spinal Cord ◽  
Cerebrospinal Fluid Leak ◽  
Resonance Imaging ◽  
Cervical Trauma ◽  
Cord Injury ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

Stab wound injury to the cervical spinal cord is a rare occurrence and usually presents with immediate, disastrous, and permanent neurological consequences. Rarer, and potentially as severe, is the complication of a delayed cerebrospinal fluid leak following a stab wound to the cervical spine. In this case, magnetic resonance imaging demonstrates a cerebrospinal fluid leak that extends to the skin with injury to the posterior dura at the C1/C2 level. Epidemiology and management of penetrating cervical spinal cord injury and delayed cerebrospinal fluid leaks are discussed.

Management of intra-operative cerebrospinal fluid leak following endoscopic trans-sphenoidal pituitary surgery

2010 ◽  
Vol 125 (3) ◽  
pp. 311-313 ◽  
Author(s):  
C G L Hobbs ◽  
A Darr ◽  
W V Carlin
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Pituitary Surgery ◽  
Gelatin Sponge ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage ◽  
Cerebrospinal Fluid Leaks ◽  
Low Incidence ◽  
Fluid Leak

AbstractObjective:Cerebrospinal fluid leakage is the most common complication of endoscopic trans-sphenoidal pituitary surgery. However, there is no uniformly accepted way of managing this complication when it occurs intra-operatively. This paper describes a quick, simple technique, involving layered fibrin glue and gelatin sponge, which does not compromise post-operative patient follow up.Method:Retrospective review of all endoscopic pituitary surgery cases conducted at a single institution since the introduction of this technique in 2002.Results:A total of 120 endoscopic pituitary operations were performed (96 primary procedures and 24 revisions). All intra-operative cerebrospinal fluid leaks were managed using the described method, with a failure rate of 3.6 per cent. The overall post-operative leakage rate was 1.7 per cent.Conclusion:This simple, conservative technique avoids the need for further dissection and the use of non-absorbable foreign material, and has a low incidence of post-operative cerebrospinal fluid leakage.

scholarly journals Sphenoid Cranial Base Defects in Siblings Presenting with Cerebrospinal Fluid Leak

Skull Base ◽  
1997 ◽  
Vol 7 (04) ◽  
pp. 193-197 ◽  
Author(s):  
Joseph M. Bernstein ◽  
J. Thomas Roland ◽  
Mark S. Persky
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Cranial Base ◽  
Fluid Leak

Radiological findings in spontaneous cerebrospinal fluid leaks of the temporal bone

2021 ◽  
pp. 1-7
Author(s):  
T Hendriks ◽  
A Thompson ◽  
R Boeddinghaus ◽  
H E I Tan ◽  
J Kuthubutheen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Temporal Bone ◽  
Cerebrospinal Fluid Leak ◽  
Resonance Imaging ◽  
Cerebrospinal Fluid Leaks ◽  
Temporal Bones ◽  
Fluid Leak

Abstract Background and objective Spontaneous cerebrospinal fluid leak of the temporal bone is an emerging clinical entity for which prompt and accurate diagnosis is difficult given the subtle signs and symptoms that patients present with. This study sought to describe the key temporal bone abnormalities in patients with spontaneous cerebrospinal fluid leak. Methods A retrospective cohort study was conducted of adult patients with biochemically confirmed spontaneous cerebrospinal fluid leak. Demographics and radiological features identified on computed tomography imaging of the temporal bones and/or magnetic resonance imaging were analysed. Results Sixty-one patients with spontaneous cerebrospinal fluid leak were identified. Fifty-four patients (88.5 per cent) underwent both temporal bone computed tomography and magnetic resonance imaging. Despite imaging revealing bilateral defects in over 75 per cent of the cohort, only two patients presented with bilateral spontaneous cerebrospinal fluid leaks. Anterior tegmen mastoideum defects were most common, with an average size of 2.5 mm (range, 1–10 mm). Conclusion Temporal bone computed tomography is sensitive for the identification of defects when suspicion exists. In the setting of an opacified middle ear and/or mastoid, close examination of the skull base is crucial given that this fluid is potentially cerebrospinal fluid.

scholarly journals Endoscopic endonasal repair of a cerebrospinal fluid leak secondary to a meningoencephalocele using a posterior – based middle turbinate flap

2020 ◽  
Author(s):  
G Jugmohansingh ◽  
H Peng ◽  
J Clarke
Keyword(s):  
Cerebrospinal Fluid ◽  
Middle Turbinate ◽  
Cerebrospinal Fluid Leak ◽  
Endoscopic Endonasal ◽  
Important Differential Diagnosis ◽  
Surgical Options ◽  
Cerebrospinal Fluid Leaks ◽  
Csf Rhinorrhoea ◽  
Materials Used ◽  
Fluid Leak

Cerebrospinal fluid leaks are rare but remain an important differential diagnosis for patients presenting with persistent, unilateral rhinorrhoea. This case describes a middle-aged female with persistent left sided rhinorrhea. She was minimally responsive to treatment for chronic sinusitis. On re-evaluation, a cerebrospinal fluid leak secondary to a meningoencephalocele was identified. This was subsequently repaired with a pedicled, vascularized graft using an endoscopic endonasal approach. The discussion which follows reviews the management of CSF rhinorrhoea with an emphasis on the available surgical options as well as the materials used for repair.

scholarly journals Spontaneous cerebrospinal fluid leak from the optic canal

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774828
Author(s):  
Kyle Hannabass ◽  
Jeb M Justice
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Retrospective Chart Review ◽  
Cerebrospinal Fluid Leak ◽  
Optic Nerve Sheath ◽  
Anatomic Site ◽  
Endoscopic Closure ◽  
Nerve Sheath ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

Objective: To present a case of successful repair of a spontaneous cerebrospinal fluid leak in a previously unreported anatomic site. Methods: Retrospective chart review. Results: A 48-year-old woman developed a spontaneous cerebrospinal fluid leak from the optic nerve sheath and underwent a multilayer endoscopic closure with no damage to the optic nerve. Conclusion: Endoscopic surgeons can successfully repair cerebrospinal fluid leaks from the optic nerve sheath without causing loss of vision.

Sign in / Sign up

Export Citation Format

Share Document