Endonasal endoscopic repair of anterior skull-base fistulas: the Kuala Lumpur experience

2005 ◽  
Vol 119 (11) ◽  
pp. 866-874 ◽  
Author(s):  
B S Gendeh ◽  
A Mazita ◽  
B M Selladurai ◽  
T Jegan ◽  
J Jeevanan ◽  
...  
Keyword(s):  
Skull Base ◽  
Middle Turbinate ◽  
Pituitary Surgery ◽  
Fascia Lata ◽  
Anterior Skull Base ◽  
Endoscopic Procedure ◽  
Sinus Surgery ◽  
Kuala Lumpur ◽  
Endoscopic Repair ◽  
Tertiary Referral Centre

The purpose of this retrospective study is to determine the pattern of cerebrospinal fluid (CSF) rhinorrhoea presenting to our tertiary referral centre in Kuala Lumpur and to assess the clinical outcomes of endonasal endoscopic surgery for repair of anterior skull base fistulas. Sixteen patients were treated between 1998 and 2004. The aetiology of the condition was spontaneous in seven and acquired in nine patients. In the acquired category, three patients had accidental trauma and this was iatrogenic in six patients (five post pituitary surgery), with one post endoscopic sinus surgery (ESS). Imaging included computed tomography (CT) scan and magnetic resonance imaging (MRI). Endoscopic repair is less suited for defects in the frontal sinuses with prominent lateral extension and defects greater than 1.5 cm in diameter involving the skull base. Fascia lata, middle turbinate mucosa, nasal perichondrium and ear fat (’bath plug’) were the preferred repair materials in the anterior skull base, whereas fascia lata, cartilage and abdominal fat obliteration was preferentially used in the sphenoid leak repair. Intrathecal sodium flourescein helped to confirm the site of CSF fistula in 81.3 per cent of the patients. Ninety per cent of the patients who underwent ’bath plug’ repair were successful. The overall success rate for a primary endoscopic procedure was 87.5 per cent, although in two cases a second endoscopic procedure was required for closure. In the majority of cases endoscopic repair was successful, and this avoids many of the complications associated with craniotomy, particularly in a young population. Therefore it is our preferred option, but an alternative procedure should be utilized should this prove necessary.

S281 – Closure of Anterior Skull Base Cerebrospinal Fluid Fistulas

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P169-P169
Author(s):  
Yadiel A Alameda ◽  
Jose Busquets ◽  
Juan C. Portela
Keyword(s):  
Skull Base ◽  
Revision Surgery ◽  
Statistical Significance ◽  
Anterior Skull Base ◽  
Sinus Surgery ◽  
Fisher Exact Test ◽  
Endoscopic Repair ◽  
Presenting Symptoms ◽  
Surgical Data

Objectives 1) Describe the presenting symptoms, etiology, treatment, and long-term outcomes of patients with anterior skull base CSF fistulas treated endoscopically at our institution. 2) Study the association between closure techniques and complications, and between the use of image guidance surgery (IGS) and complications. Methods A retrospective analysis of patients with anterior CSF fistulas treated endoscopically from November 2004 to December 2007. Demographic and surgical data were collected. Postoperative complications, recurrence, and need for revision surgery were determined. Associations between the use of IGS and complications, and between the closure technique and complications were analyzed using Fisher Exact Test. Results Endoscopic repair of anterior skull base defect was performed in 19 cases. The etiology was spontaneous leak in 10 patients, menigoencephalocele in 7 patients, previous sinus surgery in 1 patient, and trauma in 1 patient. 5 patients had suffered bacterial meningitis before surgery. The most common location of leak was the cribiform plate (9 patients), followed by the ethmoid roof (5 patients). An overlay technique was used for repair in 61% of the procedures. One patient presented with leak recurrence, and underwent successful revision surgery. No statistical significance was found between the use of IGS and complications. The mean follow-up was 17 months. Our overall initial rate of closure was 94%, and 100% after a second procedure. At the last follow-up, none of the patients reported episodes of meningitis postoperatively. Conclusions Endoscopic repair of anterior skull base CSF fistulas has a high success rate and lower morbidity and mortality when compared with open approaches.

Middle Turbinate Preservation in Endoscopic Transsphenoidal Surgery of the Anterior Skull Base

Skull Base ◽  
2008 ◽  
Vol 18 (S 01) ◽  
Author(s):  
Seth Brown ◽  
Abtin Tabaee ◽  
Vijay Anand ◽  
Ameet Singh ◽  
Theodore Schwartz
Keyword(s):  
Skull Base ◽  
Transsphenoidal Surgery ◽  
Middle Turbinate ◽  
Anterior Skull Base ◽  
Endoscopic Transsphenoidal Surgery

The “Parachute” technique for the endoscopic repair of high-flow anterior skull-base CSF leaks

2021 ◽  
Author(s):  
Giorgio Fiore ◽  
Giulio Andrea Bertani ◽  
Giorgio Giovanni Carrabba ◽  
Claudio Guastella ◽  
Giovanni Marfia ◽  
...  
Keyword(s):  
Skull Base ◽  
High Flow ◽  
Anterior Skull Base ◽  
Endoscopic Repair ◽  
Csf Leaks

scholarly journals Purely Endoscopic Repair of Traumatic Cerebrospinal Fluid Rhinorrhea From the Anterior Skull Base

2011 ◽  
Vol 51 (3) ◽  
pp. 222-225 ◽  
Author(s):  
Mika KOMATSU ◽  
Fuminari KOMATSU ◽  
Luigi M. CAVALLO ◽  
Domenico SOLARI ◽  
Vita STAGNO ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Anterior Skull Base ◽  
Endoscopic Repair ◽  
Cerebrospinal Fluid Rhinorrhea

Endoscopic Repair of Anterior Skull Base Defects

2010 ◽  
pp. 281-285
Author(s):  
Manuel Bernal-Sprekelsen ◽  
Isam Alobid ◽  
Joaquim Mullol ◽  
Alfonso Garcia-Piñero
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Endoscopic Repair ◽  
Skull Base Defects

scholarly journals Skull base reconstruction after anterior subcranial tumor resection

2002 ◽  
Vol 12 (5) ◽  
pp. 1-7 ◽  
Author(s):  
Dan M. Fliss ◽  
Ziv Gil ◽  
Sergey Spektor ◽  
Leonor Leider-Trejo ◽  
Avraham Abergel ◽  
...  
Keyword(s):  
Skull Base ◽  
Double Layer ◽  
Fibrous Tissue ◽  
Fascia Lata ◽  
Anterior Skull Base ◽  
Benign Tumors ◽  
Skull Base Reconstruction ◽  
Reliable Technique ◽  
Tension Pneumocephalus ◽  
Csf Leakage

Object The goal of this study was to demonstrate the efficacy of a simple and reliable technique for anterior skull base and craniofacial reconstruction in patients who have undergone excision of tumors via the subcranial approach. Methods There were 63 patients who had undergone 71 anterior skull base resections of tumors via the aforementioned approach. Twenty-nine cases (41%) involved malignant tumors and 42 (59%) involved benign tumors. Reconstruction of the anterior skull base was performed by a single team who used double-layer fascial graft. Limited dural defects were reconstructed using the temporalis fascia, whereas large anterior skull base defects were reconstructed using a fascia lata sheath. Reconstruction was achieved without the support of bone graft or titanium mesh and without pericranial, galeal, or free flaps. Pericranial flap wrapping of the frontonasoorbital segment was performed to prevent osteoradionecrosis if postoperative radiotherapy was planned. The incidence of cerebrospinal fluid (CSF) leakage, intracranial infection, and tension pneumocephalus was 5.6%. Histopathological examination of fascia lata grafts obtained in patients who had undergone a second procedure demonstrated integration of vascularized fibrous tissue to the graft, as well as local proliferation of a newly formed vascular layer embedding the fascial sheath. Conclusions The use of a double-layer fascial graft alone was adequate for prevention of CSF leakage, meningitis, tension pneumocephalus, and brain herniation. The double-layer fascial flap provided a simple and reliable means for anterior skull base reconstruction after en bloc resection of both malignant and benign tumors.

Endoscopic repair of the anterior skull base -is there a learning curve?

2018 ◽  
Vol 32 (4) ◽  
pp. 407-411
Author(s):  
Paul Nix ◽  
Seyed A. Alavi ◽  
Atul Tyagi ◽  
Nick Phillips
Keyword(s):  
Learning Curve ◽  
Skull Base ◽  
Anterior Skull Base ◽  
Endoscopic Repair

Pre-operative assessment of patients undergoing endoscopic, transnasal, transsphenoidal pituitary surgery

2007 ◽  
Vol 122 (6) ◽  
pp. 644-646 ◽  
Author(s):  
D Lubbe ◽  
P Semple
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Previous History ◽  
Pituitary Surgery ◽  
Anterior Skull Base ◽  
Nasal Discharge ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Pituitary Macroadenoma ◽  
Main Complaint ◽  
History Of

AbstractObjective:To demonstrate the importance of pre-operative ear, nose and throat assessment in patients undergoing endoscopic, transsphenoidal surgery for pituitary tumours.Case reports:Literature pertaining to the pre-operative otorhinolaryngological assessment and management of patients undergoing endoscopic anterior skull base surgery is sparse. We describe two cases from our series of 59 patients undergoing endoscopic pituitary surgery. The first case involved a young male patient with a large pituitary macroadenoma. His main complaint was visual impairment. He had no previous history of sinonasal pathology and did not complain of any nasal symptoms during the pre-operative neurosurgical assessment. At the time of surgery, a purulent nasal discharge was seen emanating from both middle meati. Surgery was abandoned due to the risk of post-operative meningitis, and postponed until the patient's chronic rhinosinusitis was optimally managed. The second patient was a 47-year-old woman with a large pituitary macroadenoma, who presented to the neurosurgical department with a main complaint of diplopia. She too gave no history of previous nasal problems, and she underwent uneventful surgery using the endoscopic, transnasal approach. Two weeks after surgery, she presented to the emergency unit with severe epistaxis. A previous diagnosis of hereditary haemorrhagic telangiectasia was discovered, and further surgical and medical intervention was required before the epistaxis was finally controlled.Conclusions:Pre-operative otorhinolaryngological assessment is essential prior to endoscopic pituitary or anterior skull base surgery. A thorough otorhinolaryngological history will determine whether any co-morbid diseases exist which could affect the surgical field. Nasal anatomy can be assessed via nasal endoscopy and sinusitis excluded. Computed tomography imaging is a valuable aid to decisions regarding additional procedures needed to optimise access to the pituitary fossa.

scholarly journals Endoscopic Endonasal Reconstructive Methods to the Anterior Skull Base

2017 ◽  
Vol 31 (04) ◽  
pp. 203-213 ◽  
Author(s):  
Srikant Chakravarthi ◽  
Lior Gonen ◽  
Alejandro Monroy-Sosa ◽  
Sammy Khalili ◽  
Amin Kassam
Keyword(s):  
Skull Base ◽  
Middle Turbinate ◽  
Reconstruction Algorithm ◽  
Inferior Turbinate ◽  
Anterior Skull Base ◽  
Endoscopic Endonasal ◽  
Fascial Flap ◽  
Skull Base Defects ◽  
Reconstructive Techniques ◽  
Csf Leaks

AbstractThe success of expanded endoscopic endonasal approaches (EEAs) to the anterior skull base, sellar, and parasellar regions has been greatly aided by the advancement in reconstructive techniques. In particular, the pedicled vascularized flaps have been developed and effectively cover skull base defects of varying sizes with a significant reduction in postoperative CSF leaks. There are two aims to this review: (1) We will provide our current, simplified reconstruction algorithm. (2) We will describe, in detail, the relevant anatomy, indications/contraindications, and surgical technique, with a particular emphasis on the nasoseptal flap (NSF). The inferior turbinate flap (ITF), middle turbinate flap (MTF), pericranial flap (PCF), and temporoparietal fascial flap (TPFF) will also be described. The NSF should be the primary option for reconstruction of majority of skull base defects following endonasal endoscopic surgery. In general, for the planum, cribriform, and upper two-thirds of the clivus, the NSF is ideal. For the lower-third of the clivus, the NSF may not be adequate and may require additional reconstructive options. Although limited in reach or more technically challenging, these reconstructive flaps should still be considered and kept in the surgical algorithm.

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