Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery

Objectives We describe the strategy used to repair intraoperative leaks of various grades and define factors for preventing postoperative cerebrospinal fluid leakage (CSF) after surgery via the endoscopic endonasal transsphenoidal approach (EETA). Study design Retrospective chart review at a tertiary referral center. Methods Patients who underwent surgery via EETA from January 2009 to May 2020 were retrospectively reviewed. Intraoperative CSF leakage was graded 0–3 in terms of the dural defect size; various repairs were used depending on the grade. Results A total of 777 patients underwent 869 operations via EETA; 609 (70.1%) experienced no intraoperative CSF leakage (grade 0) but 260 (29.9%) did. Leakage was of grade 1 in 135 cases (15.5%), grade 2 in 83 (9.6%), and grade 3 in 42 (4.8%). In 260 patients with intraoperative CSF leakage, a buttress was wedged into the sellar defect site in 178 cases (68.5%) and a pedicled flap was placed in 105 cases (40.4%). Autologous fat (108 cases, 41.5%) and a synthetic dural substitute (91 cases, 35%) were used to fill the dead space of the sellar resection cavity. Postoperative CSF leakage developed in 21 patients: 6 of grade 1, 7 of grade 2, and 8 of grade 3. Buttress placement significantly decreased postoperative leakage in grade 1 patients (p = 0.041). In patients of perioperative leakage grades 2 and 3, postoperative CSF leakage was significantly reduced only when both fat and a buttress were applied (p = 0.042 and p = 0.043, respectively). Conclusion A buttress prevented postoperative CSF leakage in grade 1 patients; both fat and buttress were required by patients with intraoperative leakage of grades 2 and 3.

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Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma

Journal of Neurosurgery ◽

10.3171/jns/2008/108/2/0275 ◽

2008 ◽

Vol 108 (2) ◽

pp. 275-280 ◽

Cited By ~ 29

Author(s):

Rudolf A. Kristof ◽

Jochen M. Grimm ◽

Birgit Stoffel-Wagner

Keyword(s):

Cerebrospinal Fluid ◽

Recurrence Rate ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Postoperative Recurrence ◽

Cerebrospinal Fluid Leakage ◽

Subdural Space ◽

Subdural Hygroma ◽

Fluid Leakage ◽

Csf Leakage

Object The purpose of this study was to clarify whether cerebrospinal fluid (CSF) leakage into the subdural space is involved in the genesis of chronic subdural hematoma (CSDH) and subdural hygroma (SH) and to clarify whether this leakage of CSF into the subdural space influences the postoperative recurrence rate of CSDH and SH. Methods In this prospective observational study, 75 cases involving patients treated surgically for CSDH (67 patients) or SH (8 patients) were evaluated with respect to clinical and radiological findings at presentation, the content of β -trace protein (β TP) in the subdural fluid (βTPSF) and serum (βTPSER), and the CSDH/SH recurrence rate. The βTPSF was considered to indicate an admixture of CSF to the subdural fluid if βTPSF/βTPSER > 2. Results The median β TPSF level for the whole patient group was 4.29 mg/L (range 0.33–51 mg/L). Cerebrospinal fluid leakage, as indicated by βTPSF/βTPSER > 2, was found to be present in 93% of the patients with CSDH and in 100% of the patients with SH (p = 0.724). In patients who later had to undergo repeated surgery for recurrence of CSDH/SH, the βTPSF concentrations (median 6.69 mg/L, range 0.59–51 mg/L) were significantly higher (p = 0.04) than in patients not requiring reoperation (median 4.12 mg/L, range 0.33–26.8 mg/L). Conclusions As indicated by the presence of βTP in the subdural fluid, CSF leakage into the subdural space is present in the vast majority of patients with CSDH and SH. This leakage could be involved in the pathogenesis of CSDH and SH. Patients who experience recurrences of CSDH and SH have significantly higher concentrations of βTPSF at initial presentation than patients not requiring reoperation for recurrence. These findings are presented in the literature for the first time and have to be confirmed and expanded upon by further studies.

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Spontaneous cerebrospinal fluid leakage through fistulas at the clivus repaired with endoscopic endonasal approach

Surgical Neurology International ◽

10.4103/2152-7806.158898 ◽

2015 ◽

Vol 6 (1) ◽

pp. 106 ◽

Cited By ~ 1

Author(s):

Yasuhiko Hayashi ◽

Masayuki Iwato ◽

Daisuke Kita ◽

Issei Fukui

Keyword(s):

Cerebrospinal Fluid ◽

Cerebrospinal Fluid Leakage ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Fluid Leakage

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Utility of nonpenetrating titanium clips for dural closure during spinal surgery to prevent postoperative cerebrospinal fluid leakage

Journal of Neurosurgery Spine ◽

10.3171/2015.3.spine141215 ◽

2015 ◽

Vol 23 (6) ◽

pp. 812-819 ◽

Cited By ~ 16

Author(s):

Kiyoshi Ito ◽

Tatsuro Aoyama ◽

Tetsuyoshi Horiuchi ◽

Kazuhiro Hongo

Keyword(s):

Cerebrospinal Fluid ◽

Dura Mater ◽

Spinal Surgery ◽

Water Pressure ◽

Cerebrospinal Fluid Leakage ◽

Fluid Leakage ◽

Dural Closure ◽

Significant Difference ◽

Csf Leakage ◽

Titanium Clips

OBJECT The nonpenetrating titanium clip has been successfully used in peripheral arterial bypass surgery. The purpose of this study was to evaluate the leakage pressures and patterns of nonpenetrating titanium clips using a simple model that mimicked spinal surgery. In addition, the authors describe their surgical experience with these clips and the follow-up results in 31 consecutive patients. METHODS The authors compared nonpenetrating titanium clips and expanded polytetrafluoroethylene (ePTFE) sutures in relation to the water pressure that could be tolerated by sutured ePTFE sheets, and the leakage pressure patterns were determined. The changes in leakage pressures at 5 minutes, 30 minutes, and 12 hours were examined when the clips and sutures were used in combination with the mesh-and-glue technique in an in vitro study. Thirty-one patients underwent spinal intradural procedures using nonpenetrating titanium clips to suture the dura maters using the meshand-glue technique, involving fibrin glue and polyglycolic acid-fibrin sheets. RESULTS A significant difference was apparent between the ePTFE suture group and the nonpenetrating titanium clip group, with the latter showing a leakage pressure that could be sustained and was 1508% higher than that of the former (p = 0.001). In relation to leakage patterns, the nonpenetrating titanium clips did not make any suture holes in the ePTFE sheet and fluid leakage occurred between the clips, whereas fluid leakage was associated with the pressure elevation that occurred at the suture holes made by the ePTFE sutures. Of the 31 patients who underwent spinal intradural procedures using nonpenetrating titanium clips, 1 (3.2%) experienced cerebrospinal fluid (CSF) leakage postoperatively. No other complications—for example, allergic reactions, adhesions, or infections—were encountered. CONCLUSIONS The interrupted placement of nonpenetrating titanium clips enables dural closure without creating any holes. These clips facilitate improvements in the initial leakage pressure and reduce postoperative CSF leakage following spinal surgery. The authors conclude that it is very beneficial to suture the spinal dura mater using nonpenetrating titanium clips given the anatomical characteristics of the spinal dura mater and the fact that the clips do not create suture holes.

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Difference in the incidence of cerebrospinal fluid leakage and residual tumors between functional and nonfunctional pituitary adenomas treated by endoscopic transsphenoidal pituitary adenomectomy

Journal of International Medical Research ◽

10.1177/0300060519875857 ◽

2019 ◽

Vol 47 (11) ◽

pp. 5660-5670

Author(s):

Ching-Yi Lee ◽

Yuan-Chuan Chen ◽

Ying-Piao Wang ◽

Shiu-Jau Chen

Keyword(s):

Cerebrospinal Fluid ◽

Diabetes Insipidus ◽

Pituitary Adenomas ◽

Symptom Relief ◽

Brain Magnetic Resonance Imaging ◽

Cerebrospinal Fluid Leakage ◽

Large Tumor ◽

Endoscopic Endonasal ◽

Csf Leakage ◽

Nonfunctional Pituitary Adenomas

Objective This study compared the incidence of cerebrospinal fluid (CSF) leakage and residual tumors between functional and nonfunctional pituitary adenomas treated with the endoscopic endonasal transsphenoidal approach (EETA). Methods All patients underwent endocrine examinations and brain magnetic resonance imaging before and after surgery. The length of admission, incidence of central diabetes insipidus, incidence of CSF leakage, symptom relief, and presence of residual tumors were compared between patients with functional and nonfunctional pituitary adenomas. Results Thirty-eight patients were enrolled, among whom 12 and 26 had functional and nonfunctional pituitary adenomas, respectively. The incidence of CSF leakage was significantly higher in patients with nonfunctional adenomas; a hard or elastic tumor character accounted for the difference. A large tumor size and cavernous sinus invasion were risk factors for residual tumors. No significant differences were found in sex, length of admission, operative times, incidence of diabetes insipidus, or number of residual tumors between the two groups. The hormone levels were lower postoperatively than preoperatively in patients with nonfunctional adenomas. Conclusion Nonfunctional pituitary macroadenomas resulted in more CSF leakage. Use of the rescue nasoseptal flap reduced unnecessary nasal destruction. Cooperation between a neurosurgeon and otolaryngologist was safer and more effective when using the EETA.

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Recurrent subdural hematoma caused by cerebrospinal fluid leakage

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.2.183 ◽

2006 ◽

Vol 4 (2) ◽

pp. 183-185 ◽

Cited By ~ 12

Author(s):

Junichi Mizuno ◽

Praveen V. Mummaneni ◽

Gerald E. Rodts ◽

Daniel L. Barrow

Keyword(s):

Cerebrospinal Fluid ◽

Computerized Tomography ◽

Subdural Hematoma ◽

Nerve Root ◽

Csf Leak ◽

Cerebrospinal Fluid Leakage ◽

Dural Defect ◽

Ct Myelography ◽

Csf Fistula ◽

Csf Leakage

✓The authors report a case of a recurrent subdural hematoma (SDH) that was caused by a persistent cerebrospinal fluid (CSF) leak from an L1–2 fistula. A 34-year-old man experienced severe headaches due to SDH, and he underwent aspiration of subdural fluid four times due to recurrent collections. Further evaluation with computerized tomography (CT) myelography demonstrated extradural extravasation of contrast through an L1–2 fistula. The patient underwent an L1–2 laminectomy; a small dural defect with CSF leakage at the left nerve root sleeve was found and was repaired. Following the repair, the patient had no further recurrence of SDH. Recurrent SDH, caused by spontaneous CSF leakage through a lumbar CSF fistula, is extremely rare. In cases of recurrent SDH, radiographic workup with spinal CT myelography should be considered.

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Development of severe hyponatremia due to cerebrospinal fluid leakage following meningomyelocele surgery in a newborn

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.11.peds17386 ◽

2018 ◽

Vol 21 (6) ◽

pp. 597-600

Author(s):

Ismail Kürşad Gökce ◽

Hatice Turgut ◽

Ramazan Ozdemir ◽

Selami Cagatay Onal

Keyword(s):

Cerebrospinal Fluid ◽

Wound Dehiscence ◽

Sodium Content ◽

Dietary Sodium ◽

Cerebrospinal Fluid Leakage ◽

Neurodevelopmental Outcomes ◽

Newborn Period ◽

Severe Hyponatremia ◽

Fluid Leakage ◽

Csf Leakage

Cerebrospinal fluid leakage following meningomyelocele surgery is a frequent complication in the wound-healing period and is associated with wound dehiscence. CSF loss can cause severe hyponatremia, especially in the newborn and early infancy periods when dietary sodium content is relatively low. Hyponatremia in the newborn period can result in adverse neurodevelopmental outcomes. In addition, hyponatremia’s cerebral effects can increase complications in neurosurgery patients. The authors present the case of a newborn in whom CSF leakage from the operative site and severe hyponatremia developed following meningomyelocele surgery. To the best of their knowledge, severe hyponatremia caused by CSF leakage after meningomyelocele surgery has not been previously reported in the literature.

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