scholarly journals Utilization of the Nasoseptal Flap for Repair of Cerebrospinal Fluid Leak after Endoscopic Endonasal Approach for Resection of Pituitary Tumors

2019 ◽  
Vol 7 (1) ◽  
pp. 10 ◽  
Author(s):  
Remi A. Kessler ◽  
Tomas Garzon-Muvdi ◽  
Eileen Kim ◽  
Murugappan Ramanathan ◽  
Michael Lim
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Tumors ◽  
Cerebrospinal Fluid Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Fluid Leak

scholarly journals Concerns of cerebrospinal fluid leak in aggressive expanded endonasal endoscopic approach for craniopharyngiomas

2020 ◽  
Vol 10 (4) ◽  
pp. 154-156
Author(s):  
Marlon Ortiz Machín ◽  
Omar López Arbolay
Keyword(s):  
Cerebrospinal Fluid ◽  
Third Ventricle ◽  
Cerebrospinal Fluid Leak ◽  
Endoscopic Approach ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Fluid Leak

Cerebrospinal fluid leak represents a frequent complication in Craniopharyngioma´s Endoscopic Endonasal Approach. A descriptive observational investigation was performed in 50 adult patients operated of Craniopharyngiomas by aggressive Expanded Endonasal Endoscopic Approach (EEEA) in “Hermanos Ameijeiras” Hospital since 2010 to 2019 using nasoseptal flap. The 14% of all patients develop CSF leak and 85,7 % of these cases had a great communication into third ventricle creating a cisternoventricular space. Was identified relation with tumor size, hypothalamic invasion and adhesion strength of tumour. Surgical cavity suffered hydrostatic and hydrodynamic pression than lead to CSF leak independent of multilayer reparation.

The endoscopic endonasal approach for cerebrospinal fluid leak repair in the elderly

2015 ◽  
Vol 132 ◽  
pp. 21-25 ◽  
Author(s):  
Enzo Emanuelli ◽  
Laura Milanese ◽  
Marta Rossetto ◽  
Diego Cazzador ◽  
Elena d’Avella ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
The Elderly ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Fluid Leak

Bilateral Smell Preservation is Routinely Possible following Endoscopic Endonasal Approach for Sellar/Suprasellar Lesions

2019 ◽  
Author(s):  
Kuan-Chung Ting ◽  
Wei-Hsin Wang ◽  
Edward C. Kuan ◽  
Yung-Yang Lin ◽  
Ming-Ying Lan
Keyword(s):  
Effective Means ◽  
Tertiary Care ◽  
Pituitary Tumors ◽  
Olfactory Function ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
The Impact

Abstract Objective The endoscopic endonasal approach (EEA) has been shown to be an effective means to access sellar lesions. However, there are limited studies centered on evaluating olfactory function after surgery. In this study, we assessed the pre- and postoperative olfactory function of patients who underwent EEA for sellar and suprasellar lesions. The impact of nasoseptal flap use on olfaction was further analyzed. Study Design A retrospective study. Setting A tertiary-care referral center in Taiwan. Participants Patients with sellar and suprasellar lesions who underwent EEA and pre- and postoperative olfaction assessment from August 2015 to March 2018 were included in the study. Main Outcome Measures The patients' olfactory function was examined pre-and postoperatively using the Sniffin' Sticks odor identification test. Data regarding demographics, olfactory scores, pathology, reconstructive technique, graft usage, and extent of resection were retrieved. Results A total of 106 patients (36 males and 70 females) were enrolled, with a mean age of 51 years. There were 76 pituitary tumors, 12 Rathke's cleft cysts, 7 craniopharyngiomas, 7 meningiomas, and 4 other lesions. The nasoseptal flap was used in 39 patients for skull base reconstruction, and these patients had no statistically significant change between pre- and postoperative olfactory scores (p = 0.283). Moreover, a statistically significant improvement of olfactory scores was found in patients in whom the nasoseptal flap was not used. Conclusions Olfactory function may be reliably preserved after EEA, with or without nasoseptal flap harvest and use.

Compare the Outcome of Endoscopic Endonasal versus Transcranial Approach for Cerebrospinal Fluid Leak Repair

2021 ◽  
Vol 15 (8) ◽  
pp. 2224-2227
Author(s):  
Mohammad Mushtaq ◽  
Haider Ali ◽  
Naeem Ul Haq ◽  
Muhammad Anwar Ullah ◽  
Anwar Shah ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Recurrence Rate ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Group I ◽  
Transcranial Approach ◽  
Group Ii ◽  
Fluid Leak

Objective: The aim of this study is to compare the outcome of endoscopic endonasal verus transcranial approach for cerebrospinal fluid leak repair. Study Design: Comparative study Place and Duration: Conducted at department of Neurosurgery, Mardan Medical Complex/ Bacha Khan Medical College, Mardan during the period from 1st January 2020 to 31st December 2021. Methods: Total eighty patients of both genders were presented in this study. Patients were aged between 20-65 years. Patients’ detailed demographics age, sex and body mass were recorded after taking written consent. Patients had CSF leaks and the history of CSF leak was presented. Patients were equally divided into two groups, I and II. Group I received endonasal technique and group II received transcranial approach. All the patients underwent MRI and CT scan. Complete follow up among both groups were taken in the duration of 8 months for the assessment of efficacy. Complete data was analyzed by SPSS 24.0 version. Results: Mean age of the patients in group I was 33.08±14.90 years with mean BMI28.4±3.12 kg/m2 and in group II mean age was 31.66±4.84 years with mean BMI 27.45±1108 kg/m2. Total 50 (62.5%) patients were males (25 in each group) and 30 (37.5%) patients were females (15 in each group). In group I recurrence rate was found in 3 (7.5%) cases and in group II recurrence rate was 6 (15%). 3 (7.5%) patients in group II developed infection but no infection rate was found in the endoscopic endonasal group. Satisfaction among patients in the endonasal group was greater than that of the transcranial group. Overall efficacy rate among both groups was 71 (88.8%). Conclusion: We concluded in this study that for repair of cerebrospinal fluid leak endoscopic endonasal approach was effective and safe method as compared to transcranial approach. Minimum rate of recurrence and high rate of recovery was fund in endonasal approach. Keywords: CSF, Endoscopic endonasal, Transcranial approach, Complications, Recurrence

ENDOSCOPIC ENDONASAL RESECTION OF ANTERIOR CRANIAL BASE MENINGIOMAS

Neurosurgery ◽  
2008 ◽  
Vol 63 (1) ◽  
pp. 36-54 ◽  
Author(s):  
Paul A. Gardner ◽  
Amin B. Kassam ◽  
Ajith Thomas ◽  
Carl H. Snyderman ◽  
Ricardo L. Carrau ◽  
...  
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Tumor Location ◽  
Cranial Base ◽  
Complete Resection ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Petroclival Meningiomas ◽  
Anterior Cranial Base ◽  
Fluid Leak

ABSTRACT OBJECTIVE The endonasal route may be feasible for the resection of anterior cranial base tumors that abut the paranasal sinuses. There are several case reports and mixed case series discussing this approach. Other than pituitary adenomas, there is a lack of literature describing the outcomes of endonasal approaches for single-tumor types such as meningiomas. METHODS In this study, we describe our current endoscopic endonasal technique and demonstrate the feasibility of using it to access anterior cranial base meningiomas from the back wall of the frontal sinus to the sella and laterally to the region of the midorbit. After this discussion, which includes key technical considerations and nuances, we address safety and efficacy by reporting the outcomes of our early experience with endoscopic endonasal resection of 35 anterior cranial base meningiomas. RESULTS A total of 35 patients underwent endoscopic endonasal resection of anterior cranial base meningiomas from October 2002 to October 2005. Degree of resection by tumor location was as follows: 10 of the 12 (83%) patients with olfactory groove meningiomas planned for complete resection underwent gross total (seven of 12) or near-total (>95%) (three of 12) resection (67% of all 15 olfactory tumors); 12 of 13 patients (92%) with tuberculum meningiomas underwent gross (11 of 13) or near (>95%) (one of 13) total resection; five patients diagnosed with petroclival meningiomas had successful resection of the parasellar portion of their tumors with relief of visual symptoms (no patients underwent complete resection of their tumors via the endoscopic, endonasal approach); two giant petroclival meningiomas were debulked with 63 and 89% resection, respectively. All patients experienced resolution or improvement of visual symptoms. No patient experienced permanent worsening of vision after surgery. Only one (3%) patient without preoperative endocrine dysfunction experienced a new, permanent pituitary deficit, diabetes insipidus. One (3%) patient experienced a new neurological deficit after experiencing a hemorrhage 3 weeks after surgery. The postoperative cerebrospinal fluid leak rate was 40% (14 of 35) and varied by tumor location. All leaks were resolved without craniotomy. There were no cases of bacterial meningitis. One patient developed a superinfection of a sterile granuloma from a sinusitis 2 years after surgery. There were two cases of deep venous thrombosis and one pulmonary embolus. There were no operative or perioperative deaths. CONCLUSION Cranial base meningiomas can be successfully managed via a purely endoscopic endonasal approach with acceptable morbidity and mortality rates. The extent of resection is guided by patient factors and symptoms, not by approach. This series had a high cerebrospinal fluid leak rate. With the evolution of new reconstruction techniques, these rates have been substantially reduced.

scholarly journals Pediatric skull base reconstruction: case report of a tunneled temporoparietal fascia flap

2016 ◽  
Vol 17 (3) ◽  
pp. 371-377 ◽  
Author(s):  
Jeffrey C. Rastatter ◽  
Patrick C. Walz ◽  
Tord D. Alden
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Nasoseptal Flap ◽  
Pediatric Case ◽  
Clival Chordoma ◽  
Temporoparietal Fascia ◽  
Temporoparietal Fascia Flap ◽  
Fluid Leak ◽  
Fascia Flap

The authors of this report present a pediatric case involving the use of a tunneled temporoparietal fascia flap to reconstruct a skull base defect for a multiply recurrent clival chordoma and cerebrospinal fluid leak, demonstrate the surgical technique through illustrations and intraoperative photos, and review the pertinent literature. A 9-year-old female patient underwent extensive clival chordoma resection via both the endoscopic and open approaches, which ultimately exhausted the bilateral nasoseptal flaps and other intranasal reconstructive options. Following proton beam radiation and initiation of chemotherapy, tumor recurrence was managed with further endoscopic resection, which was complicated by a recalcitrant cerebrospinal fluid leak. A tunneled temporoparietal fascia flap was used to provide vascular tissue to augment an endoscopic repair of the leak and reconstruction of the skull base. While the nasoseptal flap remains the workhorse for many pediatric and adult endoscopic skull base reconstructions, the tunneled temporoparietal fascia flap has a demonstrated efficacy in adults when the nasoseptal flap and other intranasal flaps are unavailable. This report documents a pediatric case, serving as a step toward establishing this technique in the pediatric population.

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