scholarly journals Endoscopic endonasal repair of sphenoid cerebrospinal fluid leak, review and institutional experience

2019 ◽  
Vol 5 (2) ◽  
pp. 241
Author(s):  
Isra Al-Jazeeri ◽  
Hassan Al-Jazeeri ◽  
Ali Al-Momen
Keyword(s):  
Demographic Data ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Uncommon Presentation ◽  
Pubmed Database ◽  
Intracranial Complications ◽  
Csf Leaks

<p class="abstract"><strong>Background:</strong> Rhinogenic CSF leaks are not an uncommon presentation. Considering the possibility of drastic intracranial complications if left untreated, makes the management of such cases of outmost importance. Most of the non-traumatic CSF leaks will need a surgical repair. And since the introduction of the endoscopic nasal surgeries, these repairs are done almost always through the endoscopic endonasal approach.</p><p class="abstract"><strong>Methods:</strong> Retrospective review of cases with endoscopic repair of sphenoid CSF leak, who presented to King Fahad Specialist Hospital in Dammam (KFSH-D), from November 2003 to December 2017. And the U.S. National Library of Medicine (Pubmed) database was searched for “Sphenoid CSF Leak”.  </p><p class="abstract"><strong>Results:</strong> We had a total of 12 cases. The demographic data, diagnostic investigations and operative data were retrieved and reviewed.</p><p class="abstract"><strong>Conclusions:</strong> We advise using high resolution CT and intra-operative fluroscein for a reliable localization. And we found no complications with use of correct concentration of fluroscein. Endoscopic endonasal approach for repair of sphenoid CSF leak was found to be both effective and safe.</p>

Endoscopic Endonasal Approaches to the Clivus with No Violation of the Nasopharynx: Surgical Anatomy and Clinical Illustration

2021 ◽  
Author(s):  
Carlos D. Pinheiro-Neto ◽  
Laura Salgado-Lopez ◽  
Luciano C.P.C. Leonel ◽  
Serdar O. Aydin ◽  
Maria Peris-Celda
Keyword(s):  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Surgical Anatomy ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Abstract Background Despite the use of vascularized intranasal flaps, endoscopic endonasal posterior fossa defects remain surgically challenging with high rates of postoperative cerebrospinal fluid leak. Objective The aim of the study is to describe a novel surgical technique that allows complete drilling of the clivus and exposure of the craniovertebral junction with preservation of the nasopharynx. Methods Two formalin-fixed latex-injected anatomical specimens were used to confirm feasibility of the technique. Two surgical approaches were used: sole endoscopic endonasal approach and transnasion approach. The sole endonasal approach was used in a patient with a petroclival meningioma. Results In both anatomical dissections, the inferior clivectomy with exposure of the foramen magnum was achieved with a sole endoscopic endonasal approach. The addition of the transnasion approach helped to complete drilling of the inferior border of the foramen magnum and exposure of the arch of C1. Conclusion This study shows the anatomical feasibility of total clivectomy and exposure of the craniovertebral junction with preservation of the nasopharynx. A more favorable anatomical posterior fossa defect for the reconstruction is achieved with this technique. Further clinical studies are needed to assess if this change would impact the postoperative CSF leak rate.

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.

scholarly journals Endoscopic Endonasal Approaches to the Clival Region

2021 ◽  
Vol 49 (1, 2, 3) ◽  
pp. 45
Author(s):  
Janez Ravnik ◽  
Borut Hribernik ◽  
Boštjan Lanišnik
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Neurenteric Cyst ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Transnasal Approach ◽  
Endoscopic Endonasal ◽  
Post Operative Period ◽  
Operative Complications ◽  
Post Operative Complications

<p><strong>Objective</strong>. Our main objectives were to analyze and determine the safety, risk of post-operative complications, and surgical outcome of the endoscopic endonasal approach to the clival region.</p><p><strong>Methods</strong>. From May 2011 to May 2019, we operated on 19 patients using the endoscopic endonasal approach to the clival region. Their pathologies were diverse: pituitary macroadenoma, craniopharyngioma, metastasis, and a prepontine neurenteric cyst. The first operations were supervised by an experienced center using telementoring. We explained our surgical technique and analyzed the patients’ data, which were included in our study.</p><p><strong>Results. </strong>We managed to achieve complete removal of the pathological process in 14 patients. There were no deaths in the perioperative and early post-operative period. The most common complication was a cerebrospinal fluid leak, which was successfully managed in all of the cases. There were no deaths or significant morbidities in the post-operative period.</p><p><strong>Conclusion. </strong>An endoscopic transnasal approach to the clival region is safe and effective. It provides better visualization of that region compared to other transcranial approaches. The risk of post-operative complications is significantly lower with the help of modern reconstructive techniques. CSF leak is the most frequent complication.</p>

Endoscopic endonasal repair of anterior skull base non-traumatic cerebrospinal fluid leaks, meningoceles, and encephaloceles

2010 ◽  
Vol 113 (5) ◽  
pp. 961-966 ◽  
Author(s):  
Gurston G. Nyquist ◽  
Vijay K. Anand ◽  
Saral Mehra ◽  
Ashutosh Kacker ◽  
Theodore H. Schwartz
Keyword(s):  
Skull Base ◽  
Frontal Sinus ◽  
Anterior Skull Base ◽  
Cribriform Plate ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Closure Rate ◽  
Endoscopic Endonasal ◽  
Csf Leaks

Object The endoscopic endonasal approach has become the preferred technique for CSF leak and encephalocele repair of the anterior skull base. The purpose of this study is to identify patient characteristics; review adjunctive perioperative treatments, reconstruction techniques, and outcomes; and identify risk factors for failure in patients undergoing endoscopic endonasal repair of anterior skull base CSF leaks and encephaloceles. Methods This is a prospective observational study of patients undergoing endoscopic endonasal repair of a CSF leak between October 2004 and May 2009. Twenty-eight consecutive patients underwent 32 procedures. Twenty-two of the patients were women, which represents a statistically significant trend toward the female sex (p < 0.05). The average body mass index (33.9) was significant for obesity. The origin of the skull base defect included the cribriform plate (in 9 cases), fovea ethmoidalis (in 7), combined fovea ethmoidalis/cribriform plate (in 2), lateral sphenoid sinus (in 6), sella (in 4), clivus (in 3), and frontal sinus (in 1). Results The overall endonasal closure rate was 93.8% (30 of 32 procedures). One failure occurred due to overaggressive postoperative debridement, while the other recurred along the posterior wall of the frontal sinus, and endoscopic repair would have occluded the recess. Conclusions The endoscopic endonasal approach for the treatment of CSF leaks and encephaloceles of the anterior skull base is the preferred method of repair in the vast majority of cases. The authors' 93.8% closure rate in a variety of anatomical locations compares favorably with the transcranial approach and echoes the results of other endoscopic series.

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

scholarly journals Predictive Factors, 30-Day Clinical Outcomes, and Costs Associated with Cerebrospinal Fluid Leak in Pituitary Adenoma Resection

2019 ◽  
Vol 81 (01) ◽  
pp. 043-055 ◽  
Author(s):  
Adish Parikh ◽  
Arjun Adapa ◽  
Stephen E. Sullivan ◽  
Erin L. McKean
Keyword(s):  
Cerebrospinal Fluid ◽  
Multivariate Analysis ◽  
Pituitary Adenoma ◽  
Demographic Data ◽  
Cerebrospinal Fluid Leak ◽  
Hospital Charges ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Financial Variables ◽  
Clinical Complications

AbstractCerebrospinal fluid (CSF) leak is a complication of endoscopic endonasal pituitary adenoma resection. Previous studies examining complications of pituitary adenoma resection have not examined associations of an exhaustive list of clinical and financial variables with CSF leak. We designed a retrospective analysis of 334 consecutive patients that underwent endoscopic endonasal pituitary adenoma resection at a single institution over 5 years, analyzing associations between CSF leak and demographic data, operative data, comorbidities, clinical complications and outcomes, costs, charges, and payments. Of the 20 preoperative variables studied, none were positively associated with CSF leak in between-groups comparison, although multivariate analysis revealed an association with a history of radiation to the skull base (odds ratio [OR], 8.67; 95% confidence interval [CI], 0.94–57.03; p < 0.05). CSF leak was associated with a significantly higher rate of postoperative diabetes insipidus (Δ = 33.4%, p = 0.040) and increased length of stay after operation in between-groups comparison. Multivariate analysis on postoperative variables revealed significant associations between CSF leak and intracerebral hemorrhage (OR, 17.44; 95% CI, 0.65–275.3; p < 0.05) and postoperative intracranial infection (OR, 28.73; 95% CI, 2.04–438.7; p < 0.05). Also, CSF leak was associated with significantly higher costs (Δ = $15,643, p < 0.05) and hospital charges (Δ = $46,026, p < 0.05). Operating room time, room and board, and supplies and implants were the strongest cost drivers. This study highlights the difficulty of utilizing preoperative variables to predict CSF leak, the clinical complications and outcomes of leak, and the financial subcategories that drive the costs, charges, and payments associated with this complication.

Sensitivity and specificity of intrathecal fluorescein and white light excitation for detecting intraoperative cerebrospinal fluid leak in endoscopic skull base surgery: a prospective study

2016 ◽  
Vol 124 (3) ◽  
pp. 621-626 ◽  
Author(s):  
Shaan M. Raza ◽  
Matei A. Banu ◽  
Angela Donaldson ◽  
Kunal S. Patel ◽  
Vijay K. Anand ◽  
...  
Keyword(s):  
Skull Base ◽  
Sensitivity And Specificity ◽  
Skull Base Surgery ◽  
False Negative ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Predictive Values ◽  
Endoscopic Skull Base Surgery ◽  
Csf Leaks

OBJECT The intraoperative detection of CSF leaks during endonasal endoscopic skull base surgery is critical to preventing postoperative CSF leaks. Intrathecal fluorescein (ITF) has been used at varying doses to aid in the detection of intraoperative CSF leaks. However, the sensitivity and specificity of ITF at certain dosages is unknown. METHODS A prospective database of all endoscopic endonasal procedures was reviewed. All patients received 25 mg ITF diluted in 10 ml CSF and were pretreated with dexamethasone and Benadryl. Immediately after surgery, the operating surgeon prospectively noted if there was an intraoperative CSF leak and fluorescein was identified. The sensitivity, specificity, and positive and negative predictive power of ITF for detecting intraoperative CSF leak were calculated. Factors correlating with postoperative CSF leak were determined. RESULTS Of 419 patients, 35.8% of patients did not show a CSF leak. Fluorescein-tinted CSF (true positive) was noted in 59.7% of patients and 0 false positives were encountered. CSF without fluorescein staining (false negative) was noted in 4.5% of patients. The sensitivity and specificity of ITF were 92.9% and 100%, respectively. The negative and positive predictive values were 88.8% and 100%, respectively. Postoperative CSF leaks only occurred in true positives at a rate of 2.8%. CONCLUSIONS ITF is extremely specific and very sensitive for detecting intraoperative CSF leaks. Although false negatives can occur, these patients do not appear to be at risk for postoperative CSF leak. The use of ITF may help surgeons prevent postoperative CSF leaks by intraoperatively detecting and confirming a watertight repair.

Endoscopic Endonasal Approach for Resection of Cranial Base Chordomas

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 614-625 ◽  
Author(s):  
Maria Koutourousiou ◽  
Paul A. Gardner ◽  
Matthew J. Tormenti ◽  
Stephanie L. Henry ◽  
Susan T. Stefko ◽  
...  
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Neurological Complications ◽  
Tumor Location ◽  
Cranial Base ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Success Rates ◽  
Endoscopic Endonasal ◽  
Previously Treated Patients ◽  
Previously Treated

Abstract BACKGROUND: Gross total resection (GTR) of cranial base chordomas represents a surgical challenge because of the location, invasiveness, and tumor extension. In the past decade, the endoscopic endonasal approach (EEA) has been used with notable outcomes. OBJECTIVE: To present the endoscopic endonasal experience in the treatment of cranial base chordomas at our institution. METHODS: From April 2003 to March 2011, 60 patients underwent an EEA for primary (n = 35) or previously treated (n = 25) cranial base chordomas. We evaluated the degree of GTR and complications. We studied the factors that influenced outcomes and compared our surgical results in the early and late years of our experience. RESULTS: The overall rate of GTR of cranial base chordomas was 66.7% (82.9% in primary and 44% in previously treated patients). The most important limitations for GTR were tumor volume greater than 20 cm3 (P = .042), tumor location in the lower clivus with lateral extension (P = .022), and previously treated disease (P = .002). The learning curve had a significant impact on GTR, increasing the success rate to 88.9% (92.6% in primary patients and 63.6% in previously treated patients) during recent years (P &lt; .0001). The most frequent complication was cerebrospinal fluid leak (20%) resulting in meningitis in 3.3%. Carotid injuries occurred in 2 patients without any resulting deficit. Neurological complications included new cranial neuropathies (6.7%) and long tract deficits (1.7%). There was no operative mortality in our series. CONCLUSION: For the treatment of cranial base chordomas, the EEA is a competitive alternative to transcranial approaches with minimal morbidity and high success rates of GTR when performed by experienced cranial base surgeons.

Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions

2007 ◽  
Vol 106 (3) ◽  
pp. 400-406 ◽  
Author(s):  
Ilya Laufer ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Sella Turcica ◽  
Significant Risk ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Rathke Cleft Cyst ◽  
Extended Transsphenoidal Approach ◽  
Csf Leakage ◽  
Planum Sphenoidale

Object The extended transsphenoidal approach is a less invasive method for removing purely suprasellar lesions compared with traditional transcranial approaches. Most advocates have used a sublabial incision and a microscope and have reported a significant risk of cerebrospinal fluid (CSF) leakage. The authors report on a series of purely endoscopic endonasal surgeries for resection of suprasellar supradiaphragmatic lesions above a normal-sized sella turcica with a low risk of CSF leakage. Methods A purely endoscopic endonasal approach was used to remove suprasellar lesions in a series of 10 patients. Five lesions were prechiasmal (three tuberculum sellae and two planum sphenoidale meningiomas) and five were post-chiasmal (four craniopharyngiomas and one Rathke cleft cyst). The floor of the planum sphenoidale and the sella turcica was reconstructed using a multilayer closure with autologous and synthetic materials. Spinal drainage was performed in only five cases. Complete resection of the lesions was achieved in all but one patient. The pituitary stalk was preserved in all but one patient, whose stalk was invaded by a craniopharyngioma and who had preoperative diabetes insipidus (DI). Vision improved postoperatively in all patients with preoperative impairment. Six patients had temporary DI; in five, the DI became permanent. Four patients with craniopharyngiomas required cortisone and thyroid replacement. After a mean follow up of 10 months, there was only one transient CSF leak when a lumbar drain was clamped prematurely on postoperative Day 5. Conclusions A purely endoscopic endonasal approach to suprasellar supradiaphragmatic lesions is a feasible minimally invasive alternative to craniotomy. With a multilayer closure, the risk of CSF leakage is low and lumbar drainage can be avoided. A larger series will be required to validate this approach.

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