Middle Turbinectomy Complicated by Cerebrospinal Fluid Leak Secondary to Ethmoid Encephalocele: Transethmoid Repair

The value of middle turbinectomy for cephalalgia in carefully selected patients has been established. Although surgical treatment for middle turbinate syndrome is usually easy and safe, it may result in complications especially in the presence of unrecognized malformations of the anterior skull base. In the patient presented, cerebrospinal fluid rhinorrhea that was due to an ethmoid encephalocele occurred 1 month following surgery. An intranasal, transethmoid subfrontal craniotomy was devised to repair this defect under direct vision without subjecting the patient to the added risks of subfrontal craniotomy through external incisions. The case is reported to highlight an uncommon surgical hazard and a new approach to its repair and to address questions regarding the adequacy of the standard preoperative evaluation.

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Endoscopic reconstruction of large anterior skull base defects with opening of the sellar diaphragm. Experience at a tertiary level university hospital

The Journal of Laryngology & Otology ◽

10.1017/s0022215119001841 ◽

2019 ◽

Vol 133 (10) ◽

pp. 889-894

Author(s):

C Carnevale ◽

M Tomás-Barberán ◽

G Til-Pérez ◽

J Ibañez-Domínguez ◽

D Arancibia-Tagle ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Middle Turbinate ◽

Cerebrospinal Fluid Leak ◽

Lateral Wall ◽

Anterior Skull Base ◽

University Hospital ◽

Endoscopic Reconstruction ◽

Skull Base Defects ◽

Fluid Leak

AbstractBackgroundThe indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm.MethodA prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap.ResultsTwenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent).ConclusionThe combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.

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A Novel Technique for Endoscopic Repair of Large Anterior Skull Base Defects: The PDS Wrap

American Journal of Rhinology and Allergy ◽

10.1177/1945892419873991 ◽

2019 ◽

Vol 34 (1) ◽

pp. 70-73 ◽

Cited By ~ 1

Author(s):

Karan Jolly ◽

Okechukwu Okonkwo ◽

Georgios Tsermoulas ◽

Shahzada K. Ahmed

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Skull Base Surgery ◽

Cerebrospinal Fluid Leak ◽

Anterior Skull Base ◽

Brain Herniation ◽

Novel Technique ◽

Endoscopic Skull Base Surgery ◽

Fluid Leak ◽

The Brain

Background Endoscopic skull base surgery continues to push boundaries with increased complexity of work and subsequently larger defects requiring repair. Robust repair following endoscopic skull base surgery is essential to reduce significant postoperative complications such as cerebrospinal fluid leak, meningitis, and pneumocephalus. Objective To describe and further validate our novel technique of using a polydioxanone plate wrap used in large anterior skull base resections where brain herniation can be of concern. Method After large resections where there is obvious brain herniation, our PDS (polydioxanone) wrap can be deployed to provide rigid support to the brain. The PDS plate is wrapped in a dural graft material and sutured closed in order to allow deployment by releasing the sutures when in position under the bony ridge of the defect. Conclusion Till date we have successfully used this technique in 3 patients following large skull base resections of olfactory meningiomas, where there was herniation of the brain. Postoperatively, there was no evidence of cerebrospinal fluid leak. We therefore recommend the use of the PDS wrap to prevent brain herniation and provide additional support to the repair.

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Otogenic cerebrospinal fluid rhinorrhea: A new technique for closure of cerebrospinal fluid leak

American Journal of Otolaryngology ◽

10.1016/s0196-0709(00)80016-2 ◽

2000 ◽

Vol 21 (2) ◽

pp. 240-243 ◽

Cited By ~ 1

Author(s):

R SATALOFF ◽

M ZAVOD ◽

D MYERS

Keyword(s):

Cerebrospinal Fluid ◽

Cerebrospinal Fluid Leak ◽

New Technique ◽

Cerebrospinal Fluid Rhinorrhea ◽

A New Technique ◽

Fluid Leak

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215114001431 ◽

2014 ◽

Vol 128 (7) ◽

pp. 626-629 ◽

Cited By ~ 3

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.

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Traumatic Nonmissile Penetrating Transnasal Anterior Skull Base Fracture and Brain Injury with Cerebrospinal Fluid Leak: Intraoperative Leak Detection and an Effective Reconstruction Procedure for a Localized Skull Base Defect Especially After Coronavirus Disease 2019 Outbreak

World Neurosurgery ◽

10.1016/j.wneu.2020.05.236 ◽

2020 ◽

Vol 140 ◽

pp. 166-172

Author(s):

Yuichiro Yoneoka ◽

Naotaka Aizawa ◽

Yoriko Nonomura ◽

Manabu Ogi ◽

Yasuhiro Seki ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Brain Injury ◽

Skull Base ◽

Cerebrospinal Fluid Leak ◽

Leak Detection ◽

Anterior Skull Base ◽

Reconstruction Procedure ◽

Skull Base Fracture ◽

Skull Base Defect ◽

Fluid Leak

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

Caribbean Medical Journal ◽

10.48107/cmj.2020.08.003 ◽

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.

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Evaluation of Endoscopic Transnasal versus Non-endoscopic Routes as Surgical Treatment of Cerebrospinal Fluid Rhinorrhea

QJM ◽

10.1093/qjmed/hcab094.014 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Ashraf Mohamed Farrag ◽

Talaat Ali Hassan El Samnni ◽

Tamer Abdul Wahab El Sabri Abou El Ezz ◽

Mohamed Naguib Mohamed El Sayed

Keyword(s):

Cerebrospinal Fluid ◽

Meta Analysis ◽

Cerebrospinal Fluid Leak ◽

Csf Leak ◽

Csf Rhinorrhea ◽

Cerebrospinal Fluid Rhinorrhea ◽

Csf Leakage ◽

Fluid Leak ◽

The Brain ◽

Better Than

Abstract Introduction Cerebrospinal fluid (CSF) leak happens when there is an abnormal connection between the brain cavity inside and environment outside. It is important to establish a good barrier between the brain tissue and the nose to prevent cerebrospinal fluid leak and protect the brain from exposure to infection. which can be done either by endoscopic or non-endoscopic surgical repair. Patients and methods The aim of this work is to evaluate the effectiveness of endoscopic and non-endoscopic repair of CSF leakage in patients suffering from CSF rhinorrhea. The search retrieved 1693 unique records. We then retained 89 potentially eligible records for full-texts screening. Finally, 11 studies (Total No. of patients = 355) were included in the present systematic review and meta-analysis. Results CSF rhinorrhea resolved in endoscopic surgery group giving a success rate of 88.8%to 100%. recurrence rate is 2% to 12.2% and postoperative complications occurred in 5% to 16.7%. Conclusion The endoscopic approach is highly effective, better than non-endoscopic route and is associated with low morbidity for the management of CSF rhinorrhea .

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Postoperative Cerebrospinal Fluid Leak after Septoplasty: A Potential Complication of Occult Anterior Skull Base Encephalocele

Allergy & Rhinology ◽

10.2500/ar.2013.4.0043 ◽

2013 ◽

Vol 4 (1) ◽

pp. ar.2013.4.0043 ◽

Cited By ~ 5

Author(s):

Resha S. Soni ◽

Osamah J. Choudhry ◽

James K. Liu ◽

Jean Anderson Eloy

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Cerebrospinal Fluid Leak ◽

Anterior Skull Base ◽

Intracranial Abscess ◽

Ethmoid Bone ◽

Csf Rhinorrhea ◽

Csf Leakage ◽

Skull Base Defect ◽

Fluid Leak

Postoperative cerebrospinal fluid (CSF) rhinorrhea after septoplasty is a known entity resulting from errors in surgical technique and improper handling of the perpendicular plate of the ethmoid bone. When these occur, urgent management is necessary to prevent deleterious sequelae such as meningitis, intracranial abscess, and pneumocephalus. Encephaloceles are rare occurrences characterized by herniation of intracranial contents through a skull base defect that can predispose patients to CSF rhinorrhea. In this report, we present a case of CSF rhinorrhea occurring 2 weeks after septoplasty likely from manipulation of an occult anterior skull base encephalocele. To our knowledge, no previous similar case has been reported in the literature. Otolaryngologists should be aware of the possibility of occult encephaloceles while performing septoplasties because minimal manipulation of these entities may potentially result in postoperative CSF leakage.

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