ENDOSCOPIC ENDONASAL APPROACHES FOR CEREBROSPINAL FLUID LEAKS REPAIR

2016 ◽  
Author(s):  
Filippo Giovannetti
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Endonasal ◽  
Cerebrospinal Fluid Leaks

Improved Sinonasal Quality of Life Outcomes Following Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Leaks

2020 ◽  
Author(s):  
Feras Y. Ackall ◽  
Lyndon Chan ◽  
Kevin Choi ◽  
Jordan Teitelbaum ◽  
Patrick Codd ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cerebrospinal Fluid ◽  
Life Outcomes ◽  
Endoscopic Endonasal ◽  
Quality Of Life Outcomes ◽  
Cerebrospinal Fluid Leaks

scholarly journals Complications of Extended Endoscopic Endonasal Surgery in Elderly Patients

2018 ◽  
Vol 79 (S 03) ◽  
pp. S287-S288 ◽  
Author(s):  
Tyler Kenning ◽  
Carlos Pinheiro-Neto
Keyword(s):  
Cerebrospinal Fluid ◽  
Elderly Population ◽  
Operative Time ◽  
The Elderly ◽  
High Flow ◽  
Endoscopic Endonasal ◽  
Surgical Interventions ◽  
Perioperative Morbidity ◽  
Increased Risk ◽  
Cerebrospinal Fluid Leaks

AbstractExtended endoscopic endonasal procedures are not unique among surgical interventions in carrying increased risk in the elderly population. There are, however, components of the procedure, namely high-flow cerebrospinal fluid leaks, that do result in the potential for increased perioperative morbidity for these patients. We present the case of a 77-year-old male with a large invasive pituitary macroadenoma resected through a transplanum-transtuberculum-transsellar endonasal approach. A gross total resection was obtained with resolution of the patient's preoperative ophthalmologic deficits. One month postoperatively, the patient developed progressive lethargy and cranial imaging demonstrated a left convexity subacute subdural hematoma. This was evacuated through a twist drill craniostomy. Despite measures to limit the operative time of the initial endonasal procedure as well as the absence of a postoperative cerebrospinal fluid fistula, the patient still developed this complication. Along with more typical potential causes of postoperative decline following extended endonasal procedures, problems from high-flow intraoperative cerebrospinal fluid leaks alone can result in morbidity in the elderly population. This should be acknowledged preoperatively and a high suspicion should exist for the presence of intracranial hemorrhage in these patients with any postoperative deficits. Additional intraoperative measures can be utilized to minimize such risks.The link to the video can be found at: https://youtu.be/EkLmt2T8_UE.

Endoscopic Endonasal Management of Petroclival Cerebrospinal Fluid Leaks: Anatomical Study and Preliminary Clinical Experience

2008 ◽  
Vol 51 (06) ◽  
pp. 336-339 ◽  
Author(s):  
P. Castelnuovo ◽  
I. Dallan ◽  
M. Bignami ◽  
A. Pistochini ◽  
P. Battaglia ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Experience ◽  
Anatomical Study ◽  
Endoscopic Endonasal ◽  
Cerebrospinal Fluid Leaks

Opiate Use After Endoscopic Endonasal Transsphenoidal Surgery

2021 ◽  
pp. 194589242110619
Author(s):  
Tara J. Wu ◽  
Reza Kianian ◽  
Emmanuel G. Villalpando ◽  
Morcos N. Nakhla ◽  
Christine Wells ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Transsphenoidal Surgery ◽  
Endoscopic Endonasal ◽  
Opiate Use ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Cerebrospinal Fluid Leaks ◽  
Grade 3

Background The literature on opiate use after endoscopic endonasal transsphenoidal surgery (EETS) is limited. Objective To determine the risk factors for higher opiate use following EETS and the quantity of opiates used after discharge. Methods A retrospective review of 144 patients undergoing EETS from July 2018 to July 2020 was conducted. Patient, tumor, and surgical factors were documented. Pain scores and medications used on postoperative days (POD) 0 and 1, and discharge prescriptions, were recorded. Opiate use was quantified using morphine milligram equivalents (MME) dose. Multiple linear regression determined risk factors independently associated with POD0 to 1 opiate use. Results On POD 0 to 1, mean pain score was 4.9/10 (standard deviation [SD] ± 2.0). Mean acetaminophen use was 3.4 tablets (SD ± 1.6; 650 mg per tablet). Mean opiate use was 35.6 MME (SD ± 36.3), equivalent to 4.7 tablets (SD ± 4.8) of oxycodone 5 mg. Multiple linear regression showed that current smokers required an additional 37.1 MME ( P = .011), and patients with grade 3 intraoperative cerebrospinal fluid leaks required an additional 36.7 MME ( P = .046) on POD0 to 1. On discharge, mean opiate prescription was 117.7 MME (SD ± 102.1), equivalent to 15.7 tablets (SD ± 13.6) of oxycodone 5 mg. Thirty-nine patients (27.1%) did not require prescriptions. Only 10 patients (6.9%) required opiate refill(s) within 30 days after surgery. Conclusion Patients undergoing EETS have higher opiate needs compared to those undergoing endoscopic sinus surgery, although the overall requirements are still considered low. Independent risk factors associated with higher opiate use in the immediate postoperative period included current smokers and grade 3 intraoperative cerebrospinal fluid leaks.

Endoscopic Endonasal Approaches For Repair Of Cerebrospinal Fluid Leaks: Nine-Year Experience

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-246-ONS-257 ◽  
Author(s):  
Davide Locatelli ◽  
Federico Rampa ◽  
Ilaria Acchiardi ◽  
Maurizio Bignami ◽  
Francesca De Bernardi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Multidisciplinary Approach ◽  
Surgical Repair ◽  
Correct Diagnosis ◽  
Cranial Base ◽  
Successful Outcome ◽  
Surgical Approaches ◽  
Endoscopic Endonasal ◽  
Invasive Approach ◽  
Cerebrospinal Fluid Leaks

Abstract Objective: To describe surgical endoscopic experience in the repair of cerebrospinal fluid leaks treated by transnasal approaches. Methods: Different surgical approaches and techniques in the repair of cranial base defects are reviewed in a series of 135 patients. Results: Success rate at first attempt was 93.3%. Only 9 patients (6.7%) needed a second surgical repair, and in one patient, a coronal approach with frontal craniotomy was necessary. In the other eight cases, an endoscopic procedure was chosen. Two patients needed a third endonasal endoscopic surgical repair, with successful outcome. Conclusion: The target of endoscopic endonasal technique in the repair of cerebrospinal fluid leaks is to ensure a stable duraplasty with the least invasive approach avoiding craniotomy. A correct diagnosis surely allows the choice of the best treatment, surgical approach, graft, and technique. Our multidisciplinary approach to this pathology during these years has been essential to gain our challenging results.

scholarly journals Endoscopic Endonasal Repair of Sphenoid Sinus Cerebrospinal Fluid Leaks: Our Experience

2015 ◽  
Vol 67 (4) ◽  
pp. 412-416 ◽  
Author(s):  
Trichy Narayanan Janakiram ◽  
Vijayalakshmi Subramaniam ◽  
Palak Parekh
Keyword(s):  
Cerebrospinal Fluid ◽  
Sphenoid Sinus ◽  
Endoscopic Endonasal ◽  
Cerebrospinal Fluid Leaks

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

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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