Endoscopic repair of cerebrospinal fluid leaks in the lateral sphenoid sinus recess

2010 ◽  
Vol 112 (2) ◽  
pp. 444-448 ◽  
Author(s):  
Boaz Forer ◽  
Dharmbir S. Sethi
Keyword(s):  
Cerebrospinal Fluid ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Endoscopic Repair ◽  
Singapore General Hospital ◽  
Csf Leakage ◽  
Transcranial Approach ◽  
Cerebrospinal Fluid Leaks ◽  
Skull Base Defect ◽  
Csf Leaks

Object Cerebrospinal fluid leaks may occur as a result of trauma or following surgery, and occasionally may also be spontaneous. Leakage of CSF from the lateral sphenoid recess is rare and challenging to treat. The authors present their experience with repairs of 10 CSF leaks that were confined to the lateral sphenoid recess and were treated at the Singapore General Hospital. Methods A retrospective chart review was conducted for all patients who underwent operations for lateral sphenoid recess CSF leaks between 2001 and 2008. Results Ten repairs were performed in 8 patients by using a transpterygoid approach, with a 90% success rate. In 3 cases the transcranial approach had failed prior to endoscopic repair. “Sandwich reconstruction” under direct vision was performed in all cases, and was completed using cartilage or bone as a rigid support. Conclusions This series demonstrates that CSF leakage can be managed safely and effectively by using an endoscopic transpterygoid approach in patients in whom both external and endoscopic attempts have failed. The transpterygoid approach used in all of the cases in this series provides wide exposure around the skull base defect, which is crucial for successful repair.

scholarly journals Sandwich wound closure reduces the risk of cerebrospinal fluid leaks in posterior fossa surgery

2016 ◽  
Vol 6 (2) ◽  
Author(s):  
Verena Heymanns ◽  
Abidemi W. Oseni ◽  
Ameer Alyeldien ◽  
Homajoun Maslehaty ◽  
Richard Parvin ◽  
...  
Keyword(s):  
New York ◽  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Wound Closure ◽  
Posterior Fossa Surgery ◽  
Dural Closure ◽  
Csf Leakage ◽  
Cerebrospinal Fluid Leaks ◽  
Closure Method ◽  
Csf Leaks

Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

Endonasal Endoscopic Repair of Sternberg???s Canal Cerebrospinal Fluid Leaks

2007 ◽  
Vol 117 (2) ◽  
pp. 345-349 ◽  
Author(s):  
Paolo Castelnuovo ◽  
Iacopo Dallan ◽  
Andrea Pistochini ◽  
Paolo Battaglia ◽  
Davide Locatelli ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Repair ◽  
Cerebrospinal Fluid Leaks

External frontal sinusotomy and endoscopic repair of cerebrospinal fluid fistula in the posterior wall: preliminary report of a new technique

2011 ◽  
Vol 125 (8) ◽  
pp. 802-806 ◽  
Author(s):  
P Thulasi Das ◽  
D Balasubramanian
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
Posterior Wall ◽  
Anterior Wall ◽  
New Technique ◽  
Endoscopic Repair ◽  
Tertiary Referral Centre ◽  
Cerebrospinal Fluid Leaks ◽  
A New Technique

AbstractIntroduction:Cerebrospinal fluid rhinorrhoea is the abnormal leakage of cerebrospinal fluid into the nasal cavity. The posterior wall of the frontal sinus can be the site of such leakage. Traditionally, these leaks were repaired via external osteoplastic or neurosurgical approaches. Despite advances in instrumentation, it is difficult to manage superiorly or laterally placed defects endoscopically. We present a new technique of endoscopic repair of frontal sinus posterior wall defects, via access holes drilled in the anterior wall of the frontal sinus.Study design:Preliminary study involving patients presenting with frontal sinus cerebrospinal fluid leaks, with defects in the frontal sinus posterior wall, between 2006 and 2010.Setting:Patients were treated in a tertiary referral centre for nose and sinus diseases. Patient records were reviewed and analysed.Results:Nine patients underwent external frontal sinusotomy under endoscopic vision. Repair was successful in all cases, with no complications. Follow up ranged from three months to three years.Conclusion:External frontal sinusotomy and endoscopic repair is a simple, precise and cosmetically acceptable alternative to osteoplastic and major neurosurgical techniques for management of frontal sinus posterior wall defects. This new, previously undescribed technique enables otolaryngologists to play a role in managing such defects.

Significance of Empty Sella in Cerebrospinal Fluid Leaks

2003 ◽  
Vol 128 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Rodney J. Schlosser ◽  
William E. Bolger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Sella Turcica ◽  
Radiographic Finding ◽  
Empty Sella ◽  
Senior Author ◽  
Csf Leak ◽  
Benign Intracranial Hypertension ◽  
Cerebrospinal Fluid Leaks ◽  
Csf Leaks

OBJECTIVE: The role of elevated cerebrospinal fluid (CSF) pressures in the pathophysiology of various CSF leaks is not clear. Empty sella syndrome (ESS) is a radiographic finding that can be associated with elevated CSF pressures and may represent a radiographic indicator of intracranial hypertension. We present our experience with CSF leaks of various causes, the prevalence of ESS in the spontaneous and nonspontaneous categories, and the potential pathophysiology and unique management issues of the spontaneous CSF leak group. METHODS: We conducted a retrospective review of medical records, imaging studies, and surgical treatment of CSF leaks in patients treated by the senior author. RESULTS: Sixteen patients with spontaneous CSF leaks and 12 patients with nonspontaneous CSF leaks were surgically treated from 1996 through 2002. In the spontaneous group, 15 patients had complete imaging of the sella turcica. Ten had completely empty sellae and 5 had partially empty sellae, for a total of 100% (15 of 15). In the nonspontaneous group, 9 patients had complete imaging of the sella. Only 11% (1 of 9) had a partially empty sella and that was a congenital leak. Comparison of proportions between these 2 groups was significant ( P = 0.01). The spontaneous group consisted primarily of obese, middle-aged females (13 of 16 patients). CONCLUSION: Empty sella probably represents a sign of elevated intracranial pressure that leads to idiopathic, spontaneous CSF leaks. Spontaneous CSF leaks are strongly associated with the radiographic finding of an empty sella and are more common in obese females, similar to benign intracranial hypertension. This unique population may require more aggressive surgical and medical treatment to prevent recurrent or multiple leaks.

A physiological sealant for cerebrospinal fluid leaks

1977 ◽  
Vol 46 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Gerald D. Silverberg ◽  
Christina B. Harbury ◽  
Edward Rubenstein
Keyword(s):  
Cerebrospinal Fluid ◽  
Histological Examination ◽  
Content Type ◽  
Cerebrospinal Fluid Leaks ◽  
The Brain ◽  
Fine Print ◽  
Csf Leaks

✓ A combination of concentrated platelets, thrombin, and fibrinogen was used to adhere a pericranial graft to surgically produced cerebrospinal fluid (CSF) fistulas in dogs. This sealant successfully stopped leakage of CSF in all fistulas produced in both acute and chronic preparations. All control animals leaked CSF acutely. In chronic control animals the CSF leaks sealed spontaneously but the grafts were not well incorporated. Histological examination of the grafts and underlying brain showed no injury to the brain or meningeal vessel from exposure to the platelet glue. Good fibrous union of the grafts to the dura was confirmed.

Endoscopic Repair of Supraorbital Ethmoid Cerebrospinal Fluid Leaks

ORL ◽  
2009 ◽  
Vol 71 (2) ◽  
pp. 93-98 ◽  
Author(s):  
Michael T. Purkey ◽  
Bradford A. Woodworth ◽  
Samuel Hahn ◽  
James N. Palmer ◽  
Alexander G. Chiu
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Repair ◽  
Cerebrospinal Fluid Leaks
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