scholarly journals Spontaneous cerebrospinal fluid leakage through fistulas at the clivus repaired with endoscopic endonasal approach

2015 ◽  
Vol 6 (1) ◽  
pp. 106 ◽  
Author(s):  
Yasuhiko Hayashi ◽  
Masayuki Iwato ◽  
Daisuke Kita ◽  
Issei Fukui
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leakage ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Fluid Leakage

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 Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248229
Author(s):  
Il Hwan Lee ◽  
Do Hyun Kim ◽  
Jae-Sung Park ◽  
Sin-Soo Jeun ◽  
Yong-Kil Hong ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Retrospective Chart Review ◽  
Pedicled Flap ◽  
Cerebrospinal Fluid Leakage ◽  
Dural Defect ◽  
Endoscopic Endonasal ◽  
Tertiary Referral Center ◽  
Fluid Leakage ◽  
Csf Leakage ◽  
Grade 3

Objectives We describe the strategy used to repair intraoperative leaks of various grades and define factors for preventing postoperative cerebrospinal fluid leakage (CSF) after surgery via the endoscopic endonasal transsphenoidal approach (EETA). Study design Retrospective chart review at a tertiary referral center. Methods Patients who underwent surgery via EETA from January 2009 to May 2020 were retrospectively reviewed. Intraoperative CSF leakage was graded 0–3 in terms of the dural defect size; various repairs were used depending on the grade. Results A total of 777 patients underwent 869 operations via EETA; 609 (70.1%) experienced no intraoperative CSF leakage (grade 0) but 260 (29.9%) did. Leakage was of grade 1 in 135 cases (15.5%), grade 2 in 83 (9.6%), and grade 3 in 42 (4.8%). In 260 patients with intraoperative CSF leakage, a buttress was wedged into the sellar defect site in 178 cases (68.5%) and a pedicled flap was placed in 105 cases (40.4%). Autologous fat (108 cases, 41.5%) and a synthetic dural substitute (91 cases, 35%) were used to fill the dead space of the sellar resection cavity. Postoperative CSF leakage developed in 21 patients: 6 of grade 1, 7 of grade 2, and 8 of grade 3. Buttress placement significantly decreased postoperative leakage in grade 1 patients (p = 0.041). In patients of perioperative leakage grades 2 and 3, postoperative CSF leakage was significantly reduced only when both fat and a buttress were applied (p = 0.042 and p = 0.043, respectively). Conclusion A buttress prevented postoperative CSF leakage in grade 1 patients; both fat and buttress were required by patients with intraoperative leakage of grades 2 and 3.

scholarly journals The efficacy of an endoscopic endonasal approach in the repair of cerebrospinal fluid fistula: a clinical analysis

2019 ◽  
Vol 5 (4) ◽  
pp. 90
Author(s):  
Fulya Ozer ◽  
Can Alper Cagici ◽  
Cem Ozer ◽  
Cuneyt Yilmazer
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Approach ◽  
Graft Material ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Cerebrospinal Fluid Fistula ◽  
Endoscopic Repair ◽  
Endoscopic Endonasal ◽  
Csf Leakage ◽  
Fluid Fistula

<p class="abstract"><strong>Background:</strong> Cerebrospinal fluid (CSF) fistula is an abnormal CSF leakage due to bone and/or dural defect of the skull base and usually operated with endonasal endoscopic approach. The aim of this study was to determine the efficacy of an endonasal endoscopic approach in the repair of CSF leakage and to find the reasons of the recurrence of endoscopic procedure.</p><p class="abstract"><strong>Methods:</strong> The medical records of 24 patients that presented with the diagnosis of cerebrospinal fluid fistula and who had undergone endonasal endoscopic repair surgery were reviewed retrospectively.  </p><p class="abstract"><strong>Results:</strong> 13 patients (54.2%) were found to have spontaneous CSF fistulas without any history of trauma, while 11 patients (45.8%) had posttraumatic CSF fistulas. The mean body mass index (BMI) of patients was 31. 3 kg/m² (20.1-49.6). Nasal septal cartilage was used as a graft material in 19 patients (79%) while only fascia was used in 5 patients (21%). The evaluation of long-term results revealed recurrence in 4 patients (16.6%). Two of these patients required a second surgical repair.</p><p class="abstract"><strong>Conclusions:</strong> An endoscopic endonasal approach is a safe method with less morbidity and a reliable outcome in the repair of CSF fistulas. The most important causative factors in the recurrence of endoscopic repair of CSF leak might be to have high BMI and not to use multilayered graft material for closure of fistula.</p><p class="abstract"> </p>

Endoscopic Endonasal Approach to the Ventral Jugular Foramen: Anatomical Basis, Technical Considerations, and Clinical Series

2017 ◽  
Vol 13 (4) ◽  
pp. 482-491 ◽  
Author(s):  
Francisco Vaz-Guimaraes ◽  
Ana Carolina I. Nakassa ◽  
Paul A. Gardner ◽  
Eric W. Wang ◽  
Carl H. Snyderman ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Jugular Foramen ◽  
Cerebrospinal Fluid Leakage ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Lower Cranial Nerve ◽  
Presenting Symptoms ◽  
Anatomical Basis ◽  
Clinical Series

Abstract BACKGROUND: Surgical exposure of the jugular foramen (JF) is challenging given its complex regional anatomy and proximity to critical neurovascular structures. OBJECTIVE: To describe the anatomical basis, surgical technique, and outcomes of a group of patients who underwent the endoscopic endonasal approach to the JF. METHODS: Five silicon-injected anatomical specimens were prepared for dissection. Additionally, a chart review was conducted through our patient database, searching for endonasal exposure of the JF. Demographic data, clinical presentation, pathological findings, extent of resection in the JF, and occurrence of complications were analyzed. RESULTS: The endonasal exposure of the JF requires 3 sequential steps: a transpterygoid, a “far-medial,” and an “extreme-medial” approach. Mobilization or transection of the cartilaginous portion of the eustachian tube (ET) is necessary. In the clinical series, cranial neuropathies were the presenting symptoms in 16 patients (89%). Eighteen tumors (10 chondrosarcomas, 7 chordomas, 1 adenocarcinoma) extended secondarily into the JF. Total tumor resection was achieved in 10 patients (56%), near total (≥90%) in 6 (33%), and subtotal (&lt;90%) in 2 (11%). ET dysfunction (75% of cases), transient palatal numbness (17%), cerebrospinal fluid leakage (17%), and lower cranial nerve palsy (17%) were the most common postoperative complications. There were no carotid artery or jugular vein injuries. CONCLUSION: The endoscopic endonasal approach to the JF requires mobilization or transection of the cartilaginous portion of the ET. This maneuver provides a safe infrapetrosal surgical route to the JF. It may be considered a valid option, in well-selected cases, for resection of malignant and recurrent cranial base tumors.

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