scholarly journals Spontaneous CSF Leaks and Meningoencephaloceles: Endoscopic Repair and Possible Etiology

2011 ◽  
Vol 3 (3) ◽  
pp. 151-155
Author(s):  
Andrey S Lopatin ◽  
Dmitry N Kapitanov ◽  
Alexander A Potapov
Keyword(s):  
Success Rate ◽  
Endoscopic Surgery ◽  
Sphenoid Sinus ◽  
Lateral Part ◽  
Nasal Discharge ◽  
Bony Defect ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Etiological Factors ◽  
Csf Fistula

ABSTRACT Objective To assess the outcomes of endonasal endoscopic repair of spontaneous cerebrospinal fluid (CSF) rhinorrhea and to analyze its possible etiological factors. Patients During the period between January 1999 and November 2011, 173 patients who presented with spontaneous CSF rhinorrhea underwent endonasal endoscopic surgery. Preoperative examination included CT scans, nasal endoscopy, measurement of glucose concentration in the nasal discharge and, in some cases, cisternographic evaluation via CT or MRI. CSF fistula closure was performed using endonasal endoscopic technique under general anesthesia. In all, 186 surgeries (173 primary attempts and 13 revisions) were carried out over the 12-year period. A combination of different plastic materials, i.e. nasal septum cartilage, facia lata, abdominal fat, rotating middle turbinate flaps, and fibrin glue was used for fistula repair. Results At the time of the surgery, sites of the CSF fistula were determined as follows: Cribriform plate—70, fovea ethmoidalis—55, sphenoid sinus—45, frontal sinus—3. Extremely pneumatized lateral extension of the sphenoid sinus was found in 26 patients, and a meningo/encephalocele protruding through the bony defect was the source of the leak in 23 of them. In terms of up to 11 years, 165 patients were treated successfully after first attempt and five more recovered after revision endoscopic surgery. Success rate after the first surgery was 95.4%, overall success rate—97.7%. There were no postoperative complications. Conclusion Possible etiological factors of this disease include obesity, innate skull base malformations, overpneumatized sphenoid sinus, particularly presence of its lateral extensions and the empty sella syndrome. Endoscopic endonasal repair of spontaneous CSF rhinorrhea appears to be a safe and successful procedure. However, technique of endoscopic closure of CSF fistulas in the lateral part of the sphenoid sinus needs further perfection.

Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: Learning from Our Failures

2001 ◽  
Vol 15 (5) ◽  
pp. 333-342 ◽  
Author(s):  
Paolo Castelnuovo ◽  
Silvia Mauri ◽  
Davide Locatelli ◽  
Enzo Emanuelli ◽  
Giovanni Delù ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Csf Leak ◽  
Graft Material ◽  
Literature Analysis ◽  
Endoscopic Repair ◽  
Common Procedure ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea

Endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea is becoming a common procedure. The purpose of this study was to perform a literature analysis centering cases of treatment failure and to review our 31 cases with a 1-year minimum follow-up. An extensive search of the literature was conducted, which focused on success rate, follow-up, diagnostic techniques, graft material used, failure rate, and comments on failures. A retrospective analysis of our 31 patients was carried out, and all cases were treated with the endoscopic approach with a 1-year minimum follow-up. From the literature analysis, the median success rate at the first endoscopic attempt is 90%. Our success rate was 87.1%. Failures were analyzed. A unique protocol for CSF leak diagnosis does not exist; we suggest our diagnostic algorithm. Graft material used depends on the authors’ experience, and based on this review of cases to date, did not significantly influence the success rate. The analysis of cases of failure shows that the majority of authors omit details. More research is needed to improve prevention of failures.

Endoscopic management of spontaneous meningoencephalocele of the lateral sphenoid sinus

2010 ◽  
Vol 112 (5) ◽  
pp. 1070-1077 ◽  
Author(s):  
Abtin Tabaee ◽  
Vijay K. Anand ◽  
Paolo Cappabianca ◽  
Aldo Stamm ◽  
Felice Esposito ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Sphenoid Sinus ◽  
Clinical Manifestations ◽  
Early Postoperative Period ◽  
Endoscopic Management ◽  
Endoscopic Repair ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Endoscopic Closure ◽  
Postoperative Meningitis

Object Spontaneous meningoencephaloceles of the lateral sphenoid sinus are rare lesions that are hypothesized to result from persistence of the lateral craniopharyngeal canal. Prior reports of the management of this lesion have been limited by its relative rarity. The objective of this paper is to report the theoretical etiology, surgical technique, and outcomes in patients undergoing endoscopic repair of spontaneous meningoencephalocele of the sphenoid sinus. Methods The authors conducted a retrospective review of a multiinstitutional series of 13 cases involving patients who underwent endoscopic repair of spontaneous meningoencephalocele of the lateral sphenoid sinus. The surgical technique and pathophysiological considerations are discussed. Results The clinical manifestations included CSF rhinorrhea (85%), chronic headache (77%), and a history of meningitis (15%). The endoscopic approaches to the lateral sphenoid sinus were transnasal (39%), transpterygoid (23%), and transethmoid (39%). Two patients (8%) had postoperative CSF leaks, one of which closed spontaneously and one of which required revision endoscopic closure. All patients were free of leak at most recent follow-up. One patient experienced postoperative meningitis in the early postoperative period. Conclusions Endoscopic endonasal closure is an effective modality in the treatment of spontaneous meningoencephaloceles of the lateral sphenoid sinus. If the sphenoid sinus has extensive lateral pneumatization, adequate exposure may require a transpterygoid approach.

scholarly journals Delayed Spontaneous Cerebrospinal Leak through Clival Recess: Emphasis on Technique of Repair

2017 ◽  
Vol 10 (1) ◽  
pp. 42-44
Author(s):  
Satyawati Mohindra ◽  
Sandeep Mohindra ◽  
Kiran Joshi ◽  
Harsimrat S Sodhi
Keyword(s):  
Magnetic Resonance ◽  
Sphenoid Sinus ◽  
Lateral Wall ◽  
Csf Leak ◽  
Nasal Discharge ◽  
Transnasal Approach ◽  
Csf Rhinorrhea ◽  
Repeat Magnetic Resonance Imaging ◽  
Computed Tomographic ◽  
General Physical

ABSTRACT Objective To report a rare case of delayed spontaneous cerebrospinal fluid (CSF) leak through clival region in the sphenoid sinus. Case report A 35-year-old female presented to our outdoor clinic with watery right nasal discharge for past 2 months, which increased on bending forward. Her medical history, general physical and neurological examinations were unremarkable. High-resolution computed tomographic scan and magnetic resonance cisternography were performed and suggestive of defect in right cribriform plate and right sphenoid sinus. Endoscopic repair was done but same symptoms occurred after 1 month. Repeat magnetic resonance imaging showed fistula in the lateral wall of right sphenoid sinus. Revision endoscopic transnasal CSF rhinorrhea repair was done. Lumbar subarachnoid drain was left in place for 5 days. No recurrence was noted at 12-week follow-up. Conclusion Endoscopic transnasal approach is the best modality of treatment for midline skull base defects. Delayed leaks can present from previously weak areas and all the doubtful areas must be examined during surgery. How to cite this article Mohindra S, Mohindra S, Joshi K, Sodhi HS. Delayed Spontaneous Cerebrospinal Leak through Clival Recess: Emphasis on Technique of Repair. Clin Rhinol An Int J 2017;10(1):42-44.

Cerebrospinal Fluid Rhinorrhea: The Place for Endoscopic Surgery

2010 ◽  
Vol 3 (1) ◽  
pp. 11-12
Author(s):  
Arvind Soni
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Surgery ◽  
Revision Surgery ◽  
Safe Procedure ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Transnasal Endoscopic Repair

Abstract Transnasal endoscopic repair of CSF rhinorrhea is an effective and safe procedure. A retrospective follow-up of nineteen patients who underwent transnasal endoscopic repair was done. A variety of graft materials and grafting techniques were used. None of the patients had any complications or required revision surgery.

scholarly journals Arachnoid Pit and Extensive Sinus Pnematization as the Cause of Spontaneous Lateral Intrasphenoidal Encephalocele

2012 ◽  
Vol 2 ◽  
pp. 1 ◽  
Author(s):  
Ali AlMontasheri ◽  
Bandar Al-Qahtani ◽  
Nader Aldajani
Keyword(s):  
Magnetic Resonance Imaging ◽  
Sphenoid Sinus ◽  
Rare Case ◽  
Cerebral Spinal Fluid ◽  
Bony Defect ◽  
Resonance Imaging ◽  
Lateral Aspect ◽  
Csf Rhinorrhea ◽  
Lateral Recess ◽  
Intrasphenoidal Encephalocele

Lateral sphenoid encephalocele, especially within the lateral aspect of the sphenoid sinus, when the sphenoid sinus has pneumatized extensively into the pterygoid recess, are considered exceedingly rare. We report a rare case of lateral intrasphenoidal encephalocele with spontaneous cerebral spinal fluid (CSF) rhinorrhea. Computed tomography demonstrated bilateral arachnoid pit, extensive sphenoid sinus pneumatization, and a defect in the superior wall of the left lateral recess of the sphenoid sinus. Magnetic resonance imaging demonstrated anteromedial temporal lobe herniating through the bony defect.

scholarly journals Transnasal Endoscopic Cerebrospinal Fluid Rhinorrhea Repair: Our Experience of 35 Cases

2014 ◽  
Vol 7 (2) ◽  
pp. 47-51 ◽  
Author(s):  
Mohnish Grover ◽  
Pawan Singhal ◽  
Shashank Nath Singh ◽  
Man Prakash Sharma ◽  
Avani Jain
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Endoscopic Techniques ◽  
The Past ◽  
Intracranial Complications ◽  
Csf Leaks

ABSTRACT Cerebrospinal fluid rhinorrhea results from a breakdown of barriers between the subarachnoid space and aerodigestive tract. Because of the risk of potential intracranial complications, all persistent cerebrospinal fluid (CSF) leaks should be repaired. Over the past few decades, with the advances in endoscopic techniques, the surgical management of CSF rhinorrhea has changed significantly. CSF leak repair has advanced from the conventional open intracranial approaches by neurosurgeons to the transnasal endoscopic ones by otorhinolaryngologists. In this study, 35 patients with CSF leaks underwent endoscopic repair with a 94.3% first attempt success rate, and 100% overall success rate. There were no major intraoperative or postoperative complications. To conclude, the endoscopic approach has a high success rate with minimal morbidity and has therefore, become the preferred method. How to cite this article Jain A, Singhal P, Sharma MP, Singh SN, Grover M. Transnasal Endoscopic Cerebrospinal Fluid Rhinorrhea Repair: Our Experience of 35 Cases. Clin Rhinol An Int J 2014;7(2):47-51.

scholarly journals Bilateral Choanal Atresia and Endoscopic Surgery: A Chance for CHARGE Patients

2021 ◽  
Vol 10 (13) ◽  
pp. 2951
Author(s):  
Maria Baldovin ◽  
Diego Cazzador ◽  
Claudia Zanotti ◽  
Giuliana Frasson ◽  
Athanasios Saratziotis ◽  
...  
Keyword(s):  
Congenital Malformation ◽  
Endoscopic Surgery ◽  
Granulation Tissue ◽  
Choanal Atresia ◽  
Tissue Formation ◽  
Endoscopic Repair ◽  
Granulation Tissue Formation ◽  
Charge Association ◽  
Cohort Data

Bilateral choanal atresia (CA) is a rare congenital malformation frequently associated with other anomalies. CHARGE association is closely linked to bilateral CA. The aim of this study was to describe the outcomes of the endoscopic repair in bilateral CA, and to assess the role of postoperative nasal stenting in two cohorts of CHARGE-associated and non-syndromic CA. Thirty-nine children were retrospectively analyzed (16 patients had CHARGE-associated CA). The rate of postoperative neochoanal restenosis was 31.3% in the CHARGE population, and 47.8% in the non-syndromic CA cohort. Data on postoperative synechiae and granulation tissue formation, need for endonasal toilette and dilation procedures, and number of procedures per patient were presented. Stent positioning led to a higher number of postoperative dilation procedures per patient in the non-syndromic cohort (p = 0.018), and to a higher rate of restenosis both in the CHARGE-associated, and non-syndromic CA populations. Children with CHARGE-associated and non-syndromic bilateral CA benefitted from endonasal endoscopic CA correction. The postoperative application of an endonasal stent should be carefully evaluated.

Extradural cartilage inlay graft in cerebrospinal fluid fistula repair

2010 ◽  
Vol 124 (12) ◽  
pp. 1294-1297 ◽  
Author(s):  
P Thulasi Das ◽  
D Balasubramanian
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Success Rate ◽  
Bony Defect ◽  
Cerebrospinal Fluid Fistula ◽  
Fistula Repair ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Skull Base Defects ◽  
Fluid Fistula

AbstractObjective:To present our experience in managing cerebrospinal fluid rhinorrhoea using the cartilage inlay (underlay) technique to repair skull base defects larger than 4 mm.Study design:Retrospective study involving patients presenting with cerebrospinal fluid rhinorrhoea between 1994 and 2008.Setting:Patients were treated in a tertiary referral centre for nose and sinus diseases. Patients' medical records were reviewed and analysed.Results:A total of 62 patients were operated upon using a cartilage inlay technique to repair bony skull base defects ranging in size from 4 to 20 mm (widest diameter). Of these 62 patients, 16 constituted revisions of earlier procedures undertaken elsewhere. The success rate of the technique was 100 per cent. Patient follow up ranged from six months to 16 years, with a median follow up of 15 months. Three patients had minor post-operative sinus infections; no serious complications were encountered.Conclusion:Extradural cartilage inlay appears to be an effective technique in the management of cerebrospinal fluid rhinorrhoea, especially for large defects and revision procedures. To our knowledge, the described patients represent the largest reported series of cerebrospinal fluid rhinorrhoea cases managed using the cartilage inlay technique. We believe that the crucial factors in our high success rate for cerebrospinal fluid fistula repair are: precise identification of the bony defect; meticulous preparation of the graft bed; careful elevation of the dura; judicious use of just enough graft tissue; and adequate graft support.

Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles

2012 ◽  
Vol 32 (6) ◽  
pp. E5 ◽  
Author(s):  
Richard F. Schmidt ◽  
Osamah J. Choudhry ◽  
Joseph Raviv ◽  
Soly Baredes ◽  
Roy R. Casiano ◽  
...  
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Skull Base Surgery ◽  
Surgical Anatomy ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Lateral Recess ◽  
Sternberg Canal ◽  
Deep Location ◽  
Repair Techniques

Lateral sphenoid encephaloceles of the Sternberg canal are rare entities and usually present with spontaneous CSF rhinorrhea. Traditionally, these were treated via transcranial approaches, which can be challenging given the deep location of these lesions. However, with advancements in endoscopic skull base surgery, including improved surgical exposures, angled endoscopes and instruments, and novel repair techniques, these encephaloceles can be resected and successfully repaired with purely endoscopic endonasal approaches. In this report, the authors review the endoscopic endonasal transpterygoid approach to the lateral recess of the sphenoid sinus for repair of temporal lobe encephaloceles, including an overview of the surgical anatomy from an endoscopic perspective, and describe the technical operative nuances and surgical pearls for these cases. The authors also present 4 new cases of lateral sphenoid recess encephaloceles that were successfully treated using this approach.

Sphenoid sinus mucocele: 10 cases and literature review

2009 ◽  
Vol 124 (1) ◽  
pp. 44-47 ◽  
Author(s):  
S R Soon ◽  
C M Lim ◽  
H Singh ◽  
D S Sethi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Endoscopic Sinus Surgery ◽  
Sphenoid Sinus ◽  
Sinus Surgery ◽  
Nasal Discharge ◽  
Resonance Imaging ◽  
Presenting Symptoms ◽  
Singapore General Hospital

AbstractIntroduction:Sphenoid sinus mucoceles represent only 1–2 per cent of all paranasal sinus mucoceles. Patients may present with a myriad of symptoms. Pre-operative investigations include nasoendoscopy, computed tomography and/or magnetic resonance imaging. Treatment is by endoscopic sinus surgery.Methodology:A retrospective review of the archives of the Singapore General Hospital otolaryngology department (1999–2006) identified 10 cases of sphenoid sinus mucocele. Patient demographics, presenting symptoms, investigations and treatment were evaluated.Results:The 10 patients identified (three women and seven men) had a mean age of 54.5 years (range 24–70 years). Thirty per cent of patients had a history of nasopharyngeal carcinoma treated with radiotherapy. Presenting symptoms, in order of decreasing frequency, were: ocular symptoms (50 per cent), headaches (30 per cent), nasal discharge (30 per cent) and facial pain (10 per cent). All patients underwent pre-operative computed tomography or magnetic resonance imaging. Twenty per cent of patients had evidence of intracranial involvement on imaging. All patients underwent uncomplicated transnasal sphenoidotomy and drainage of the mucocele. There was no clinical or radiological evidence of recurrence at a mean follow up of 29 months (range 4–90 months).Conclusion:Sphenoid sinus mucocele is a rare condition. In this study, radiation to the head and neck appeared to be a predisposing factor, and eye symptoms were the commonest presentation. Endoscopic sinus surgery is a safe and effective treatment modality.

Sign in / Sign up

Export Citation Format

Share Document