scholarly journals Frontal Meningoencephalocele: Changing Trends

2014 ◽  
Vol 7 (3) ◽  
pp. 125-129
Author(s):  
Sourabha K Patro ◽  
Varun Nabh
Keyword(s):  
Skull Base ◽  
Frontal Sinus ◽  
Endoscopic Approach ◽  
Endoscopic Repair ◽  
Changing Trends ◽  
Post Traumatic ◽  
Skull Base Defects

ABSTRACT Frontal sinus defects involving the posterior table has always been challenging for the otolaryngologists. It traditionally involved open approaches like osteoplastic approach for the repair of defects or fractures involving the posterior table of frontal sinus. Better instrumentation, technique, and experience have increased the feasibility of endoscopic repair of frontal sinus skull-base defects. With the increased possibilities of endoscopic approach and instrumentation for the frontal sinus, an endoscopic repair of a posterior table defect with a meningoencephalocele in a long standing post-traumatic case has been described. How to cite this article Gupta AK, Patro SK, Nabh V. Frontal Meningoencephalocele: Changing Trends. Clin Rhinol An Int J 2014;7(3):125-129.

Endoscopic Repair of Expanded Endonasal Skull Base Defects Using a Stable Bilayer “Button” Closure

Skull Base ◽  
2009 ◽  
Vol 19 (03) ◽  
Author(s):  
Adam Luginbuhl ◽  
James Evans ◽  
Zachary Louderback ◽  
Jared Goldfarb ◽  
Marc Rosen
Keyword(s):  
Skull Base ◽  
Endoscopic Repair ◽  
Skull Base Defects

Differentiated approach to plastic surgery of cerebrospinal fluid fistulas in the frontal sinus based on the analysis of computed tomograms

2021 ◽  
pp. 182 (244)-194 (253)
Author(s):  
Elizaveta Vladimirovna Shelesko ◽  
Nadezhda Alekseevna Chernikova ◽  
Y. V. Strunina ◽  
S. D. Nikonova ◽  
Arslan Khanbagamaevich Abdulgamidov Arslan Khanbagamaevich Abdulgamidov ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Plastic Surgery ◽  
Frontal Sinus ◽  
Nasal Septum ◽  
Anatomical Variations ◽  
Endoscopic Approach ◽  
Surgical Tactics ◽  
Skull Base Defects ◽  
Base Of The Skull

The choice of the method of plasty of cerebrospinal fluid fistulas in the area of the frontal sinus is an important issue in neurosurgery, since there are a large number of anatomical variations in the structure of the naso-frontal canal and the sinus itself. Endoscopic, combined and transcranial approaches are described in the literature. However, there is no clear algorithm for choosing a surgical approach for nasal liquorrhea based on anatomical features. The objective of this article is to study various anatomical variants of the structure of the frontal sinus and nasolabial pocket in relation to defects of the base of the skull of a given localization and, based on the data obtained, to establish the patterns of the influence of certain indicators on surgical tactics and the quality of plastic to complement the proposed classification. This article include a retrospective analysis of case histories and computed tomograms of 38 patients who underwent surgical treatment for skull base defects in the frontal sinus region from 2010 to 2020. The patients were divided into three groups depending on the approach used, the features of intraoperative visualization of the defect, and relapses. In a series of 38 cases, the endoscopic approach was used in 26 (68.4 %) cases, combined in 12 (31.6 %) cases. The defect was completely visualized using angled optics during surgery in 32 (84.2 %) cases, and in 6 (15.8 %) cases the defect was not visualized or partially visualized (up to 50 %) using angled optics. Relapses were observed in 6 (15.8 %) cases. The main craniometric indicators affecting the choice of surgical tactics and the quality of plastics are the distance from the center of the defect to the nasal septum, the value of the angle between the nasal septum and the line drawn through the edges of the defect, and the size of the defect. The recurrence rate is directly related to the visualization of the defect during surgery. The distance from the defect to the nasal septum can serve as an objective indicator for choosing access to intermediate defects of the frontal sinus: at a distance of more than 0.95 cm, it is advisable to perform a combined approach; at a distance of less than 0.95 cm, it is possible to achieve full visualization of the defect and perform high-quality plastic surgery with an endoscopic approach. English version of the article on pp. 244-253 is available at URL: https://panor.ru/articles/differentiated-approach-in-frontal-sinus-csf-fistula-plasty-based-on-computed-tomogram-analysis/63924.html

Endoscopic Repair of Anterior Skull Base Defects

2010 ◽  
pp. 281-285
Author(s):  
Manuel Bernal-Sprekelsen ◽  
Isam Alobid ◽  
Joaquim Mullol ◽  
Alfonso Garcia-Piñero
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Endoscopic Repair ◽  
Skull Base Defects

scholarly journals A retrospective study to analyze treatment of post traumatic cerebro spinal fluid rhinorrhea and role of trans cranial pedicled pericranial repair in present day context

2022 ◽  
Vol 7 (4) ◽  
pp. 111-118
Author(s):  
Shashivadhanan ◽  
Abhishek Mishra
Keyword(s):  
Retrospective Study ◽  
Skull Base ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Spinal Fluid ◽  
Csf Leak ◽  
Care Hospital ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Post Traumatic

: Skull base fractures are a major cause of morbidity and mortality in head injury. Anterior cranial Fossa (ACF) skull base fracture, leading to Cerebro Spinal Fluid (CSF) Rhinorrhea is one of the most commonly encountered presentation in ACF base fractures. The key to successful management of such cases lies in early diagnosis and surgical management before it leads to meningitis and avoidable mortality.To evaluate the cases of post traumatic CSF rhinorrhea and analyze the parameters utilized to guide the management strategies. An attempt was made to come up with guidelines for its management in a tertiary care hospital.This was a retrospective study in which all cases of traumatic CSF Rhinorrhea admitted to Tertiary care hospital were included. Patients were divided into three groups. First group was conservatively managed in which the rhinorrhea and serial imaging findings showed favourable response.In thesecond group patients were subjected to endoscopic repair by the ENT surgeon based on anatomical considerations. The third group included patients who were had failed the trial of conservative management and the site of leak did not favor endoscopic repair.The outcomes in all these groups were analyzed and conclusions drawn.A total of 54 patients were included in the study which was conducted between Jan 2014 to 2020. 24 were successfully managed conservatively,10 were managed with endoscopic repair and 20 were managed by bifrontal craniotomy and pedicled pericranial ACF Base repair. There was one case from the first group who developed CSF leak after one month necessitating ACF base repair. There was no recurrence reportedin the cases managed endoscopically, whereas one case subjected to craniotomy had recurrence requiring lumbar drain placement. With each transcranial surgery there was a refinement in the technique further minimizing complications. We have elaborated on the surgical nuances to ensurebetter outcomes. : Pedicledpericranial flap ACF base repair is an elegant approach which requires an understanding of the mechanism of CSF leak from skull base fractures. This procedure can easily be mastered and when performed correctly provides best results for cases where there are multiple ACF defects, those not accessible by endoscope and also in those cases where imaging is not able to localize the exact site of defect leading to CSF rhinorrhea. Anosmia is an in evitable complication of this procedure. However, the trade off between mortality resulting from meningitis versus anosmia makes it a viable and attractive treatment option.

Endonasal Endoscopic Management of Frontal Sinus Cerebrospinal Fluid Leak

2017 ◽  
Vol 31 (6) ◽  
pp. 406-411 ◽  
Author(s):  
Javaneh Jahanshahi ◽  
Mehdi Zeinalizadeh ◽  
Hasan Reza Mohammadi ◽  
Seyed Mousa Sadrehosseini
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Frontal Sinus ◽  
Surgical Approaches ◽  
Endoscopic Management ◽  
Graft Material ◽  
Endoscopic Repair ◽  
Skull Base Reconstruction ◽  
Csf Rhinorrhea

Background A frontal sinus leak is uncommon and is seen in ∼15% of cases of patients with cerebrospinal fluid (CSF) rhinorrhea. Now, endonasal endoscopic techniques have been reported to reconstruct skull base defects in the frontal sinus with a favorable outcome. Objective To review our experience in the repair of frontal sinus CSF leaks through an endonasal endoscopic approach. Methods Twenty-four patients with a frontal sinus leak who underwent endonasal endoscopic repair entered the study. Clinical presentation, location, frontal sinusotomy, graft material, follow-up, and frontal sinus status were evaluated. Results Among >100 cases of surgically repaired CST rhinorrhea, the frontal sinus was the site of the leak in 24 patients (mean age, 28.9 years; mean follow-up, 22 months). The etiology consisted of spontaneous leak and traumatic leak; whereas patients with skull base reconstruction after removal of tumor were excluded. Surgical approaches included Draf IIb, Draf III, Draf IIa in 20, 3, and 1 patients, respectively. Tree autografts as two-layer inlay fat–muscle and onlay fascia lata were used in the majority of patients. A success rate was achieved in 95.83% of the patients. Conclusion Endonasal endoscopic repair of a frontal sinus leak was a successful procedure, with a low failure rate and minimal morbidity.

scholarly journals Outcome of Endoscopic Repair of CSF Rhinorrhea with Endonasal Endoscopic Approach in terms of Success of Repair.

2019 ◽  
Vol 23 (4) ◽  
Author(s):  
Muhammad Ishfaq ◽  
Talha Abbas ◽  
Muhammad Akmal ◽  
Nabeel Choudhry ◽  
Adeeb Ul Hassan ◽  
...  
Keyword(s):  
Age Groups ◽  
Case Series ◽  
Endoscopic Approach ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Female Patients ◽  
Significant Difference ◽  
Post Traumatic ◽  
Gender Groups ◽  
Successful Repair

Objective: This descriptive case series conducted to evaluate the outcome of CSF rhinorrhea repair with the Endonasal Endoscopic approach in terms of success of the repair.Materials and Methods: The study was conducted at Neurosurgery department, Unit II, Punjab institute of neurosciences, Lahore. This study involved 40 patients aged between 3-80 years of both genders diagnosed of CSF rhinorrhea with presented with in 1 week after trauma and spontaneous and postoperative cases.Results: The age of the patients ranged from 5 years to 53 years with a mean of 22.75 ± 15.59 years. Total 30 (75%) male and 10 (25%) female patients are included in the study. The underlying etiology was found to be post-traumatic (67.5%) 27 cases, followed by post-operative in 7 (17.5%) and spontaneous in 6 (15.0%) cases. Successful repair was observed in 36 (90.0%). No significant difference was found in the frequency of successful repair among various age groups; 5-20, 21-36 and 37-53 years (95.7%, 83.3% and 81.8%; p = 0.381), gender groups; male verses female (86.2% and 100.0%; p = 0.194) and etiological groups; post-traumatic vs. post-operative vs. spontaneous (92.6% vs. 71.4% vs. 100.0%; p = 0.169).Conclusions: The frequency of successful repair was found to be 90% in patients of CSF rhinorrhea treated through Endonasal endoscopic approach. No statistically significant difference was found in successful repair frequency across patient’s gender, age and underlying cause of CSF rhinorrhea.

Endoscopic repair of spontaneous skull base defects decreases the incidence rate of intracranial complications

2019 ◽  
Vol 9 (10) ◽  
pp. 1089-1096 ◽  
Author(s):  
Jordan J. Allensworth ◽  
Nicholas R. Rowan ◽  
Kristina A. Storck ◽  
Bradford A. Woodworth ◽  
Rodney J. Schlosser
Keyword(s):  
Skull Base ◽  
Incidence Rate ◽  
Endoscopic Repair ◽  
Intracranial Complications ◽  
Skull Base Defects

Endoscopic Repair of Large Skull Base Defects after Powered Sinus Surgery

2003 ◽  
Vol 129 (3) ◽  
pp. 204-209 ◽  
Author(s):  
Christopher A. Church ◽  
Alexander G. Chiu ◽  
Winston C. Vaughan
Keyword(s):  
Skull Base ◽  
Sinus Surgery ◽  
Intracranial Injury ◽  
Endoscopic Repair ◽  
Endoscopic Techniques ◽  
Tissue Removal ◽  
Cerebrospinal Fluid Leaks ◽  
Pathology Reports ◽  
Skull Base Defects

OBJECTIVES: To evaluate the management of patients with large skull base defects (> 2 cm) and intracranial injury caused by powered endoscopic sinus surgery. STUDY DESIGN AND SETTING: All patients treated for postendoscopic sinus surgery skull base injury over a 4-year period were reviewed. RESULTS: Three patients with skull base defects greater than 2 cm in size and associated intracranial injury from powered ESS were identified. All patients presented with active cerebrospinal fluid leaks. CT scans showed intracranial injury and pathology reports revealed brain tissue removal. Using image-guided endoscopic techniques, all defects were addressed with multilayer repair. Closure was achieved in all patients on the first attempt, with an average follow-up of 27 months. CONCLUSIONS: The use of powered instrumentation along the skull base can be dangerous and can result in extensive skull base defects with associated loss of dura and gray matter. Large ethmoid roof defects and significant intracranial injury, however, are not absolute contraindications to endoscopic repair.

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