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Xu R, So RJ, Materi J, Nair SK, Alomari SO, Huang J, Lim M, Bettegowda C. Factors Predicting Cerebrospinal Fluid Leaks in Microvascular Decompressions: A Case Series of 1011 Patients. Oper Neurosurg (Hagerstown) 2023; 24:262-267. [PMID: 36656065 DOI: 10.1227/ons.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/07/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Microvascular decompression (MVD) using a retrosigmoid approach is a highly effective, open-surgical procedure for neurovascular conflict in the posterior fossa, although there is a risk of postoperative cerebrospinal fluid (CSF) leak. OBJECTIVE To identify factors associated with postoperative CSF leakage after MVD. METHODS We retrospectively reviewed all patients who underwent MVDs at our institution from 2007 to 2020. Patient demographics, clinical diagnoses, and procedural characteristics were recorded and compared. Factors leading to CSF leak were analyzed using χ 2 , univariate, and multivariate regression. RESULTS Of 1011 patients who underwent MVDs, 37 (3.7%) presented with postoperative CSF leaks. In univariate analysis, the use of Cranios/Norian to obliterate the air cells was protective against CSF leak ( P = .01). Craniotomies ( P = .002), the use of dural substitutes such as Durepair ( P = .04), dural onlays such as DuraGen ( P = .04), muscle/fascia ( P = .03), and titanium mesh cranioplasty >5 cm ( P = .03) were associated with CSF leak. On multivariate analysis, only the presence of craniotomies ( P = .04) and nonprimary dural closure ( P = .03) were significant risk factors for CSF leak. When excluding the 34 (3.4%) patients who underwent a craniotomy, the lack of primary dural closure still remained significantly associated with postoperative CSF leak ( P = .04). CONCLUSION Our results represent one of the largest series of posterior fossa surgeries for a uniform indication in North America. Our study demonstrates increased risk for postoperative CSF leak when craniotomies are performed and when primary dural closure is not established. Given the small sample of patients who received a craniotomy, however, future studies corroborating this finding should be performed.
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Affiliation(s)
- Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raymond J So
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua Materi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Safwan O Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Martinez-Perez R, Kunigelis KE, Ward RC, Ung TH, Arnone GD, Cass SP, Gubbels SP, Youssef AS. Hydroxyapatite cement cranioplasty for reconstruction of translabyrinthine approach: aesthetic results, long-term satisfaction, quality of life, and complications. Acta Neurochir (Wien) 2022; 164:669-677. [PMID: 34642820 DOI: 10.1007/s00701-021-05024-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/02/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Translabyrinthine approaches (TLAs) for resection of skull base neoplasms are complex with variable reconstruction techniques. Fat grafts in conjunction with hydroxyapatite bone cement techniques have seldom been described in terms of possible superiority to other skull base reconstruction techniques. We sought to determine the impact of this skull base reconstruction technique on clinical outcomes and patient's satisfaction. METHOD We performed a retrospective analysis of all patients who underwent translabyrinthine approaches for resection of CPA lesions over a 5-year period. Both post-op objective and subjective markers of reconstruction, as well as postoperative complications, were collected and analyzed. RESULTS Sixty-nine patients were included, 34 underwent reconstruction with hydroxyapatite and fat (rHAC) and 35 with fat alone (rF). rHAC was associated with fewer cranial wound superficial infection/dehiscence (0% vs 14.3%; p = 0.029) and shorter length of stay (mean ± standard deviation) (6.9 ± 7.4 vs 4.4 ± 3.7 days, p = 0.008). Postoperative subjective characterization of rHAC demonstrated improved satisfaction scores (1.38 ± 0.5 vs 1.83 ± 1; p = 0.049) and fewer reports of post-operative irregularities (11.5% vs 37.5%; p = 0.017). CONCLUSION The use of hydroxyapatite for cranial reconstruction after translabyrinthine approaches has improved patient satisfaction and decreased cranial defects in our small series. Postoperative complications are consistent with other described methods, but with shorter hospital stay, decreased risk of superficial wound dehiscence/infection, and a perceived superiority in preventing percutaneous post-op CSF leaks.
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Sharma M, Aljuboori Z, Dietz N, Wang D, Ugiliweneza B, Williams B, Andaluz N. Incidence and Long-Term Health Care Utilization Associated With Pseudomeningocele Repair Following Vestibular Schwannoma Resection: A National Database Analysis. Cureus 2022; 14:e21248. [PMID: 35186536 PMCID: PMC8844231 DOI: 10.7759/cureus.21248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction To compare the healthcare utilization in patients who presented with no pseudomeningocele (PSM) following vestibular schwannoma (VS) surgery (nd-PSM), PSM following VS surgery and required surgical repair (s-PSM) and those who presented with PSM and did not require surgical repair (ns-PSM). Methods MarketScan database was queried using the International Classification of Diseases, ninth and tenth revisions, and current procedural terminology four, from 2000 to 2018. We included patients ≥18 years of age with a PSM diagnosis with at least two years of continuous enrollment. The hospital admissions, outpatient services, medication refills, and associated payments were analyzed. Results Of 1,460 patients, 96.6% (n=1,411) had no PSM following surgery for VS, 2.4% (n=35) were in s-PSM and only 0.95% (n=14) were in ns-PSM cohorts. Patients in the s-PSM cohort incurred higher hospital readmission rate, outpatient payments compared to those in the nd-PSM and ns-PSM cohorts at six months, one-year, and two-years following the following VS resection. At one-year following VS resection, the median combined payments for the s-PSM cohort were $74,683 compared to $42,664 for the ns-PSM and $9,476 for the nd-PSM cohort, p<0.0001. Similarly, at two-years, median combined payments for s-PSM cohort were $83,351 compared to $63,942 for ns-PSM and $18,839 for the nd-PSM cohort, p<0.0001. Conclusion Patients in the s-PSM cohort incurred eight times and 4.4 times the combined payments at one- and two-years, respectively, compared to the nd-PSM cohort. Also, patients in the ns-PSM cohort incurred 4.5 times and 3.4 times the payments compared to the nd-PSM cohort.
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Cerebrospinal Fluid Leak Following Translabyrinthine Vestibular Schwannoma Surgery-Is Mesh Cranioplasty Necessary for Prevention? Otol Neurotol 2021; 42:e593-e597. [PMID: 33443978 DOI: 10.1097/mao.0000000000003038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate the incidence of cerebrospinal fluid leak following vestibular schwannoma surgery for mesh cranioplasty closure versus periosteal closure in the translabyrinthine approach. Determine nonsurgical variables associated with higher rates of cerebrospinal fluid leak following vestibular schwannoma surgery. STUDY DESIGN Retrospective chart review. SETTING Tertiary academic referral center. PATIENTS One hundred thirty-two patients with adequate documentation who underwent sporadic vestibular schwannoma resection via a translabyrinthine approach between 2000 and 2019. INTERVENTION Translabyrinthine excision of vestibular schwannoma with mesh cranioplasty closure or watertight periosteal closure. MAIN OUTCOME MEASURES Primary outcome measures included the incidence of postoperative cerebrospinal fluid leak, total length of hospital stay (including the initial hospital stay as well as hospital days during any readmission within 30 days), and total operative time. RESULTS Our overall cerebrospinal fluid leak rate was 9.1% with a leak rate of 12.8% in our translabyrinthine titanium mesh closure group and 0% in our translabyrinthine periosteal closure. There was no statistically significant effect of age, body mass index, or size of tumor on the incidence of cerebrospinal fluid leak. There was also no statistically significantly difference between the two groups on length of operative time or number of days spent in the intensive care unit. CONCLUSION Mesh cranioplasty is not a prerequisite for achieving a low cerebrospinal fluid leak rate following translabyrinthine approach for vestibular schwannoma resection. In our series, a significantly lower cerebrospinal fluid leak rate was demonstrated with the periosteal closure.
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Yang HA, Sun SC, Zheng XR, Ding F, Bie YF. Effect of subdural muscle packing in repairing dura mater after retrosigmoid craniotomy. J Int Med Res 2021; 48:300060520910299. [PMID: 32223659 PMCID: PMC7132562 DOI: 10.1177/0300060520910299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study was performed to evaluate a new type of autologous muscle
tamponade to repair dura mater that has undergone dural defects to prevent
cerebrospinal fluid leakage or subcutaneous fluid accumulation. Methods Three hundred thirty-two patients who underwent retrosigmoid craniotomy were
selected and divided into two groups: bone window craniotomy and bone flap
craniotomy. Each group was further divided into two groups: artificial dura
repair and autologous muscle repair. We then analysed the incidence of
postoperative cerebrospinal fluid leakage or subcutaneous fluid accumulation
and compared the effects of the two repair methods. Results For all patients, autologous muscle repair of the dura mater had a lower
incidence of cerebrospinal fluid leakage than artificial dura mater repair,
especially in patients with craniotomy. Conclusions Subdural craniotomy of the bone window is more effective than conventional
methods in preventing cerebrospinal fluid leakage.
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Affiliation(s)
- Hong-An Yang
- Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Shi-Cheng Sun
- Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiang-Rong Zheng
- Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Feng Ding
- Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yi-Fan Bie
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
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Gelfand Y, Longo M, Berezin N, Nakhla JP, De la Garza-Ramos R, Agarwal V. Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma. J Neurol Surg B Skull Base 2020; 81:546-552. [PMID: 33134021 DOI: 10.1055/s-0039-1692478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction We analyzed perioperative risk factors for morbidity and mortality for the patients undergoing surgical intervention for vestibular schwannoma along with rates of cerebrospinal fluid (CSF) leaks that required surgery. Materials and Methods Patients undergoing surgery vestibular schwannoma were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016 using current procedural terminology (CPT) codes for posterior fossa surgical approaches and International Classification of Diseases 9th revision (ICD 9) and ICD 10 codes for peripheral nerve sheath tumor. Preoperative laboratories, comorbidities, and operative times were analyzed along with CSF leaks and unplanned returns to the operating room. Results Nine-hundred ninety-three patients fit the inclusion criteria. Average age was 51, 41% were male, and 58% were female. Mortality within 30 days of the operation was very low at 0.4%, complications were 7% with infection being the most common at 2.3%, and unplanned reoperations happened in 7.4% of the cases. Dependent functional status (odds ratio [OR]: 5.7, 95% confidence interval [CI]: 1.9-16.6, p = 0.001), preoperative anemia (OR: 2.4, 95% CI: 1.2-4.5, p = 0.009), and operative time over 8 hours (OR: 1.9, 95% CI: 1.1-3.4, p = 0.017) were the only significant predictors of perioperative complications. CSF leak postoperatively occurred in 37 patients (3.7%). Reoperation for CSF leak was necessary in 56.3% of the cases. Operative time over 8 hours was the only independent significant predictor of postoperative CSF leak (OR: 2.2, 95% CI: 1.1-4.3, p = 0.028). Conclusion Dependent functional status preoperatively, preoperative anemia, and duration of surgery over 8 hours are the greatest predictors of complications in the 30-day postoperative period.
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Affiliation(s)
- Yaroslav Gelfand
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Ce/Snter/Albert Einstein College of Medicine, Bronx, New York, Unites States
| | - Michael Longo
- Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, United States
| | - Naomi Berezin
- Department of Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Jonathan P Nakhla
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, United States
| | - Rafael De la Garza-Ramos
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Ce/Snter/Albert Einstein College of Medicine, Bronx, New York, Unites States
| | - Vijay Agarwal
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Ce/Snter/Albert Einstein College of Medicine, Bronx, New York, Unites States
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Zhang H, Xuan J, Chen TH, Chen ZX, Sun LJ, Tian NF, Zhang XL, Wang XY, Lin Y, Wu YS. Projection of the Most Anterior Line of the Spinal Canal on Lateral Radiograph: An Anatomic Study for Percutaneous Kyphoplasty and Percutaneous Vertebroplasty. J INVEST SURG 2018; 33:134-140. [PMID: 29883213 DOI: 10.1080/08941939.2018.1480676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACTPurpose: To measure the projection of the most anterior line of the spinal canal on lateral radiographs of the vertebra (C3-L5) and evaluate the efficacy of the safety line (SL) in preventing intraspinal cement leakage in percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Materials and Methods: Fifteen adult dry-bone spine specimens were analyzed. The projection of the SL was viewed on lateral radiographs. The distance between the SL and the posterior vertebral body line (PVBL) was measured. Two groups of patients were treated by PKP, and cement injection was stopped either before the PBVL (group 1) or before the SL (group 2) under lateral fluoroscopy. The rate of cement leakage was compared between the two groups. Results: The largest distance between the SL and PVBL was at L1 (5.22 ± 0.62 mm). From L1 to L5, the distance decreased progressively to 1.05 ± 0.64 mm. Similar variation was also observed from L1 to T1 (0.19 ± 0.18 mm). The postoperative computed tomography scan was more sensitive and accurate in detecting intraspinal leakage than radiography in group 1 (p = 0.000); however, there was no significant difference in sensitivity or accuracy between methods in group 2 (p = 0.063). The rate of intraspinal cement leakage was significantly higher in group 1 than group 2 (p = 0.000). Conclusions: The operator should frequently check to ensure that cement injection has stopped upon reaching the SL. Surgeons may benefit from this quantitative anatomical study of PKP and PVP.
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Affiliation(s)
- Hui Zhang
- Department of Orthopaedic surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jun Xuan
- Department of Orthopaedic surgery, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, China
| | - Tian-He Chen
- The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Ze-Xin Chen
- Department of Orthopaedic surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liao-Jun Sun
- Department of Orthopaedic surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nai-Feng Tian
- Department of Orthopaedic surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao-Lei Zhang
- Department of Orthopaedic surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang-Yang Wang
- Department of Orthopaedic surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan Lin
- Department of Orthopaedic surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yao-Sen Wu
- Department of Orthopaedic surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Lucke-Wold B, Brown EC, Cetas JS, Dogan A, Gupta S, Hullar TE, Smith TL, Ciporen JN. Minimally invasive endoscopic repair of refractory lateral skull base cerebrospinal fluid rhinorrhea: case report and review of the literature. Neurosurg Focus 2018; 44:E8. [PMID: 29490552 DOI: 10.3171/2017.12.focus17664] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cerebrospinal fluid (CSF) leaks occur in approximately 10% of patients undergoing a translabyrinthine, retrosigmoid, or middle fossa approach for vestibular schwannoma resection. Cerebrospinal fluid rhinorrhea also results from trauma, neoplasms, and congenital defects. A high degree of difficulty in repair sometimes requires repetitive microsurgical revisions-a rate of 10% of cases is often cited. This can not only lead to morbidity but is also costly and burdensome to the health care system. In this case-based theoretical analysis, the authors summarize the literature regarding endoscopic endonasal techniques to obliterate the eustachian tube (ET) as well as compare endoscopic endonasal versus open approaches for repair. Given the results of their analysis, they recommend endoscopic endonasal ET obliteration (EEETO) as a first- or second-line technique for the repair of CSF rhinorrhea from a lateral skull base source refractory to spontaneous healing and CSF diversion. They present a case in which EEETO resolved refractory CSF rhinorrhea over a 10-month follow-up after CSF diversions, wound reexploration, revised packing of the ET via a lateral microscopic translabyrinthine approach, and the use of a vascularized flap had failed. They further summarize the literature regarding studies that describe various iterations of EEETO. By its minimally invasive nature, EEETO imposes less morbidity as well as less risk to the patient. It can be readily implemented into algorithms once CSF diversion (for example, lumbar drain) has failed, prior to considering open surgery for repair. Additional studies are warranted to further demonstrate the outcome and cost-saving benefits of EEETO as the data until now have been largely empirical yet very hopeful. The summaries and technical notes described in this paper may serve as a resource for those skull base teams faced with similar challenging and otherwise refractory CSF leaks from a lateral skull base source.
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Affiliation(s)
- Brandon Lucke-Wold
- 1School of Medicine, West Virginia University, Morgantown, West Virginia; and
| | | | | | | | - Sachin Gupta
- 3Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
| | - Timothy E Hullar
- 3Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
| | - Timothy L Smith
- 3Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
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Cost Analysis of Cerebrospinal Fluid Leaks and Cerebrospinal Fluid Leak Prevention in Patients Undergoing Cerebellopontine Angle Surgery. Otol Neurotol 2017; 38:147-151. [PMID: 27779560 DOI: 10.1097/mao.0000000000001252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine if cranioplasty techniques following translabyrinthine approaches to the cerebellopontine angle are cost-effective. STUDY DESIGN Retrospective case series. PATIENTS One hundred eighty patients with available financial data who underwent translabyrinthine approaches at a single academic referral center between 2005 and 2015. INTERVENTION Cranioplasty with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws Main Outcome Measures: billing data was obtained for each patient's hospital course for translabyrinthine approaches and postoperative cerebrospinal fluid (CSF) leaks. RESULTS One hundred nineteen patients underwent translabyrinthine approaches with an abdominal fat graft closure, with a median cost of $25759.89 (range, $15885.65-$136433.07). Sixty-one patients underwent translabyrinthine approaches with a dural substitute, abdominal fat graft, and a resorbable mesh for closure, with a median cost of $29314.97 (range, $17674.28-$111404.55). The median cost of a CSF leak was $50401.25 (range, $0-$384761.71). The additional cost of a CSF leak when shared by all patients who underwent translabyrinthine approaches is $6048.15. The addition of a dural substitute and a resorbable mesh plate after translabyrinthine approaches reduced the CSF leak from 12 to 1.9%, an 84.2% reduction, and a median savings per patient of $2932.23. Applying our cohort's billing data to previously published cranioplasty techniques, costs, and leak rate improvements after translabyrinthine approaches, all techniques were found to be cost-effective. CONCLUSION Resorbable mesh cranioplasty is cost-effective at reducing CSF leaks after translabyrinthine approaches. Per our billing data and achieving the same CSF leak rate, cranioplasty costs exceeding $5090.53 are not cost-effective.
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Aldahak N, Dupre D, Ragaee M, Froelich S, Wilberger J, Aziz KM. Hydroxyapatite bone cement application for the reconstruction of retrosigmoid craniectomy in the treatment of cranial nerves disorders. Surg Neurol Int 2017; 8:115. [PMID: 28680734 PMCID: PMC5482167 DOI: 10.4103/sni.sni_29_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 04/07/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Retromastoid craniectomy (RSC) is a cardinal surgical approach used to access the posterior fossa. Hydroxyapetite bone cement (HBC) is frequently employed for cranioplasty in efforts to prevent cerebrospinal fluid (CSF) leak, whilst maintaining low complication rates and good cosmetic satisfaction. The authors aim to determine the safety and effectiveness of HBC for reconstruction RSC used for treatment of various cranial nerves disorders. METHODS The authors conducted a retrospective one-center two surgeons review of 113 patients who underwent RSC filled with HBC for the treatment of cranial nerve disorders. The study period extended from January 2011 through April 2016. Charts were reviewed for documentation of descriptors pertinent to the endpoints described above. Revisions and reoperations were excluded from analysis. RESULTS Ninety-three patients met the inclusion criteria; there was one case of postoperative pseudomeningocele, which was considered as CSF leak (1%), 3 (3,2%) superficial infections, and no deep infections. Cosmetic satisfaction was obtained in all but one case (98.9% satisfaction) and long-term incisional pain was problematic in 1 (1.1%) patient. Other complications (serous drainage, headache, ear pain) accounted for three cases (3.2%). CONCLUSIONS The application of HBC in the reconstruction of RSC for the treatment of cranial nerves disorders is an effective method, yielding good cosmetic results whilst eliminating CSF leak. Additionally, it is safe due to the lack of deep-seated wound infections with low incidence of chronic incisional pain.
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Affiliation(s)
- Nouman Aldahak
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.,Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris VII-Diderot, Paris, France
| | - Derrick Dupre
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Mohamed Ragaee
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Sebastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris VII-Diderot, Paris, France
| | - Jack Wilberger
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Khaled M Aziz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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11
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Wong RH, Agazzi S, van Loveren H. "Inverted Gull Wing" Dural Closure and Middle Fossa Floor Reconstruction After Transzygomatic Infratemporal Fossa Approach. World Neurosurg 2016; 89:280-4. [PMID: 26875654 DOI: 10.1016/j.wneu.2016.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ineffective closure of complex skull base approaches leads to wound complications and cerebrospinal fluid (CSF) leak. This can result in protracted hospital stays, additional procedures, delayed postoperative recovery, and increased cost of care. Removal of large middle fossa-infratemporal fossa tumors are particularly problematic as they result in a large dead space with gravity-facilitated CSF leakage into the cavity. In this report we describe the use of a novel technique, the "inverted gull wing" titanium mesh reconstruction. METHODS Attempts to address this problem have focused primarily on closure and the use of myocutaneous flaps. Patients who have had multiple prior treatments are often afflicted with significant tissue attenuation that preclude dural closure or the use of local flaps. Although vascularized free flaps are an effective option in this scenario, they can add significant operative time and often yield suboptimal cosmetic results. We describe the use of the inverted gull wing titanium mesh reconstruction in the closure of 2 patients who underwent complex transzygomatic infratemporal fossa approaches for tumor with dural and sinonasal transgression. RESULTS Postoperatively, there were no pseudomeningoceles, CSF leaks, or technique-related morbidities. CONCLUSIONS The inverted gull wing technique represents a simple, fast, and effective closure for complex transzygomatic infratemporal fossa approaches.
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Affiliation(s)
- Ricky H Wong
- Department of Neurosurgery, NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, Illinois, USA.
| | - Siviero Agazzi
- Department of Neurosurgery, NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Harry van Loveren
- Department of Neurosurgery, NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, Illinois, USA
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12
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Yang H, Tantai J, Zhao H. Clinical experience with titanium mesh in reconstruction of massive chest wall defects following oncological resection. J Thorac Dis 2015; 7:1227-34. [PMID: 26380739 DOI: 10.3978/j.issn.2072-1439.2015.05.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/06/2015] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To present our experience of reconstructing wide defects with porously titanium mesh after radical resection of malignant chest wall tumors. METHODS A retrospective review of surgical reconstruction for large chest wall resections with titanium mesh was conducted from January 2009 to August 2014 in Shanghai Chest Hospital. RESULTS A total of 27 patients underwent major chest wall reconstructions with titanium mesh, following oncological resections. Chest wall sarcomas were the most frequent (63.0%). The mean tumor size was 72.4 (range, 36-140) cm(2). The average size of the applied porously titanium mesh was 140.9 (range, 80-225) cm(2). Mean postoperative length of stay was 7.1 (range, 4-14) days. There were no perioperative mortalities. Four (14.8%) patients experienced treatable complications. All had a resection of at least 3 ribs (median 3, mean 3.5 ribs). A total of 22 patients underwent ribs without sternal resections, and five patients underwent partial sternal resections with adjacent costal cartilage. Anterior chest wall resections were performed in 13 patients while lateral chest wall resections were performed in 9 patients. Three patients had extended resections beyond the chest wall in patients with primary chest wall malignancies, including two with wedge resections of lung and one with partial resection of pericardium. No patient was lost to follow-up. Mean follow-up was 30.7 months. Neither chest wall instability nor wound infection/necrosis was observed. Of these, 23 patients (85.2%) were alive at the last follow-up. Local recurrence was detected in three cases. The 5-year disease-free and overall survivals of primary chest tumors were 72.1% and 80.8%, respectively. CONCLUSIONS Our results showed that chest wall reconstruction utilizing synthetic titanium meshes following extensive resections of the chest wall malignant tumors allowed adequate resection size, with acceptable complications and survival benefits.
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Affiliation(s)
- Haitang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Jicheng Tantai
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
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Prevention of Postoperative Cerebrospinal Fluid Leaks After Translabyrinthine Tumor Resection With Resorbable Mesh Cranioplasty. Otol Neurotol 2015. [DOI: 10.1097/mao.0000000000000835] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Novel technique for cranial reconstruction following retrosigmoid craniectomy using demineralized bone matrix. Clin Neurol Neurosurg 2015; 136:66-70. [DOI: 10.1016/j.clineuro.2015.05.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 04/30/2015] [Accepted: 05/25/2015] [Indexed: 11/21/2022]
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15
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