Subcranial transnasal repair of cerebrospinal fluid rhinorrhea with free autologous grafts by the combined overlay and underlay techniques

OBJECTIVE

To determine the efficacy of subcranial transnasal repair of cerebrospinal fluid rhinorrhea with free autologous grafts by the combined overlay and underlay techniques using the surgical microscope and/or endoscope.

PATIENTS AND METHODS

Twenty patients with CSF rhinorrhea were included in this retrospective study. They were 13 males and 7 females. Their age ranged from 7 to 62 years (mean: 39.35). The etiologies of the leak were iatrogenic in 10 cases, spontaneous in 5 cases, traumatic in 4 cases and one case was associated with meningeo-encephalocele. Preoperative nasal endoscopic examination, computed tomography (CT) with intrathecal non-ionic contrast and magnetic resonance imaging (MRI) were done when indicated. Endoscopic and/or microscopic repair of the CSF fistula was done by a combination of both underlay and overlay repair with free autologous grafts as follows: Gelfoam with fibrin glue, strips of fat, facia lata, Gelfoam with fibrin glue (underlay), septal cartilage, Gelfoam with fibrin glue and strips of fat (overlay).

RESULTS

Complete closure of the leak was achieved in all patients. In one case of spontaneous CSF leak which was operated endoscopically, the leak recurred 6 months postoperatively and ceased spontaneously after a month with conservative medical treatment. No major complications were seen and no patients developed meningitis or postoperative anosmia.

CONCLUSION

Subcranial transnasal repair with free autologous grafts by the combined overlay and underlay techniques using the endoscope or surgical microscope is a safe and successful method of treating CSF leaks, provided that the CSF leak is precisely located and the site can be reached with the endoscope or surgical microscope.

Sellar floor reconstruction with nasal turbinate tissue after endoscopic endonasal transsphenoidal surgery for pituitary adenomas

BACKGROUND

The emerging endoscopic endonasal transsphenoidal approach for pituitary adenomas is safe and effective. An intraoperative sellar floor reconstructive method after this approach is challenging.[nl]

OBJECTIVE

To describe a simple method of sellar reconstruction after endoscopic endonasal transsphenoidal surgery for pituitary adenomas by nasal turbinate tissue.[nl]

MATERIALS AND METHODS

Thirty patients with defects in the floor of the sella turcica, after endoscopic endonasal transsphenoidal surgery for pituitary adenomas, underwent reconstruction with nasal turbinate tissue. The surgical technique is described.[nl]

RESULTS

Patients who underwent this sellar reconstruction did not show postoperative cerebrospinal leak or other complications.[nl]

CONCLUSION

Nasal turbinate tissue is an excellent source of donor material for successful reconstruction of the sellar floor. It is costless, safe, soft, malleable and easy to obtain in the same field of surgery with suitable size without inducing side effects or complications.

Hoarseness as the sole presenting symptom of foramen magnum meningioma

Foramen magnum tumours are rare. They may present with bizarre symptoms and mimic many conditions. We report a presentation with the sole complaint of hoarseness, never previously described in the literature. Voice returned to normal after surgical removal of the foramen magnum meningioma.

Primary pituitary abscess: surgical management and endocrine assessment in three cases

Three cases of pituitary abscess are described. All were women with varying degrees of anterior pituitary dysfunction, diabetes insipidus and headaches. None had visual disturbance. A history of prior head injury was obtained in both young women who developed secondary amenorrhoea and hyperprolactinaemia. All three had low density, thick rim intrasellar masses on computed tomography scanning. Certain aspects of the diagnosis and surgical management of this rare condition are discussed with particular emphasis on the importance of pre- and postoperative endocrine assessment and preoperative diagnosis and proper surgical management.

Production of collagenase and inhibitor (TIMP) by intracranial tumors and dura in vitro

The production of collagenase and collagenase inhibitor (TIMP) by various intracranial tumors (25 meningiomas, eight gliomas, seven metastases, four pituitary adenomas, and five others) was studied in short-term organ culture. While meningiomas produced negligible amounts of collagenase, two metastatic carcinomas of bronchial and breast origin produced significant amounts of the enzyme. Cultures of dura from an invasive meningioma and of bone invaded by a meningioma also produced collagenase. In varying amounts, TIMP was detected in culture media from most of the tumors studied; invasive tumors tended to produce less TIMP than noninvasive tumors. The results are discussed in relation to current views on tissue degradation and mechanisms of tumor invasion.