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Eide JG, Kshirsagar RS, Wen C, Qatanani A, Harris J, Sellers L, Abello EH, Douglas JE, Palmer JN, Adappa ND, Kuan EC. Endoscopic Repair of Anterior Skull Base Cerebrospinal Fluid Leaks is Successful in Frail Patients. Laryngoscope 2024; 134:2713-2717. [PMID: 38581362 DOI: 10.1002/lary.31440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/26/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE Surgical frailty estimates a patient's ability to withstand the physiologic stress of an intervention. There is limited data regarding the impact of frailty on endoscopic cerebrospinal fluid (CSF) leak repair. METHODS Patients undergoing CSF leak repair at two tertiary academic skull base programs were retrospectively reviewed. Demographic, treatment, and postoperative outcomes data were recorded. Frailty was calculated using validated indices, including the American Society of Anesthesiologists (ASA) classification, Charlson Comorbidity Index (CCI), and the Modified 5-Item Frailty Index (mFI-5). Outcomes included 30-day medical and surgical complications and readmission. RESULTS A total of 185 patients were included with 128 (69.2%) female patients and average age of 54 ± 14 years. The average body mass index was 34.6 ± 8.5. The most common identified etiology was idiopathic intracranial hypertension (IIH) in 64 patients (34.6%). A total of 125 patients (68%) underwent perioperative lumbar drain placement (primarily to measure intracranial pressures and diagnose IIH). Most patients were ASA class 3 (48.6%) with mean CCI 2.14 ± 2.23 and mFI-5 0.97 ± 0.90. Three patients had postoperative CSF leaks, with an overall repair success rate of 98.4%. There was no association between increased frailty and 30-day medical outcomes, surgical outcomes, or readmission (all p > 0.05). CONCLUSIONS Endoscopic CSF leak repair in a frail population, including lumbar drain placement and bed rest, was not associated with an increased rate of complications. Previous data suggests increased complications in open craniotomy procedures in patients with significant comorbidities. This study suggests that the endoscopic approach to CSF leak repair is well tolerated in the frail population. LEVEL OF EVIDENCE IV Laryngoscope, 134:2713-2717, 2024.
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Affiliation(s)
- Jacob G Eide
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Redwood City Medical Center, Redwood City, California, U.S.A
| | - Chris Wen
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Anas Qatanani
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jacob Harris
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Lauren Sellers
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Eric H Abello
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
- Department of Neurological Surgery, University of California Irvine, Orange, California, U.S.A
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Quiceno E, Soliman MAR, Khan A, Cavagnaro MJ, McSpadden RP, Pollina J, Levy EI, Mullin JP. Supraclavicular Artery Island Flap for Treatment of Cervical Wound Defects and Persistent Cerebrospinal Fluid Leaks: A Technical Note and Systematic Review of the Literature. World Neurosurg 2024; 185:e915-e925. [PMID: 38458254 DOI: 10.1016/j.wneu.2024.02.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Soft tissue defects and persistent cerebrospinal fluid (CSF) leaks can create complications after cervical spinal surgery. The supraclavicular artery island (SAI) flap is useful in closing tissue defects, particularly in these complex surgeries and multiple reinterventions. However, technical reports in this context are scarce. We describe application of the SAI flap technique to control persistent CSF leak in the first documented instance (to our knowledge) of a low-grade fibromyxoid sarcoma (LGFMS) in the cervical epidural space. Additionally, we conducted a comprehensive review of PubMed, Embase, and Google Scholar from their earliest records through December 17, 2023 using combined terms, "supraclavicular artery island flap AND spine" and "supraclavicular AND flap AND spine". TECHNICAL NOTE A 56-year-old woman with arm pain and weakness presented with a cervical epidural mass extending from C4-C6 and associated spinal cord compression. She underwent a 3-level corpectomy and tumor resection. Primary dural closure was impossible due to the dural invasion, and reintervention with an SAI flap and definitive lumboperitoneal shunting were required to control and seal the CSF leak. SYSTEMATIC LITERATURE REVIEW Seven case reports describing SAI flap for spinal surgery complications were identified. The indications in those cases were correcting esophageal and hypopharyngeal perforations after cervical fusion and discectomy and persistent soft tissue coverage after cervical instrumentation. CONCLUSIONS The SAI flap technique provided wound defect coverage in this case and is suitable for addressing issues such as persistent CSF leaks or soft tissue coverage after cervical spine surgery.
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Affiliation(s)
- Esteban Quiceno
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Maria Jose Cavagnaro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Faculty of Medicine, Stanford University, Palo Alto, California, USA
| | - Ryan P McSpadden
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
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Spinos D, Geropoulos G, Vavoulis G, Georgountzos G, Papageorgakopoulou M, Karela NR, Varoutis P, Evangelou K, Cho WS. The Association Between Obesity and Spontaneous Temporal Bone CSF Leak Outcomes: A Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:2012-2018. [PMID: 38400793 DOI: 10.1002/lary.31349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/08/2024] [Accepted: 02/02/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE We undertook a systematic review of the literature with meta-analysis to identify the role of obesity (BMI ≥30) in the patient characteristics presenting with spontaneous cerebrospinal fluid (sCSF) leaks of the lateral skull base and the outcomes of their repair. DATA SOURCES A Systematic Review of English Articles using MEDLINE, EMBASE, and Cochrane Library. REVIEW METHODS The research algorithm included the following keywords: "spontaneous CSF leak," "lateral skull base," "temporal bone," "meningocele," "encephalocele," and "otorrhea." We also manually searched the references of included studies, to identify possible studies missed during our literature search. RESULTS More than two-thirds of the patients were female (69.2%) and often were obese (mean BMI 36.5 kg/m2) with a mean age of 57. Most common presenting symptoms were otorrhea and hearing loss. Most authors did not report a routine use of a post-operative lumbar drain. Most patients had a single skull base defect and encephaloceles prolapsing through, across obese and non-obese groups. Median length of stay in hospital was 3.2 days, and the majority of patients did not have any recurrence during their follow-up (89.6%), which was not affected by obesity. CONCLUSION Obesity does not affect length of hospital stay or recurrence rate following surgical repair of lateral skull base sCSF leaks. Surgical repair is a safe and viable approach in the management of obese patients with sCSF leaks in the temporal bone. LEVEL OF EVIDENCE NA Laryngoscope, 134:2012-2018, 2024.
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Affiliation(s)
- Dimitrios Spinos
- Department of Otorhinolaryngology, Head and Neck Surgery, South Warwickshire University NHS Foundation Trust, Warwick, UK
| | - Georgios Geropoulos
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | - Panagiotis Varoutis
- Department of Neurosurgery, General Hospital of Thessaloniki Ippokratio, Thessaloniki, Greece
| | | | - Wai Sum Cho
- Department of Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Volz F, El Rahal A, Fung C, Shah M, Lützen N, Urbach H, Beck J, Wolf K. Don't delay, but don't despair: symptom duration, comorbidity and outcome after closure of spinal cerebrospinal fluid leaks. J Neurol 2024; 271:2776-2786. [PMID: 38409537 PMCID: PMC11055789 DOI: 10.1007/s00415-024-12242-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Microsurgical sealing of spinal cerebrospinal fluid (CSF) leaks is a viable treatment option in spontaneous intracranial hypotension (SIH). Several factors may influence the outcome, with symptom duration probably the most modifiable variable. METHODS Patients with closure of spinal CSF leaks between September 2020 and March 2023 and a follow-up period of 6 months were included in this retrospective single-center study. Pre- and postoperative scores for impact of headaches (Headache Impact Test, HIT-6) and quality of life (QoL, EQ-5D-5L) were systematically collected. Multiple regression modelling and subgroup analyses for different symptom durations and comorbidities were performed for these outcomes. RESULTS One hundred patients (61% female, median age 43.5 years) were included. Six months postoperatively, there was significant improvement in headache impact (HIT-6: 66 (IQR 62-69) to 52 (IQR 40-61, p < 0.001) and QoL (EQ-5D-5L VAS: 40 (IQR 30-60) to 79 (IQR 60-90); EQ-5D-5L Index: 0.67 (IQR 0.35-0.8) to 0.91 (IQR 0.8-0.94, p < 0.001, respectively). Subgroup analysis for a symptom duration above (74%) and below 90 days (26%) and comorbidity, as well as multiple regression analysis, revealed a trend in favor of early treatment and lower comorbidity. However, even after a prolonged symptom duration, improvements were significant. CONCLUSION As patients with shorter symptom duration show a trend for a better outcome, our results promote a timely diagnosis and treatment in SIH patients. However, a significant postoperative improvement can still be expected even after a prolonged symptom duration.
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Affiliation(s)
- Florian Volz
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
| | - Amir El Rahal
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
- Department of Neurosurgery, Lindenhofspital, Bern, Switzerland
| | - Mukesch Shah
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
| | - Niklas Lützen
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.
| | - Katharina Wolf
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
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Thorpe RK, Dougherty MC, Walsh JE, Graham SM, Greenlee JDW. Sellar Reconstruction With a Bioabsorbable Plate After Endoscopic Transsphenoidal Pituitary Adenoma Resection: Safe and Efficacious. Ann Otol Rhinol Laryngol 2024; 133:490-494. [PMID: 38372259 DOI: 10.1177/00034894241233870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To report outcomes of a large cohort of patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) for resection of a pituitary adenoma with subsequent Resorb-X plate (RXP) sellar reconstruction. METHODS A retrospective review of 620 EETS operations performed at a single academic center between 2005 and 2020 was conducted. RESULTS A total of 215 EETS operations of 208 patients were identified between 2012 and 2020 who underwent reconstruction with the RXP after EETS for pituitary tumor resection with a final pathologic diagnosis of pituitary adenoma. Analysis of pooled data revealed a mean preoperative tumor volume of 6.8 cm3 (range: 0.038-51.03 cm3). Postoperative cerebrospinal fluid leak occurred in 2 patients (0.93%). Postoperative meningitis occurred in 1 patient (0.47%). There were no cases of RXP extrusion. CONCLUSIONS The rate of postoperative CSF leak and meningitis after use of the RXP for sellar reconstruction compares favorably to other methods, including use of autologous grafts and flaps. Use of RXP during EETS is a safe and efficacious method of sellar reconstruction and may obviate the need for autologous tissue reconstruction after pituitary adenoma resection.
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Affiliation(s)
- Ryan Kendall Thorpe
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Mark C Dougherty
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Jarrett E Walsh
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Scott M Graham
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
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Giordano M, Gallieni M, Samii M, Samii A. "Curtain-fall" technique for cerebrospinal fluid leak prevention after removal of intradural drainage. Technical note: application in chronic subdural hematoma surgery. Neurosurg Rev 2024; 47:161. [PMID: 38625461 DOI: 10.1007/s10143-024-02412-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/06/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is frequently met in neurosurgical practice and often need urgent surgical treatment in case of neurological deterioration. Different surgical approaches to evacuate CSDH are described in the literature. In our experience, an external drainage system is crucial in order to avoid recurrences. We recently encountered a case of subcutaneous CSF collection after drainage removal. Thus, we developed a simple surgical technique to prevent postoperative CSF leak after subdural drainage system removal. METHOD We have developed a technique in which the periosteum is harvested during the surgery prior to the evacuation of the hemorrhage and fixed with sutures on the uncut dura mater opposite and laterally to the exit of the catheter exiting the dural hole caused by the passage of the Jackson-Pratt subdural drainage system. When the drainage catheter is removed, the flap, partially held by the sutures, falls over the hole avoiding CSF leakage. By using this technique, the small dural hole will be covered with the periosteum allowing for natural closure and wound healing hence preventing CSF leakage. RESULTS This technique was successfully employed in 21 patients who didn't develop postoperative CSF leakage following CSDH evacuation and removal of subdural drainage system. CONCLUSION In this technical note, we describe a safe dura closure technique that we developed to help reduce the risk of postoperative CSF leakage following subdural drainage removal, which can, however, also be applied in all surgeries in which a catheter is placed in the subdural space.
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Affiliation(s)
- Mario Giordano
- International Neuroscience Institute, Department of neurosurgery, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany
| | - Massimo Gallieni
- International Neuroscience Institute, Department of neurosurgery, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany.
| | - Madjid Samii
- International Neuroscience Institute, Department of neurosurgery, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany
| | - Amir Samii
- International Neuroscience Institute, Department of neurosurgery, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany
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Ottinger AM, Raymond MJ, Miller EM, Meyer TA. Opioid Prescribing Patterns Following Lateral Skull Base Spontaneous Cerebrospinal Fluid Leak Repair. Otol Neurotol 2024; 45:e351-e358. [PMID: 38437814 PMCID: PMC10939820 DOI: 10.1097/mao.0000000000004136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To characterize the opioid prescribing patterns for and requirements of patients undergoing repair of spontaneous cerebrospinal fluid (sCSF) leaks of the lateral skull base. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Adults with lateral skull base sCSF leaks who underwent repairs between September 1, 2014, and December 31, 2020. MAIN OUTCOME MEASURE Mean morphine milligram equivalents (MMEs) of opioids dispensed to inpatients and prescribed at discharge, additional pain control medications dispensed, and outpatient additional opioid requests were compared between groups. RESULTS Of 78 patients included, 46 (59%) underwent repair via a transmastoid (TM), 6 (7.7%) via a middle cranial fossa (MCF), and 26 (33.3%) via a combined TM-MCF approach. Inpatients received a mean of 21.3, 31.4, and 37.6 MMEs per day during admission for the TM, MCF, and combined TM-MCF approaches, respectively ( p = 0.019, ηp 2 = 0.101). Upon discharge, nearly all patients (n = 74, 94.9%) received opioids; 27.3, 32.5, and 37.6 MMEs per day were prescribed after the TM, MCF, and TM-MCF approaches, respectively ( p = 0.015, ηp 2 = 0.093). Five (6.4%) patients requested additional outpatient pain medication, after which three were prescribed 36.7 MMEs per day. Patients with idiopathic intracranial hypertension required significantly more inpatient MMEs than those without (41.5 versus 25.2, p = 0.02, d = 0.689), as did patients with a history of headaches (39.6 versus 23.6, p = 0.042, d = 0.684). CONCLUSIONS Patients undergoing sCSF leak repair via the MCF or TM-MCF approaches are prescribed more opioids postoperatively than patients undergoing the TM approach. Patients with a history of headaches or idiopathic intracranial hypertension might require more opioids postoperatively.
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Affiliation(s)
- Allie M. Ottinger
- Medical University of South Carolina, Department of Otolaryngology – Head and Neck Surgery; Medical University of South Carolina, Charleston, SC, USA
| | - Mallory J. Raymond
- Mayo Clinic -Jacksonville, Department of Otolaryngology - Head and Neck Surgery; Jacksonville, FL, USA
| | - E. Marin Miller
- Medical University of South Carolina, Department of Otolaryngology – Head and Neck Surgery; Medical University of South Carolina, Charleston, SC, USA
| | - Ted A. Meyer
- Medical University of South Carolina, Department of Otolaryngology – Head and Neck Surgery; Medical University of South Carolina, Charleston, SC, USA
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Yu J, Sang Z, Ren Z, Xu Q, Wang Y, Liao H. Initial implementation of surgical guide design utilizing digital medicine for lateral orbital decompression surgery. J Craniomaxillofac Surg 2024; 52:432-437. [PMID: 38448333 DOI: 10.1016/j.jcms.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/12/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
This study aimed to assess the feasibility of utilizing a surgical guide, designed through digital medical technology, in lateral orbital decompression surgery. METHODS: In total, 18 patients with thyroid-associated ophthalmopathy (TAO), who underwent orbital balance decompression surgery at the Affiliated Eye Hospital of Nanchang University between September 2018 and August 2022, were included. Orbital CT scanning was performed on all patients with TAO, and Mimics 21.0 software was used to reconstruct a three-dimensional model of the orbit based on the CT data. The osteotomy guide plate for lateral orbital decompression surgery was designed using 3-matic 13.0 software, adhering to the criteria of surgical effectiveness and safety. The surgical positioning guide was designed using Geomagic Wrap 21.0. Once printed, the surgical guide was sterilized with low-temperature plasma and applied during surgery. Of the nine patients treated using a surgical navigation system, three cases experienced cerebrospinal fluid leakage complications during the procedure, and two exhibited inadequate bone removal along the lateral wall. In contrast, among the nine patients treated with surgical guides, no intraoperative cerebrospinal fluid leakage or evidence of insufficient lateral wall bone removal was observed, highlighting a statistically significant distinction between the two cohorts (p = 0.046). Postoperative improvements were notable in best-corrected visual acuity (BCVA) and exophthalmos for patients afflicted with extremely severe TAO. The surgical guide, designed with digital medical technology, has been shown to be an effective and secure auxiliary tool in lateral orbital decompression surgery. It not only aids in reducing the incidence of intraoperative complications, but also enhances the accuracy and safety of surgery. These improvements offer robust support for continued exploration in this field within clinical practice.
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Affiliation(s)
- Jinhai Yu
- School of Optometry, Jiangxi Medical College, Nanchang University, China; Jiangxi Research Institute of Ophthalmology and Visual Science, China; Jiangxi Provincial Key Laboratory for Ophthalmology, China
| | - Zexi Sang
- School of Optometry, Jiangxi Medical College, Nanchang University, China; Jiangxi Research Institute of Ophthalmology and Visual Science, China; Jiangxi Provincial Key Laboratory for Ophthalmology, China
| | - Zhangjun Ren
- School of Optometry, Jiangxi Medical College, Nanchang University, China; Jiangxi Research Institute of Ophthalmology and Visual Science, China; Jiangxi Provincial Key Laboratory for Ophthalmology, China
| | - Qihua Xu
- The Affiliated Eye Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Research Center for Ophthalmic Disease, China
| | - Yaohua Wang
- The Affiliated Eye Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Research Center for Ophthalmic Disease, China.
| | - Hongfei Liao
- The Affiliated Eye Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Research Center for Ophthalmic Disease, China.
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Filip P, Chiang H, Goldberg A, Khorsandi AS, Moonis G, Moody Antonio SA, Wanna G, Cosetti M. Challenges in the Management of Symptomatic Fallopian Canal Meningoceles: A Multicenter Case Series and Literature Review. Otol Neurotol 2024; 45:434-439. [PMID: 38478412 DOI: 10.1097/mao.0000000000004155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To describe the presentations, the diagnosis, our treatment approaches, and the outcomes for 11 patients with fallopian canal meningocele (FCM). STUDY DESIGN MULTICENTER Retrospective case series. SETTING Tertiary referral centers. PATIENTS Patients (N = 11) with radiographically or intraoperatively identified, symptomatic FCM. INTERVENTIONS Surgical repair of cerebrospinal fluid (CSF) leak and meningocele versus observation. MAIN OUTCOME MEASURES Presentation (including symptoms, radiographic imaging, and comorbidities), management (including surgical approach, technique for packing, use of lumbar drain), clinical outcomes (control of CSF leak, meningitis, facial nerve function), and revision surgery. RESULTS Patients presented with spontaneous CSF leak (n = 7), conductive (N = 11) and sensorineural hearing loss (n = 3), nonpositional intermittent vertigo (n = 3), headaches (n = 4), and recurrent meningitis (n = 1). Risk factors in our series included obesity (n = 4), Chiari 1 malformation (n = 1), and head trauma (n = 2). Noncontrast computed tomography of the temporal bone and magnetic resonance imaging were positive for FCM in 10 patients. Eight patients were managed surgically via a transmastoid approach (n = 4), combined transmastoid and middle fossa (N = 3), or middle fossa alone (n = 1); three were managed conservatively with observation. Postoperative complications included worsened facial nerve palsy (n = 1), recurrent meningitis (n = 1), and persistent CSF leak that necessitated revision (n = 1). CONCLUSIONS Facial nerve meningoceles are rare with variable presentation, often including CSF otorrhea. Management can be challenging and guided by symptomatology and comorbidities. Risk factors for FCM include obesity and head trauma, and Chiari 1 malformation may present with nonspecific otologic symptoms, in some cases, meningitis and facial palsy. Layered surgical repair leads to high rates of success; however, this may be complicated by worsening facial palsy.
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Affiliation(s)
- Peter Filip
- Department of Otolaryngology-Head and Neck Surgery, The Mount Sinai Hospital
| | - Harry Chiang
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Allison Goldberg
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA
| | | | - Gul Moonis
- CUMC Division of Neuroradiology, Columbia University Medical Center, New York, NY
| | | | - George Wanna
- Department of Otolaryngology-Head and Neck Surgery, The Mount Sinai Hospital
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Abboud T, Behme D, Schatlo B, Rohde V, von der Brelie C. Targeted Epidural Blood Patch Injection Through a Mini-Open Approach for Treatment of Spontaneous Intracranial Hypotension. Oper Neurosurg (Hagerstown) 2024; 26:398-405. [PMID: 37888978 DOI: 10.1227/ons.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Spontaneous intracranial hypotension is recognized as a cause for refractory headache. Treatment can range from blind blood patch injection to microsurgical repair of the cerebrospinal fluid (CSF) leak. The objective of the study was to investigate the safety and efficacy of the targeted blood patch injection (TBPI) technique through a mini-open approach in treatment of refractory intracranial hypotension. METHODS We retrospectively reviewed cases of 20 patients who were treated for spontaneous intracranial hypotension at our institute between 2011 and 2022. Head and spine MRI and whole-spine myelography were performed in an attempt to localize the CSF leak. All patients underwent implantation of two epidural drains above and beneath the index level through a minimally invasive interlaminar microsurgical approach under general anesthesia. Then, blood patch was injected under clinical surveillance. Treatment success and surgical complications were evaluated postoperatively and at follow-up. RESULTS Patients presented with orthostatic headache, vertigo, sensory deficits, and hypacusis (95%, 15%, 15%, and 10%, respectively). Subdural effusions were present in 65% of the cases. A CSF leak was identified in all patients. The exact site of the CSF leak could be identified in 80% of cases. TBPI was performed with an average blood amount of 37.5 mL. A significant improvement of symptoms was reported in 90% of the cases. A total of 15% of the patients showed recurrent symptoms and underwent a second TBPI, resulting in symptom relief. No therapy-related complications were reported. CONCLUSION TBPI is a safe and efficient treatment for spontaneous intracranial hypotension. It is performed in a minimally invasive procedure and can be repeated, if necessary, with a very low-risk profile.
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Affiliation(s)
- Tammam Abboud
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen , Germany
| | - Daniel Behme
- University Clinic for Neuroradiology, University Hospital Magdeburg, Magdeburg , Germany
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen , Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen , Germany
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11
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Frič R, Heier I, Züchner M, Gjertsen Ø, Rezai M. Cerebrospinal fluid-lymphatic fistula in a child with generalized lymphatic anomaly treated with targeted blood patch - a rare case report and review of the literature. Childs Nerv Syst 2024; 40:1301-1305. [PMID: 38236406 PMCID: PMC10973078 DOI: 10.1007/s00381-024-06287-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
Spontaneous intracranial hypotension may result in debilitating postural headaches and severe neurological symptoms due to secondary cerebellar sagging. The most common cause is the cerebrospinal fluid (CSF) leak within the spinal canal. Although previously reported in only a few cases, also paraspinal lymphatic malformations causing vertebral bone destruction may occasionally result in CSF leak to these pathological formations. Here, we present a case of a 9-year-old girl with generalized lymphatic anomaly (GLA) presenting with severe postural headache. Radiological imaging revealed a typical feature of cerebellar sagging. Myelography localized the CSF leakage into vertebral bodies of C7 and Th1, which both were partly involved in pathological paravertebral masses of known lymphatic anomaly, and from there along the right C8 nerve root sleeve into the anomaly. As the C8-nerve root could not be ligated due to the risk of significant neurological injury, we attempted image-guided targeted percutaneous epidural placement of a blood patch directly into the foramen at the affected level. The procedure resulted in obliteration of the fistula and regression of cerebellar sagging, with significant relief of symptoms. Although it is an extremely rare coincidence, patients with paraspinal lymphatic malformations may develop intraspinal CSF leak into these pathological formations. The present case report suggests that besides a direct surgical obliteration of the fistula and sacrificing the nerve root, a targeted percutaneous epidural blood patch may be a possible alternative in the case of a functionally important nerve root.
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Affiliation(s)
- Radek Frič
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O.Box 4950, N-0424, Oslo, Norway.
| | - Ingvild Heier
- Department of Pediatric Hematology and Oncology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Mark Züchner
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O.Box 4950, N-0424, Oslo, Norway
| | - Øivind Gjertsen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Mehran Rezai
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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12
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Emengen A, Yilmaz E, Gökbel A, Uzuner A, Cabuk B, Anik I, Ceylan S. Rarely Used Endoscopic Transnasal Transdiaphragmatic Technique in Patients with Suprasellar Extension: A Tertiary Center's Experience with Eleven Patient Cases. World Neurosurg 2024; 184:e674-e681. [PMID: 38342165 DOI: 10.1016/j.wneu.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/02/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE As surgical techniques become less invasive, the use of endoscopy in brain surgery supports this trend. Numerous endoscopic surgical approaches have been defined, especially for skull base diseases. The current study summarizes our experience of using the rarely reported endoscopic transnasal transdiaphragmatic approach through the existing hole in the diaphragma sella to access lesions extending into the suprasellar region. METHODS Our surgical team performed 4876 endoscopic endonasal surgeries between August 1997 and December 2022 at the Department of Neurosurgery, Pituitary Research Center, Faculty of Medicine, Kocaeli University. The study retrospectively analyzed data from 11 patients who had undergone endoscopic transnasal transdiaphragmatic surgery since January 2020. Preoperative and postoperative magnetic resonance imaging, pituitary function examination, and clinical observation were carried out. RESULTS The mean age of the patients was 31.1 ± 10.7 years and the female/male ratio was 6:5. Pathologic subtypes observed included breast cancer metastasis (n = 1), adrenocorticotropic hormone-secreting adenoma (n = 4), growth hormone-secreting adenoma (n = 3), craniopharyngioma (n = 2), and Rathke cleft cyst (n = 1). The mean postoperative hospital stay was 4.7 ± 1.1 days and none of the patients showed cerebrospinal fluid leakage during this period. CONCLUSIONS The endoscopic transnasal transdiaphragmatic approach may be considered an alternative to the conventional extended endoscopic transnasal approach in patients with lesions extending into the suprasellar region. The main strength of this method is that it facilitates suprasellar region access through a small dural incision and bone defect in the base of the skull. As a result, it also reduces the risk of postoperative cerebrospinal fluid leakage and associated complications.
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Affiliation(s)
- Atakan Emengen
- Neurosurgery Department, Kocaeli City Hospital, Pituitary Research Center, Kocaeli, Turkey
| | - Eren Yilmaz
- Neurosurgery Department, Cihanbeyli State Hospital, Konya, Turkey
| | - Aykut Gökbel
- Neurosurgery Department, Kocaeli City Hospital, Pituitary Research Center, Kocaeli, Turkey
| | - Ayse Uzuner
- Neurosurgery Department, Pituitary Research Center, Kocaeli University, Kocaeli, Turkey
| | - Burak Cabuk
- Neurosurgery Department, Pituitary Research Center, Kocaeli University, Kocaeli, Turkey
| | - Ihsan Anik
- Neurosurgery Department, Pituitary Research Center, Kocaeli University, Kocaeli, Turkey
| | - Savas Ceylan
- Neurosurgery Department, Pituitary Research Center, Kocaeli University, Kocaeli, Turkey.
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13
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Xiao B, Chen T, Zhao Q, Zhao M, Yang G, Zhong X, Xu Y. Risk factors for surgical site infection after percutaneous endoscopic lumbar discectomy. Int Wound J 2024; 21:e14605. [PMID: 38149500 PMCID: PMC10961887 DOI: 10.1111/iwj.14605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023] Open
Abstract
The objective of this study was to investigate the risk factors associated with surgical site infection (SSI) after percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). A retrospective analysis was performed on a cohort of 335 patients who underwent PELD between January 2016 and January 2023. Data were derived from the Hospital Information System (HIS), and a comprehensive statistical assessment was performed using IBM SPSS Statistics version 25.0. Both univariate and multivariate logistic regression analyses assessed a range of risk determinants, such as age, body mass index (BMI), comorbidities, laboratory test parameters and surgery-related variables. The incidence of SSI after PELD was 2.7% (9/335). Univariate analysis highlighted BMI, diabetes mellitus, long-term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant predictors of SSI. Multivariate logistic regression identified BMI, diabetes mellitus, long-term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant risk factors for SSI after PELD. High BMI, diabetes mellitus, long-term corticosteroid consumption, long surgical time and postoperative cerebrospinal fluid leakage are predisposing factors for SSI in patients undergoing PELD. Precise interventions focused on such risk components, including careful preoperative assessment and strategic postoperative care, are essential to reduce the incidence of SSI and improve surgical efficacy.
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Affiliation(s)
- Bo Xiao
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Tian‐yi Chen
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Qiang Zhao
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Ming Zhao
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Guo‐qi Yang
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Xiao‐hui Zhong
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Yin‐zhi Xu
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
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14
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Shannon CM, Sturm JJ, Durrant FG, Meyer TA, McRackan TR. Short Postoperative Length of Stay After Lateral Cerebrospinal Fluid Leak Repair. Otolaryngol Head Neck Surg 2024; 170:1140-1146. [PMID: 38167791 DOI: 10.1002/ohn.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To characterize the short-term outcomes of patients undergoing surgical repair of lateral skull base cerebrospinal fluid (CSF) leaks followed by a shortened length of stay (LOS) protocol. STUDY DESIGN Retrospective study. SETTING Tertiary medical center. METHODS A total of 156 adult patients from July 2016 to December 2022 who underwent repair of CSF leaks via transmastoid (TM), middle cranial fossa (MCF), or combined (TM/MCF) approaches were included. Data collected included: LOS, presentation to the emergency department (ED), need for readmission, major neurologic complications (stroke, seizure, and meningitis), and CSF leak recurrence. RESULTS Approximately half of patients underwent a TM repair (49.4%), whereas the other half underwent either an MCF (3.8%) or combined TM/MCF repair (46.8%). No peri-/postoperative lumbar drains were used and only 2 (1.3%) patients were admitted to the intensive care unit after surgery. Mean LOS for the cohort was 1.1 ± 0.7 days and was longer for surgeries involving MCF (1.3 ± 0.6) compared to TM (0.8 ± 0.7). Ninety-two percent of TM cases were discharged within 24 hours (32% on the same day) while for cases involving an MCF approach, 72.2% of patients were discharged within 24 hours. Of the patients in the study, 6 (3.8%) presented to an ED for minor complications and no patient required readmission. Revision surgery was required for 3 (1.9%) patients for recurrent CSF leak. CONCLUSION Our findings suggest that short LOS after surgical repair of lateral skull base defects in the treatment of CSF leak is safe and effective.
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Affiliation(s)
- Christian M Shannon
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joshua J Sturm
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Frederick G Durrant
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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15
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de Jong WB, Hoogmoed J, Adriaensen GFJPM, Nagtegaal AP, Reitsma S. Aetiology of cerebrospinal fluid rhinorrhoea in a Dutch retrospective cohort from two tertiary referral centres. Rhinology 2024; 62:208-215. [PMID: 38073582 DOI: 10.4193/rhin23.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) rhinorrhoea has different aetiologies, with spontaneous leaks related to female gender and obesity. Limited data is available on patient characteristics and surgical outcomes across different aetiologies of CSF leaks in relatively non-obese populations. METHODS Retrospective cohort study from two tertiary referral centres including adult patients that underwent surgical closure of a CSF leak, divided into four aetiologies: traumatic, iatrogenic, secondary to structural intracranial pathology (SIP), and spontaneous. Data included patient characteristics, presenting symptoms, preoperative radiologic findings, intracranial pressure (ICP) and surgical outcomes. RESULTS 72 patients were included: 9 traumatic, 15 iatrogenic, 4 SIP and 44 spontaneous leaks. Primary surgical success was 79%, rising to 93% with reinterventions. Spontaneous leak cases displayed highest female proportion and BMI. A meningo(-encephalo)cele was present in 33 patients and was associated with surgical failure and previous meningitis. No significant differences were observed between different aetiologies regarding patient characteristics, presenting symptoms, or surgical success rates. CONCLUSIONS Even in a relatively non-obese population, the majority of CSF leaks is spontaneous and associated with female gender and obesity. Otherwise, no differences exist across aetiologies regarding patient characteristics, presenting symptoms or surgical success.
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Affiliation(s)
- W B de Jong
- Department of Otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centers, location AMC, University of Amsterdam, the Netherlands; Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - J Hoogmoed
- Department of Neurosurgery, Amsterdam University Medical Centers, location AMC, University of Amsterdam, the Netherlands
| | - G F J P M Adriaensen
- Department of Otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centers, location AMC, University of Amsterdam, the Netherlands
| | - A P Nagtegaal
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - S Reitsma
- Department of Otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centers, location AMC, University of Amsterdam, the Netherlands
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16
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Wu KC, Freedman BR, Kwon PS, Torre M, Kent DO, Bi WL, Mooney DJ. A tough bioadhesive hydrogel supports sutureless sealing of the dural membrane in porcine and ex vivo human tissue. Sci Transl Med 2024; 16:eadj0616. [PMID: 38507468 DOI: 10.1126/scitranslmed.adj0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024]
Abstract
Complete sequestration of central nervous system tissue and cerebrospinal fluid by the dural membrane is fundamental to maintaining homeostasis and proper organ function, making reconstruction of this layer an essential step during neurosurgery. Primary closure of the dura by suture repair is the current standard, despite facing technical, microenvironmental, and anatomic challenges. Here, we apply a mechanically tough hydrogel paired with a bioadhesive for intraoperative sealing of the dural membrane in rodent, porcine, and human central nervous system tissue. Tensile testing demonstrated that this dural tough adhesive (DTA) exhibited greater toughness with higher maximum stress and stretch compared with commercial sealants in aqueous environments. To evaluate the performance of DTA in the range of intracranial pressure typical of healthy and disease states, ex vivo burst pressure testing was conducted until failure after DTA or commercial sealant application on ex vivo porcine dura with a punch biopsy injury. In contrast to commercial sealants, DTA remained adhered to the porcine dura through increasing pressure up to 300 millimeters of mercury and achieved a greater maximum burst pressure. Feasibility of DTA to repair cerebrospinal fluid leak in a simulated surgical context was evaluated in postmortem human dural tissue. DTA supported effective sutureless repair of the porcine thecal sac in vivo. Biocompatibility and adhesion of DTA was maintained for up to 4 weeks in rodents after implantation. The findings suggest the potential of DTA to augment or perhaps even supplant suture repair and warrant further exploration.
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Affiliation(s)
- Kyle C Wu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Wexner Medical Center and James Cancer Hospital, Ohio State University, Columbus, OH 43210, USA
| | - Benjamin R Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02139, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02215, USA
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Phoebe S Kwon
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02215, USA
| | - Matthew Torre
- Department of Neuropathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel O Kent
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02215, USA
- Department of General Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02139, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02215, USA
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17
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El Rahal A, Haupt B, Fung C, Cipriani D, Häni L, Lützen N, Dobrocky T, Piechowiak E, Schnell O, Raabe A, Wolf K, Urbach H, Kraus LM, Volz F, Beck J. Surgical closure of spinal cerebrospinal fluid leaks improves symptoms in patients with superficial siderosis. Eur J Neurol 2024; 31:e16122. [PMID: 38015455 DOI: 10.1111/ene.16122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE Spinal cerebrospinal fluid (CSF) leaks may cause a myriad of symptoms, most common being orthostatic headache. In addition, ventral spinal CSF leaks are a possible etiology of superficial siderosis (SS), a rare condition characterized by hemosiderin deposits in the central nervous system (CNS). The classical presentation of SS involves ataxia, bilateral hearing loss, and myelopathy. Unfortunately, treatment options are scarce. This study was undertaken to evaluate whether microsurgical closure of CSF leaks can prevent further clinical deterioration or improve symptoms of SS. METHODS This cohort study was conducted using data from a prospectively maintained database in two large spontaneous intracranial hypotension (SIH) referral centers in Germany and Switzerland of patients who meet the modified International Classification of Headache Disorders, 3rd edition criteria for SIH. Patients with spinal CSF leaks were screened for the presence of idiopathic infratentorial symmetric SS of the CNS. RESULTS Twelve patients were included. The median latency between the onset of orthostatic headaches and symptoms attributed to SS was 9.5 years. After surgical closure of the underlying spinal CSF leak, symptoms attributed to SS improved in seven patients and remained stable in three. Patients who presented within 1 year after the onset of SS symptoms improved, but those who presented in 8-12 years did not improve. We could show a significant association between patients with spinal longitudinal extrathecal collections and SS. CONCLUSIONS Long-standing untreated ventral spinal CSF leaks can lead to SS of the CNS, and microsurgical sealing of spinal CSF leaks might stop progression and improve symptoms in patients with SS in a time-dependent manner.
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Affiliation(s)
- Amir El Rahal
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
- Department of Neurosurgery, Faculty of Medicine of Geneva, Geneva University Hospital, Geneva, Switzerland
| | - Benedikt Haupt
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
| | - Christian Fung
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
| | - Debora Cipriani
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
| | - Levin Häni
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Niklas Lützen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Tomas Dobrocky
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eike Piechowiak
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oliver Schnell
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katharina Wolf
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Luisa Mona Kraus
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
| | - Florian Volz
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
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18
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Abiri A, Nguyen TV, Li JY, Shan D, Hsu T, Pang JC, Goshtasbi K, Hsu FPK, Kuan EC. The impact of nasal packing on skull base reconstruction and quality-of-life outcomes following endoscopic skull base surgery. Int Forum Allergy Rhinol 2024; 14:716-719. [PMID: 37506398 DOI: 10.1002/alr.23247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/07/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023]
Abstract
KEY POINTS Nasal packing type was not associated with postoperative cerebrospinal fluid leaks Nondissolvable packing conferred an increased risk for postoperative sinonasal infections Nasal packing type did not influence short- and long-term quality-of-life scores.
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Affiliation(s)
- Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Theodore V Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Ji Y Li
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - David Shan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Timothy Hsu
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Jonathan C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
- Department of Neurological Surgery, University of California, Irvine, Orange, California, USA
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19
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LeRoy TE, Ruiz-Cardozo MA, Molina CA. Transdural Ventral Sling Technique for Calcified Thoracic Disk Herniations. World Neurosurg 2024; 183:123-127. [PMID: 38104932 DOI: 10.1016/j.wneu.2023.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Surgery for thoracic disc herniations remains an ongoing challenge, with numerous surgical approaches, all with their own inherent risks. Discectomy via a posterior laminectomy was historically the treatment of choice; however, it was deemed very high risk with elevated rates of neurologic injury. The posterior transdural approach is an alternative surgical option for soft and calcified thoracic disc herniations. METHODS A 56-year-old female with many years of numbness/tingling in her hands and difficulty with fine motor tasks presented with progressive weakness and loss of balance in her legs. Imaging revealed a prominent focal central calcified disc herniation at the T5-T6 level causing severe effacement and distortion of the spinal cord. A posterior transdural approach for direct visualization of a large calcified disc herniation was performed, removing the calcified disc without the need for extensive exposure or entry into the thoracic cavity. A ventral sling of the dura was created to allow rotation of the spinal cord while removing the disc. RESULTS Intraoperative ultrasound confirmed complete disc resection, restoring cerebral spinal fluid flow circumferentially without residual impingement or cerebrospinal fluid leaks. At six months postsurgery, the patient's gait imbalance had resolved, and she had full lower extremity strength (5/5). Radiographic evaluation indicated stable implants without subsidence, pullout, fracture, or alignment loss. CONCLUSIONS The transdural approach is less invasive in nature, minimizes surgical exposure, patient morbidity, and provides better intraoperative control of the spinal cord. This constitutes an effective alternative surgical approach to both soft and calcified central thoracic disc herniations.
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Affiliation(s)
- Taryn E LeRoy
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts, USA
| | - Miguel A Ruiz-Cardozo
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Camilo A Molina
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
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20
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Alidaei N, Sharifi G, Davoudi Z. Importance of Intraoperative Factors in Postoperative Arginine Vasopressin Deficiency After Pituitary Adenoma Surgery. Endocr Pract 2024; 30:253-258. [PMID: 38092289 DOI: 10.1016/j.eprac.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE Pituitary adenoma (PA) is the most frequent tumor in the sellar region. Arginine vasopressin deficiency (AVP-D), formerly known as central diabetes insipidus, is a common complication after pituitary surgeries. In this study, we reviewed patients with PAs after endoscopic transsphenoidal surgery, evaluated the incidence of postoperative AVP-D, and determined associated risk factors. METHODS We retrospectively studied 520 patients who underwent endoscopic transsphenoidal surgery for PAs and evaluated perioperative risk factors and their associations with postoperative AVP-D. Patients who developed AVP-D were categorized in 3 groups: (1) early AVP-D, (2) transient AVP-D, and (3) permanent AVP-D. RESULTS Of the 520 patients, 24.8% experienced early AVP-D, and 1.9% (n = 10) had transient AVP-D. Permanent AVP-D was observed in only 6 patients (1.1%). Gross total resection, hormonal remission, pituitary stalk manipulation, and intraoperative cerebrospinal fluid leak were significantly associated with a higher incidence of AVP-D (P = .027, P = .002, P < .001 and P < .001, respectively). All patients who developed permanent AVP-D had somatotroph adenomas. AVP-D was not found to be related with tumor size. The length of hospital stay was prolonged by AVP-D on average by 1.5 days (P = .018). CONCLUSION The reported incidence of AVP-D has a considerably wide range. A consistent definition and grading for AVP-D will increase consistency and comparability among studies. Nonetheless, most patients experience AVP-D on a temporary basis, and only a few require long-term treatment. Cerebrospinal fluid leak, gross total resection, and hormonal remission were identified as risk factors for postoperative AVP-D. We believe that the intraoperative risk factors play the main role in postoperative AVP-D. The course of surgery and operative findings help us plan selective postoperative patient monitoring and care.
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Affiliation(s)
- Nasim Alidaei
- Department of Neurosurgery, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Guive Sharifi
- Department of Neurosurgery, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Davoudi
- Department of Endocrinology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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21
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Shah MJ, Beck J, Meckel S, Urbach H, Duman IE, Ketterer MC, Hildenbrand T. Reliability of High-resolution Gadolinium-enhanced MR Cisternography and Gasket-seal Technique for Management of Anterior Skull Base Defects. Clin Neuroradiol 2024; 34:115-123. [PMID: 37656200 PMCID: PMC10881784 DOI: 10.1007/s00062-023-01339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Precise preoperative localization of anterior skull base defects is important to plan surgical access, increase the success rate and reduce complications. A stable closure of the defect is vital to prevent recurrence of cerebrospinal fluid (CSF) rhinorrhea. The purpose of this retrospective case series was to evaluate the reliability of a new high-resolution gadolinium-enhanced compressed-sensing SPACE technique (CS T1 SPACE) for magnetic resonance (MR) cisternography to detect cerebrospinal fluid leaks of the anterior skull base and to assess the long-term success rate of the gasket-seal technique for closure of skull base defects. METHOD All patients with spontaneous or postoperative cerebrospinal fluid rhinorrhea and defects of the anterior skull base presenting to the Departments of Otorhinolaryngology and Neurosurgery between 2019 and 2020, receiving a computed tomography (CT) cisternography and MR cisternography (on a 3T whole-body MR scanner using a 64-channel head and neck coil) with CS T1 SPACE sequence and closure of the defect with the gasket-seal technique, were enrolled in the study. For the cisternography, iodinated contrast agent (15 ml Solutrast 250 M®), saline (4 mL) mixed with a 0.5 mL of gadoteridol was injected into the lumbar subarachnoid space. RESULTS A total of four patients were included in the study and MR cisternography with CS T1 SPACE sequence was able to precisely localize CSF leaks in all patients. The imaging results correlated with intraoperative findings. All defects could be successfully closed with the gasket-seal technique. The mean follow-up was 35.25 months (range 33-37 months). CONCLUSION MR cisternography with CS T1 SPACE sequence could be a promising technique for precise localization of CSF leaks and the gasket-seal technique resulted in good closure of the CSF fistula in this case series.
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Affiliation(s)
- Mukesch Johannes Shah
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Stephan Meckel
- Institute for Diagnostic and Interventional Neuroradiology, RKH Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Germany
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Ikram Eda Duman
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Manuel Christoph Ketterer
- Department of Oto-Rhino-Laryngology, Medical Center, University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Tanja Hildenbrand
- Department of Oto-Rhino-Laryngology, Medical Center, University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany.
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Li J, Zhang S, Ouyang D, Zeng L, Qiao Y, Deng W, Liao G, Liang Y. Favorable effects of open surgery on patients with extensive skull base osteoradionecrosis through a personalized sequential approach: A case series. J Craniomaxillofac Surg 2024; 52:302-309. [PMID: 38368207 DOI: 10.1016/j.jcms.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/04/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024] Open
Abstract
The present study aimed to investigate outcomes following open surgery for extensive skull base ORN. Open surgery through a personalized sequential approach was employed to deal with five cases of extensive skull base ORN. Two patients with mild cases underwent regional debridement and sequestrectomy, and three patients with severe cases underwent extensive resection with reconstruction using free anterolateral thigh (ALT) flap. Biological glues and vascularized flaps were used for obturation of the skull base bony defect to prevent postoperative cerebrospinal fluid (CSF) leakage. The infections were controlled by antibiotic administrations which strictly followed the principles of antimicrobial stewardship (AMS). As results, both regional debridement plus sequestrectomy and extensive resection achieved satisfied outcomes in all patients. No severe complications and delayed hospitalization occurred. During the follow-up period (8-19 months), all patients were alive, pain free, without crusting or purulent discharge, and no sequestration or CSF leakage occurred. In conclusion, a personalized sequential approach including open surgery, pedicled/vascularized free flap reconstruction and AMS was advocated for patients with extensive skull base ORN.
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Affiliation(s)
- Jingyuan Li
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Sien Zhang
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Daiqiao Ouyang
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Lijuan Zeng
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Yongjie Qiao
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Wei Deng
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Guiqing Liao
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
| | - Yujie Liang
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
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Hudelist B, Idriceanu T, Moya-Plana A, Herman P, Bresson D. The "Gift Wrap" Technique - A Method that Simplifies the Placement of Fascia Lata in the Reconstruction of the Skull Base Following Endoscopic Endonasal Surgery: A Technical Note. World Neurosurg 2024; 183:41-44. [PMID: 38092352 DOI: 10.1016/j.wneu.2023.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND With the advancement of endoscopic endonasal surgery in the treatment of anterior skull base (ASB) pathologies, extended, watertight reconstructions are needed to prevent cerebrospinal fluid (CSF) leakage. This often involves the use of multilayers closure, with free fascia lata (FL) graft frequently used as an in- and/or outlay. However, positioning the FL properly can be challenging and time-consuming, particularly on wider defects. In this technical note, we present an easier and faster way to position FL using a silicone sheet. METHODS FL graft is harvested using a standard technique. The required dimensions are evaluated depending on the extent of the dural defect taking in consideration that FL graft should exceed the edges of the dural defect especially laterally. It is then wrapped around a semi rigid pattern (Silastic sheet) and secured with several monofilament 5/0 sutures. The "package" is transferred through the endonasal corridor to the defect. The sutures are divided and taken out; the fascia is unfolded, and its edges are inserted into the subdural space without any twisting or folding of the flap. Finally, the silicone sheet is withdrawn from the nasal cavity, leaving the FL well-stretched in perfect position. RESULTS We illustrate this technique in the management of a large anterior skull base chondrosarcoma, which necessitated significant bone and dural resection. CONCLUSIONS The "Gift wrap" technique offers an alternative approach for positioning the FL, which is less time-consuming compared to the traditional technique. Moreover, it enables improved placement of the FL, enhancing its efficacy.
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Affiliation(s)
- Benoit Hudelist
- Neurosurgery Department, GHU, Sainte-Anne Hospital, Paris, France.
| | - Tania Idriceanu
- Neurosurgery Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | | | | | - Damien Bresson
- Neurosurgery Department, Foch Hospital, Suresnes, France
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24
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Saltagi AK, Saltagi MZ, Kedo M, Shah MV, Nelson RF. Management of Fallopian Canal Spontaneous CSF Leaks, Implications of Elevated Intracranial Pressure: Case Report and Systematic Review of the Literature. Otol Neurotol 2024; 45:215-222. [PMID: 38361289 DOI: 10.1097/mao.0000000000004107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVES Describe the diagnosis and management of a spontaneous cerebrospinal fluid leak (sCSF-L) through the facial nerve fallopian canal and determine the role of intracranial hypertension (IH). STUDY DESIGN Retrospective case study and systematic review of the literature. METHODS Reviewed patient characteristics, radiographic findings, and management of the facial nerve canal CSF leak and postoperative IH. Conducted systematic literature review according to the PRISMA guidelines for surgical management and rates of IH. RESULTS A 50-year-old female with bilateral tegmen defects and temporal encephaloceles underwent left middle cranial fossa (MCF) repair. Intraoperative CSF egressed from the temporal bone tegmen defects. Facial nerve decompression revealed CSF leak from the labyrinthine segment. A nonocclusive temporalis muscle plug was placed in the fallopian canal, and tegmen repair was completed with bone cement. A ventriculoperitoneal shunt was placed for IH. Postoperative facial nerve function and hearing were normal. A total of 20 studies met inclusion criteria with a total of 25 unique patients. Of 13 total adult cases of fallopian canal CSF leak, there is a 46% recurrence rate, and 86% of patients had documented IH when tested. CONCLUSIONS Fallopian canal CSF leaks are rare and challenging to manage. Assessment of intracranial hypertension and CSF diversion is recommended along with MCF skull base repair to preserve facial nerve function and conductive hearing.
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Affiliation(s)
| | | | | | - Mitesh V Shah
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, IN
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25
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Xiang SW, Deng JC, Wen QQ. Risk factors of cerebrospinal-fluid leakage during endoscopic transsphenoidal pituitary-adenoma resection: A systematic review and meta-analysis. Asian J Surg 2024; 47:1166-1169. [PMID: 37977934 DOI: 10.1016/j.asjsur.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Shao-Wei Xiang
- Surgical Division III, The National Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, Hubei, PR China
| | - Jun-Chao Deng
- Surgical Division III, The National Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, Hubei, PR China
| | - Qi-Qiang Wen
- Surgical Division III, The National Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, Hubei, PR China.
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26
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Portonero I, Lo Bue E, Penner F, Di Perna G, Baldassarre BM, De Marco R, Pesaresi A, Garbossa D, Pecorari G, Zenga F. Lesson learned in endoscopic endonasal dens resection for C1-C2 spinal cord decompression. Eur Spine J 2024; 33:438-443. [PMID: 37934268 DOI: 10.1007/s00586-023-08001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/01/2023] [Accepted: 10/12/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Endoscopic endonasal approach (EEA) is the safest and most effective technique for odontoidectomy. Nevertheless, this kind of approach is yet not largely widespread. The aim of this study is to share with the scientific community some tips and tricks with our ten-year-old learned experience in endoscopic endonasal odontoidectomy (EEO), which remains a challenging surgical approach. MATERIAL AND METHODS Our case series consists of twenty-one (10 males, 11 females; age range of 34-84 years) retrospectively analyzed patients with ventral spinal cord compression for non-reducible CVJ malformation, treated with EEA from July 2011 to March 2019. RESULTS The results have recently been reported in a previous paper. The only intraoperative complication observed was intraoperative cerebrospinal fluid (CSF) leak (9.5%), without any sign of post-operative CSF leak. CONCLUSIONS Considering our experience, EEO represents a valid and safe technique to decompress neural cervical structures. Despite its technical complexity, mainly due to the use of endoscope and the challenging surgical area, with this study we encourage the use of EEO displaying our experience-based surgical tips and tricks.
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Affiliation(s)
- Irene Portonero
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.
- Skull Base Unit, Department of Neuroscience "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, Via Cherasco 15, Turin, Italy.
| | - Enrico Lo Bue
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Skull Base Unit, Department of Neuroscience "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, Via Cherasco 15, Turin, Italy
| | - Federica Penner
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Skull Base Unit, Department of Neuroscience "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, Via Cherasco 15, Turin, Italy
| | | | - Bianca Maria Baldassarre
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Skull Base Unit, Department of Neuroscience "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, Via Cherasco 15, Turin, Italy
- UOC Neurochirurgia, Ospedale SS Annunziata, Tartanto, Italy
| | - Raffaele De Marco
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Skull Base Unit, Department of Neuroscience "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, Via Cherasco 15, Turin, Italy
| | - Alessandro Pesaresi
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Skull Base Unit, Department of Neuroscience "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, Via Cherasco 15, Turin, Italy
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Skull Base Unit, Department of Neuroscience "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, Via Cherasco 15, Turin, Italy
| | - Giancarlo Pecorari
- ENT Surgery Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesco Zenga
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- Skull Base Unit, Department of Neuroscience "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, Via Cherasco 15, Turin, Italy
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Zhang J, Yuan Y, Gao H, Liao B, Qian J, Yan X. Comparative study on the technique and efficacy of microscope-assisted MI-TLIF and naked-eye MI-TLIF in lumbar revision surgery. J Orthop Surg Res 2024; 19:101. [PMID: 38297343 PMCID: PMC10832101 DOI: 10.1186/s13018-024-04591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/28/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Lumbar revision surgery can be performed by simple lumbar nerve decompression or lumbar interbody fusion, including percutaneous endoscopic lumbar discectomy, transforaminal lumbar interbody fusion (TLIF), etc. However, lumbar revision surgery is very difficult in surgical operation. We sought to explore the technique safety and efficacy of microscope-assisted minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in lumbar revision surgery. METHODS Cases of postoperative recurrence following lumbar spine surgery (n = 63) treated from December 2016 to July 2021 were retrospectively analyzed, including 24 cases of microscope-assisted MI-TLIF (microscopic group) and 39 cases of naked-eye MI-TLIF (naked-eye group). The operation time, intraoperative blood loss, incision length, postoperative drainage, length of hospital stay, initial operation, and visual analog score (VAS) of low back and leg pain before and at 7 days and 3 months after the operation and the last follow-up were compared between the two groups. The Oswestry Dysfunction Index (ODI) and the Japanese Orthopaedic Association (JOA) scores before and after the operation and the Bridwell interbody fusion grades at 1 year were compared. The independent t tests, Mann-Whitney U tests, and Chi-square tests were used for analysis. RESULTS All 63 patients were successfully treated by operation and were followed up for an average of 31.5 ± 8.6 months (range 12-48 months). The two groups had no significant difference in sex, age, incision length, initial operation, or operative segment (P > 0.05). There was no significance in operation time, VAS score, ODI score, and JOA score of low back pain or Bridwell interbody fusion grade between the two groups (P > 0.05). Significant differences in intraoperative blood loss, postoperative drainage, and the lengths of hospital stay were observed between the two groups (P < 0.05). Cerebrospinal fluid leakage (n = 2), edema of nerve roots (n = 2), and incision infection (n = 1) were observed in the naked-eye group. There were no complications in the microscopic group, such as cerebrospinal fluid leakage, edema of nerve roots, and incision infection. CONCLUSION Although microscope-assisted MI-TLIF and naked-eye MI-TLIF are both effective during lumbar revision surgery, microscope-assisted MI-TLIF brings less trauma, less bleeding, shorter postoperative hospital stay, and faster recovery. Unlike traditional surgery, microscope-assisted MI-TLIF provides a clear visual field, adequate hemostasis, and nerve decompression.
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Affiliation(s)
- JiaHuan Zhang
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
- Xi'an Medical University, Xi'an, 710054, China
| | - YiFang Yuan
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - HaoRan Gao
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Bo Liao
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - JiXian Qian
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - XiaoDong Yan
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China.
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Suchan M, Kaliarik L, Zeliznak V, Skalova M, Kollova A, Banocy J. Advantages of endoscopic transsphenoidal pituitary gland tumor surgery. BRATISL MED J 2024; 125:38-41. [PMID: 38041844 DOI: 10.4149/bll_2024_007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
OBJECTIVE The aim of the study was to hihglight the benefits and safety of the endoscopic transsphenoidal pituitary gland tumor surgery. BACKGROUND The endoscopic transsphenoidal approach to the Turkish sella minimizes traumatization of nasal cavity structures, allows direct access to the tumor and intra, para and suprasellar views (13). METHODS The surgical procedure was described. We monitored postoperative complication such as postoperative bleeding, cerebrospinal fluid leak, infection in 136 patients who underwent endoscopic transsphenoidal pituitary gland tumos resection. RESULTS Bleeding from the bed after tumor removal occured in 3 patients (2.2 %). Bleeding from the nasal cavity requiring surgical intervention was in 1 patient (0.7 %). Postoperative cerebrospinal fluid leak was detected in 12 cases (8.8 %). Duroplasty with itratecal cerebrospinal fluid drainage led to the cessation of the cerebrospinal fluid leak in all cases. We recorded meningitis in 4 patients (2.9 %) Rhinosinusitis was not recorded. CONCLUSIONS The endoscopic transsphenoidal surgery of pituitary gland tumors has become preferred becouse of its safety, low rate of complications and minimal trauma to the patient (Fig. 5, Ref. 13).
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Finlay JB, Issa K, Ackall F, Zomorodi A, Codd P, Jang DW, Goldstein BJ, Abi Hachem R. Safety and Feasibility of Steroid-Eluting Stent as a Bolster in Endoscopic Anterior Skull Base Reconstruction. Ann Otol Rhinol Laryngol 2024; 133:43-49. [PMID: 37334915 DOI: 10.1177/00034894231181178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND With a rising incidence of cerebrospinal fluid (CSF) leaks, endoscopic endonasal CSF leak repair is increasingly performed. Current approaches utilize a variety of materials including free mucosal grafts and vascularized flaps, but post-op leaks continue to be reported. Steroid-eluting bioabsorbable stents (SES) are used during functional endoscopic sinus surgery for chronic rhinosinusitis to reduce inflammation and scarring while maintaining patency of sinus ostia. OBJECTIVE The aim of this study is to assess the feasibility of SES as a graft/flap bolster for endoscopic endonasal CSF leak repair. METHODS This is a retrospective review of patients undergoing endoscopic endonasal CSF leak repair with SES placed as part of the bolster technique at a tertiary care center between January 2019 and May 2022. Age, sex, BMI, comorbid idiopathic intracranial hypertension, pathology, location of CSF leak, intraoperative CSF leak flow, reconstruction type, and presence of post-op CSF leak were recorded. RESULTS Twelve patients (mean age 52, median BMI 30.9, 58% female) had SES placement as part of the bolster technique. The most common pathology was meningoencephalocele (75%). Reconstruction was performed with either a free mucosal graft (6), or a flap (6). No post-op CSF leaks occurred at a reconstruction site with a stent, and no known complications were reported. All sinusotomies were patent at the last follow-up visit. CONCLUSIONS SES placement as an adjunct to graft and/or flap bolster appears to be safe and feasible during anterior skull base reconstruction and CSF leak repair providing longer term structural support and preserving sinus drainage patency.
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Affiliation(s)
- John B Finlay
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Medical Scientist Training Program, Duke University School of Medicine, Durham, NC, USA
| | - Khalil Issa
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Feras Ackall
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ali Zomorodi
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Duke Skull Base Center, Duke University School of Medicine, Durham, NC, USA
| | - Patrick Codd
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Duke Skull Base Center, Duke University School of Medicine, Durham, NC, USA
| | - David W Jang
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Duke Skull Base Center, Duke University School of Medicine, Durham, NC, USA
| | - Bradley J Goldstein
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Neurobiology, Duke University School of Medicine, Durham, NC, USA
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Duke Skull Base Center, Duke University School of Medicine, Durham, NC, USA
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Miranda-Lloret P, Simal-Julian JA, de San Román-Mena LP, Ramírez EP, Pancucci G, Asunción CB. CSF leak after pediatric endoscopic endonasal expanded approaches: a series review. Childs Nerv Syst 2024; 40:181-188. [PMID: 37561159 DOI: 10.1007/s00381-023-06103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/23/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Endoscopic endonasal approaches in the pediatric population pose specific challenges. Management of postoperative cerebrospinal fluid [CSF] leak is probably the major concern. The purpose of the present investigation is to describe and analyze the incidence of postoperative CSF leaks in our pediatric series of endoscopic endonasal approaches. METHODS This is a retrospective analysis, case review of our institutional series. Descriptive statistical parameters and bivariate correlations are analyzed. RESULTS Twenty-one patients have been operated through endoscopic approaches in our series. Four patients showed a postoperative CSF leak needing a revision surgery; these cases are described in further detail. Approaches expanded beyond the sellar area and non-sellar pneumatization of the sphenoid sinus were significantly associated with a higher risk of postoperative CSF leak. CONCLUSIONS CSF leak incidence after endoscopic endonasal approaches is higher in pediatric patients than in adult series. Anatomic and pathologic factors add complexity to these approaches in children. Multilayer closure is advisable to prevent and treat this complication.
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Affiliation(s)
- Pablo Miranda-Lloret
- Pediatric Neurosurgery, Hospital Universitari I Politècnica La Fe, 46010, Valencia, Spain.
| | | | | | - Estela Plaza Ramírez
- Pediatric Neurosurgery, Hospital Universitari I Politècnica La Fe, 46010, Valencia, Spain
| | - Giovanni Pancucci
- Pediatric Neurosurgery, Hospital Universitari I Politècnica La Fe, 46010, Valencia, Spain
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Häni L, Fung C, El Rahal A, Volz F, Kraus LM, Schnell O, Ferrarese R, Erny D, Schwabenland M, Urbach H, Lützen N, Beck J. Distinct Pattern of Membrane Formation With Spinal Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension. Oper Neurosurg (Hagerstown) 2024; 26:71-77. [PMID: 37747369 PMCID: PMC10688773 DOI: 10.1227/ons.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/18/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To systematically describe pertinent, intraoperative anatomic findings encountered when approaching spinal cerebrospinal fluid (CSF) leaks and CSF-venous fistulas in spontaneous intracranial hypotension (SIH). METHODS In a retrospective study, we included surgically treated patients suffering from SIH at our institution from April 2018 to March 2022. Anatomic, intraoperative data were extracted from operative notes and supplemented with data from surgical videos and images. Prominent anatomic features were compared among different types of CSF leaks. RESULTS The study cohort consists of 120 patients with a mean age of 45.2 years. We found four distinct patterns of spinal membranes specifically associated with different types of CSF leaks: (i) thick, dorsal membranes, which were hypervascular and may mimic the dura (pseudodura); (ii) thin, lateral membranes encapsulating a ventral epidural CSF compartment (confining the spinal longitudinal extradural CSF collection); (iii) ventral membranes constituting a transdural funnel-like CSF channel; and (iv) lateral membranes forming spinal cysts/meningeal diverticulae associated with lateral CSF leaks. The latter three types resemble a layer of arachnoid herniated through the dural defect. CONCLUSION We describe four distinct spinal (neo-)membranes in association with spinal CSF leaks. Formation of these membranes, or emergence by herniation of arachnoid through a dural defect, constitutes a specific pathoanatomic feature of patients with SIH and CSF leaks. Recognition of these membranes is of paramount importance for diagnosis and treatment of patients with spinal CSF leaks.
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Affiliation(s)
- Levin Häni
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany;
| | - Christian Fung
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany;
| | - Amir El Rahal
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany;
- Faculty of Medicine of Geneva, Geneva, Switzerland;
| | - Florian Volz
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany;
| | - Luisa Mona Kraus
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany;
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany;
| | - Roberto Ferrarese
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany;
| | - Daniel Erny
- Institute of Neuropathology, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany;
| | - Marius Schwabenland
- Institute of Neuropathology, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany;
| | - Horst Urbach
- Department of Neuroradiology, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany
| | - Niklas Lützen
- Department of Neuroradiology, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg im Breisgau, Germany;
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Kodera T, Isozaki M, Akazawa A, Oiwa M, Yamauchi T, Yamada S, Tai K, Kawajiri S, Kidoguchi M, Higashino Y, Hashimoto N, Arishima H, Iino S, Kikuta KI. Anatomy of the Frontal Sinus Drainage Pathway Evaluated in 247 Cadavers to Prevent Cerebrospinal Fluid Leakage After Frontobasal Craniotomy. Oper Neurosurg (Hagerstown) 2024; 26:54-63. [PMID: 37747348 DOI: 10.1227/ons.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/22/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The frontal sinus (FS) drainage pathway (FSDP) may be a conduit for cerebrospinal fluid leakage after frontobasal craniotomy. In this cadaveric study, we aimed to evaluate the anatomy of the FSDP. METHODS The FSs and FSDPs of 247 cadavers were investigated. We counted the number of FSs and FSDPs in each half-head, verified the presence of a narrowing section in each FSDP, and evaluated the depth, shape, and size of each narrowing FSDP section. RESULTS We investigated 494 sides and 472 FSDPs of 247 cadavers. FSs were unilaterally undeveloped in 13 of 247 cadavers (5.3%) and bilaterally in 8 (3.2%). FSs were unilaterally duplicated in 7 of 247 cadavers (2.8%), and no FSs were bilaterally duplicated or triplicated. No FSs had 2 or more FSDPs, and all 472 investigated FSDPs were invariably narrowed at various depths. The narrowing FSDP sections were elliptical (78.6%), circular (18.1%), triangular (1.8%), or crescent-shaped (1.4%) and of varying thickness and orientation. Although FSDPs were asymmetric in 92.2% of cadavers and narrowing FSDP sections were located deep (8.9 ± 4.4 mm from the anterior skull base), the narrowing FSDP sections were typically small (area: 5.9 ± 3.3 mm 2 ) or thin (short diameter: 2.1 ± 0.7 mm). CONCLUSION Each FS had only one FSDP, all FSDPs were invariably narrowed at various depths, and the narrowing FSDP sections were sufficiently small or thin to allow local closure, facilitating prevention of cerebrospinal fluid leakage after frontobasal craniotomy.
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Affiliation(s)
- Toshiaki Kodera
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
- Fukui Prefectural Hospital, Fukui, Japan
| | - Makoto Isozaki
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Ayumi Akazawa
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Mizuki Oiwa
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Takahiro Yamauchi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Shintaro Yamada
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Katsuhide Tai
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Satoshi Kawajiri
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Masamune Kidoguchi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Yoshifumi Higashino
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Norichika Hashimoto
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Hidetaka Arishima
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Satoshi Iino
- Department of Anatomy, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Ken-Ichiro Kikuta
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
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Abstract
The paramedian forehead flap (PMFF) has been well described for nasal reconstruction. However, it has never been reported for use in the repair of high flow anterior skull base cerebrospinal fluid (CSF) leaks. The patient was a 55 year-old African American male cocaine abuser who initially presented with a high flow anterior skull base CSF leak, extensive pneumocephalus, and intra-cerebral and intra-ventricular abscesses with an oro-nasal-cerebral fistula. The patent initially underwent bi-frontal craniotomy, exenteration of the frontal sinus, abdominal fat graft, resection of intra-cerebral abscesses, and repair of high flow anterior skull base CSF leak with a pedicled pericranial flap (PF). Eighteen months after the patient's surgery, he had resumed his use of cocaine and suffered necrosis of his PF. This caused his high flow CSF leak to recur. After extensive psychiatric treatment, he stopped cocaine use and was subsequently repaired with a pedicled de-epithelialized PMFF originating off the bilateral supratrochlear arteries. The patient has had no CSF leak for 3 years, and primary closure of the forehead was achieved with good cosmetic outcome. This case highlights the use of PMFF for the treatment of recurrent high flow anterior skull base CSF leak. It also highlights the importance of treatment of the patient's underlying medical disorder, in this case, the patient's addiction to cocaine. We provide a detailed discussion for the use of the de-epithelialized PMFF and how it can be utilized as a vascularized reconstructive technique to repair complex refractory CSF leaks.
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Affiliation(s)
- Jeremy N Ciporen
- Oregon Health & Science University, Department of Neurosurgery, Portland, OR, USA
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Chen C, Zeng C, Chen Z, Chen Z, Lin C. Transmastoid Approach to Repair Iatrogenic Cerebrospinal Fluid Otorhinorrhea After Cerebellopontine Angle Tumor Resection. J Int Adv Otol 2024; 20:26-29. [PMID: 38454285 PMCID: PMC10895819 DOI: 10.5152/iao.2024.231084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/27/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The precise treatment of iatrogenic cerebrospinal fluid (CSF) otorhinorrhea has been poorly studied. The purpose of the study was to investigate the clinical manifestation, surgical results, and management of CSF leak. METHODS Electronic medical record database of iatrogenic CSF leaks after erebellopontine angle(CPA) surgery from 2019 to 2022 was retrospectively analyzed. Three patients returned to the hospital with the complication of CSF leak. After failed attempts of conservative strategies or reverse surgical repair, adipose tissue was applied to the mastoid cracks repair. RESULTS With the techniques described above, the CSF leaks were successfully settled. The identified patients were observed for at least 10 months. and there was no recurrence or other complications. CONCLUSION Conservative treatment and initial surgical methods for occult postoperative CSF leaks are prone to delay effective results, particularly in patients with well-evaporated temporal bone. This complication can be minimized with transmastoid closure utilizing autologous fat.
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Affiliation(s)
- Chenyu Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Branch of National Clinical Medical Research Center for Otorhinolaryngologic Diseases, Fuzhou, China
| | - Chaojun Zeng
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Branch of National Clinical Medical Research Center for Otorhinolaryngologic Diseases, Fuzhou, China
| | - Zhifeng Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Branch of National Clinical Medical Research Center for Otorhinolaryngologic Diseases, Fuzhou, China
| | - Zhen Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chang Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology, Head and Neck Surgery, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Branch of National Clinical Medical Research Center for Otorhinolaryngologic Diseases, Fuzhou, China
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Wang S, Ren S, Wang J, Chen M, Wang H, Chen C. Dural Reconstruction Materials for the Repairing of Spinal Neoplastic Cerebrospinal Fluid Leaks. ACS Biomater Sci Eng 2023; 9:6610-6622. [PMID: 37988580 DOI: 10.1021/acsbiomaterials.3c01524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Spinal tumors often lead to more complex complications than other bone tumors. Nerve injuries, dura mater defect, and subsequent cerebrospinal fluid (CSF) leakage generally appear in spinal tumor surgeries and are followed by serious adverse outcomes such as infections and even death. The use of suitable dura mater replacements to achieve multifunctionality in fluid leakage plugging, preventing adhesions, and dural reconstruction is a promising therapeutic approach. Although there have been innovative endeavors to manage dura mater defects, only a handful of materials have realized the targeted multifunctionality. Here, we review recent advances in dura repair materials and techniques and discuss the relative merits in both preclinical and clinical trials as well as future therapeutic options. With these advances, spinal tumor patients with dura mater defects may be able to benefit from novel treatments.
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Affiliation(s)
- Shidong Wang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, People's Republic of China
| | - Shangjun Ren
- Department of Neurosurgery, Liaocheng People's Hospital, No. 67 Dongchang West Road, Liaocheng, 252000, People's Republic of China
| | - Juan Wang
- Department of Stomatology, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing100035, People's Republic of China
| | - Mengyu Chen
- School of Medicine, Nankai University, No. 94, Weijin Road, Nankai District, Tianjin 300071, People's Republic of China
| | - Hongru Wang
- Department of Neurology, Liaocheng People's Hospital, No. 67 Dongchang West Road, Liaocheng, 252000, People's Republic of China
| | - Chenglong Chen
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, People's Republic of China
- Department of Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing 100035, People's Republic of China
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Graupman P, Nussbaum ES, Patel PD. Preventing cerebral spinal fluid leakage following endoscopy through a burr hole using a novel watertight closure: technical note. Br J Neurosurg 2023; 37:1915-1917. [PMID: 33779446 DOI: 10.1080/02688697.2021.1903392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage is a common complication after neuroendoscopic surgery through a burr hole and can lead to further complications including infection. METHODS We describe the use of a dural substitute larger than the burr hole itself, placed over the burr hole and then secured underneath a burr hole cover by microscrews running through the graft itself into the underlying skull. RESULTS This simple technical modification contributes to achieving a watertight seal to aid in preventing CSF leakage in this setting. CONCLUSIONS Our technical modification of endoscopy through a burr hole may help to prevent postoperative CSF leak and secondary CSF infections.
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Affiliation(s)
- Patrick Graupman
- Department of Neurosurgery, Gillette Children's Hospital, St. Paul, MN, USA
| | - Eric S Nussbaum
- Department of Neurosurgery, National Brain Aneurysm & Tumor Center, St. Paul, MN, USA
| | - Puja D Patel
- Department of Medical Writing, Superior Medical Experts, Minneapolis, MN, USA
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Magill ST, Schwartz TH, Couldwell WT, Gardner PA, Heilman CB, Sen C, Akagami R, Cappabianca P, Prevedello DM, McDermott MW. International Tuberculum Sellae Meningioma Study: Surgical Outcomes and Management Trends. Neurosurgery 2023; 93:1259-1270. [PMID: 37389475 DOI: 10.1227/neu.0000000000002569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/25/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Tuberculum sellae meningiomas (TSMs) can be resected through transcranial (TCA) or expanded endonasal approach (EEA). The objective of this study was to report TSM management trends and outcomes in a large multicenter cohort. METHODS This is a 40-site retrospective study using standard statistical methods. RESULTS In 947 cases, TCA was used 66.4% and EEA 33.6%. The median maximum diameter was 2.5 cm for TCA and 2.1 cm for EEA ( P < .0001). The median follow-up was 26 months. Gross total resection (GTR) was achieved in 70.2% and did not differ between EEA and TCA ( P = .5395). Vision was the same or better in 87.5%. Vision improved in 73.0% of EEA patients with preoperative visual deficits compared with 57.1% of TCA patients ( P < .0001). On multivariate analysis, a TCA (odds ratio [OR] 1.78, P = .0258) was associated with vision worsening, while GTR was protective (OR 0.37, P < .0001). GTR decreased with increased diameter (OR: 0.80 per cm, P = .0036) and preoperative visual deficits (OR 0.56, P = .0075). Mortality was 0.5%. Complications occurred in 23.9%. New unilateral or bilateral blindness occurred in 3.3% and 0.4%, respectively. The cerebrospinal fluid leak rate was 17.3% for EEA and 2.2% for TCA (OR 9.1, P < .0001). The recurrence rate was 10.9% (n = 103). Longer follow-up (OR 1.01 per month, P < .0001), World Health Organization II/III (OR 2.20, P = .0262), and GTR (OR: 0.33, P < .0001) were associated with recurrence. The recurrence rate after GTR was lower after EEA compared with TCA (OR 0.33, P = .0027). CONCLUSION EEA for appropriately selected TSM may lead to better visual outcomes and decreased recurrence rates after GTR, but cerebrospinal fluid leak rates are high, and longer follow-up is needed. Tumors were smaller in the EEA group, and follow-up was shorter, reflecting selection, and observation bias. Nevertheless, EEA may be superior to TCA for appropriately selected TSM.
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Affiliation(s)
- Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco , California , USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Cornell University, New York , New York , USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City , Utah , USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
| | - Carl B Heilman
- Department of Neurological Surgery, Tufts University, Boston , Massachusetts , USA
| | - Chandranath Sen
- Department of Neurological Surgery, New York University, New York , New York , USA
| | - Ryojo Akagami
- Department of Neurological Surgery, University of British Columbia, Vancouver , British Columbia , Canada
| | - Paolo Cappabianca
- Department of Neurological Surgery, Universita degli Studi di Napoli Federico II, Naples , Italy
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University, Columbus , Ohio , USA
| | - Michael W McDermott
- Miami Neuroscience Institute, Baptist Health South Florida, Miami , Florida , USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco , California , USA
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Ruparelia J, Kumar VRR. Arachnoid Welding-A Simple and Economical Method of Arachnoid Closure to Prevent Cerebrospinal Fluid Leak. World Neurosurg 2023; 180:91-96. [PMID: 37739172 DOI: 10.1016/j.wneu.2023.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Collection of cerebrospinal fluid (CSF) in the subdural compartment is a major cause of postoperative morbidity, especially for posterior fossa surgeries. Arachnoid closure techniques, including suturing of the arachnoid and use of synthetic sealants, have been described in the literature. However, they are not always feasible or effective and have not been universally adopted. METHODS We describe the technique of arachnoid welding for a case of brainstem cavernoma. This is a simple, cost-effective, and easily reproducible technique using readily available bipolar cautery kept at a low-current setting. At the end of surgery, the arachnoid leaflets are closely approximated, and bipolar cautery is used to seal the edges together. An illustrative video shows the technical nuances of this procedure. This technique can also be applied for arachnoid closure at other cranial and spinal sites. RESULTS Arachnoid closure can act as an effective natural barrier to keep CSF in its physiological subarachnoid compartment. It provides an additional barrier to prevent CSF leak. It also prevents morbidity associated with adhesions and arachnoiditis. Proper closure of arachnoid makes durotomy during repeat surgery much easier and avoids injury to the underlying pia. A brief review of related literature shows the benefits of closing the arachnoid before dural closure and the different techniques that have been described so far. CONCLUSIONS The arachnoid welding technique has a wide application, is easy to learn, and can be used especially for posterior fossa surgeries in which rates of CSF leak are the highest.
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Affiliation(s)
- Jigish Ruparelia
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, India.
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Shen M, Shou X, Wang Y. How I do it? Endoscopic endonasal transpterygoid repair of sphenoid lateral recess cerebrospinal fluid leak after previous unsuccessful transcranial surgery. Acta Neurochir (Wien) 2023; 165:4125-4129. [PMID: 37851167 DOI: 10.1007/s00701-023-05820-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Direct access to the sphenoid lateral recess offers the best chance of sealing spontaneous cerebrospinal fluid (CSF) rhinorrhea caused by lateral sphenoid encephaloceles of the Sternberg canal defect. METHOD We present a case of spontaneous left-sided sphenoid lateral recess CSF leak after previous unsuccessful transcranial surgery managed with an endoscopic endonasal transpterygoid approach (EETA). An anatomical-based step-by-step illustration of the EETA was presented in the surgical video. CONCLUSION This case demonstrates the value of endoscopic endonasal transpterygoid corridor in the exposure and manipulation of the sphenoid lateral recess.
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Affiliation(s)
- Ming Shen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
- Shanghai Pituitary Tumor Center, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, China
- Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences, Beijing, China
| | - Xuefei Shou
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China
- Shanghai Pituitary Tumor Center, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, China
- Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences, Beijing, China
| | - Yongfei Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China.
- Shanghai Pituitary Tumor Center, Shanghai, 200040, China.
- National Center for Neurological Disorders, Shanghai, China.
- Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences, Beijing, China.
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Hurel C, Favier V, de Bonnecaze G, de Gabory L, Patsoura S, Molinier-Blossier S, Carrière M, Daubé P, Dufour X, Fieux M, Carsuzaa F. Transverse Venous Sinus Stenosis in Patients With Nasal Cerebrospinal Fluid Leak and Idiopathic Intracranial Hypertension. Otolaryngol Head Neck Surg 2023; 169:1647-1653. [PMID: 37435619 DOI: 10.1002/ohn.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/29/2023] [Accepted: 05/28/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE Spontaneous nasal cerebrospinal fluid (CSF) leaks are frequently linked to idiopathic intracranial hypertension (IIH). The objectives of our study were: (1) to determine the rate of transverse venous sinus stenosis (TVSS) in patients with spontaneous nasal CSF leak and in patients with IIH without CSF (controls), and (2) to study the correlation between spontaneous nasal CSF leak and brain imaging features. STUDY DESIGN A multicenter retrospective case-control study. SETTING Six French tertiary hospitals. METHODS Patients with spontaneous nasal CSF leaks and patients with IIH without nasal CSF leaks (controls) were included. The transverse venous sinus patency was analyzed by magnetic resonance imaging to identify possible stenosis or hypoplasia. RESULTS Thirty-two patients with spontaneous nasal CSF leaks and 32 controls were included. TVSS was significantly more frequent in patients with spontaneous nasal CSF leaks than in controls (p = .029). Univariate analysis indicated that TVSS (odds ratio, OR: 4.2; 95% confidence interval, CI [1.352-14.915]; p = .017) and arachnoid granulations (OR: 3; 95% CI [1.065-8.994]; p = .042) were risk factors for spontaneous nasal CSF leak. In multivariate analysis, TVSS and arachnoid granulations were independent risk factors of nasal CSF leak (OR: 5.577, 95% CI [1.485-25.837], p = .016; and OR: 4.35, 95% CI [1.234-17.756], p = .029, respectively). CONCLUSION This multicenter case-control study shows that TVSS is an independent risk factor for CSF leak in patients with IIH. Stenosis management by interventional radiology may be proposed postoperatively to increase the success of IIH surgical treatment or preoperatively to reduce the need for surgery.
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Affiliation(s)
- Charles Hurel
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Valentin Favier
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Guillaume de Bonnecaze
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Toulouse, Toulouse, France
| | - Ludovic de Gabory
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Sophia Patsoura
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | | | - Mathilde Carrière
- Department of Neuroradiology, University Hospital of Montpellier, Montpellier, France
| | - Pierre Daubé
- Department of Neuroradiology, University Hospital of Poitiers, Poitiers, France
| | - Xavier Dufour
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Maxime Fieux
- Serviced'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université de Lyon, Université Lyon 1, Pierre Bénite, France
| | - Florent Carsuzaa
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
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Ashari S, Saekhu M, Gunawan K, Aldilla A, Zaragita N, Nugroho SW. Bone fusion in transcele reconstruction of frontoethmoidal meningoencephalocele. Br J Neurosurg 2023; 37:1619-1623. [PMID: 35254175 DOI: 10.1080/02688697.2022.2047156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/23/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE In surgical correction of frontoethmoidal encephalocele with transcranial approach, advanced facilities are required. While with extracranial approach, though deemed as a safe option in area with limited facilities, procedure was associated with cerebrospinal fluid (CSF) leakage. In this case series, we evaluate the results of transcele reconstruction of frontoethmoidal encephalocele, our approach to reduce the incidence of CSF leaks by focusing on the closure of layers by its embryological derivatives, by its bone fusion. METHODS A case series of 14 patients with various types of frontoethmoidal encephalocele who underwent surgery for defect closure using transcele approach between June 2015 and December 2018 was carried out. Surgery was done by a single surgeon in the Department of Neurosurgery of Cipto Mangunkusumo Hospital in Jakarta, Indonesia. We collected the data of intraoperative blood loss and any signs of infection and CSF leak during the patients' one-year follow up. Bone fusion in the defect was evaluated from 3D rendering of head CT scan that was performed before and in 1 year after surgery. RESULTS The median percentage of intraoperative blood loss was 5.9% (0.5-18.7%). All 3D rendering of head CT post-surgery during 1 year follow up showed bone fusion and no patient experienced CSF leaks or CNS infections. CONCLUSIONS This study showed that using transcele approach in frontoethmoidal reconstruction could give good bone fusion with minimal blood loss and no CSF leaks. We assumed that closure of the layers by its embryological derivative played an important part in bone fusion and in reducing the incidence of CSF leaks, although this finding has to be validated with large-scale studies.
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Affiliation(s)
- Samsul Ashari
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Mohammad Saekhu
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Kevin Gunawan
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Amanda Aldilla
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Nadya Zaragita
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Setyo Widi Nugroho
- Department of Neurosurgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Gomes FC, Larcipretti ALL, Elvir FAR, Diniz JBC, de Melo TMV, Santana LS, de Oliveira HM, Barroso DC, Polverini AD. Early ambulation versus prolonged bed rest for incidental durotomies in spine procedures: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:310. [PMID: 37989906 DOI: 10.1007/s10143-023-02201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
Incidental durotomies are frequent complications of spine surgery associated with cerebrospinal fluid (CSF) leak-related symptoms. Management typically involves prolonged bed rest to reduce CSF pressure at the durotomy site. However, early ambulation may be a safer, effective alternative. PubMed, Web of Science, Embase, Cochrane, and Scopus were systematically searched for studies comparing early ambulation (bed rest ≤ 24 h) with prolonged bed rest (> 24 h) for patients with incidental durotomies in spine surgeries. The outcomes of interest were CSF leak, hypotensive headache, additional surgical repair, pseudomeningocele, and pulmonary complications. Systematic reviews and meta-analysis were performed following the Cochrane Handbook for Systematic Reviews of Interventions. We included a total of 704 patients from 6 studies. There was a significant reduction in the incidence of pulmonary complications (RR 0.23; 95% CI 0.08-0.67; p = 0.007) in the early mobilization group. The incidence of CSF leak (RR 1.34; 95% CI 0.83-2.14; p = 0.23), hypotensive headache (RR 0.72; 95% CI 0.27-1.90; p = 0.50), additional repair surgery (RR 1.29; 95% CI 0.76-2.2; p = 0.35), and pseudomeningocele (RR 1.29; 95% CI 0.20-8.48; p = 0.79) did not differ significantly. In patients with incidental durotomy following spinal surgery, early mobilization was associated with a lower incidence of pulmonary complications as compared with prolonged bed rest. There was no significant difference between groups in terms of CSF leak, need for additional repair, pseudomeningocele, and hypotensive headache.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Allan Dias Polverini
- Neurosurgical Oncology Division, Hospital de Amor, Fundação Pio XII, Antenor Duarte Vilela, 1331 - Dr. Paulo Prata, Barretos, Sao Paulo, 14784-400, Brazil.
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Dai G, Zhang M, Su W, Zhao J, Yu X, Sun Z, Dou Y, Geng X. Replantation of lamina spinous process ligament complex and miniature titanium plate shaping internal fixation in the treatment of tumors in the spinal canal. BMC Musculoskelet Disord 2023; 24:873. [PMID: 37950233 PMCID: PMC10636857 DOI: 10.1186/s12891-023-06984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Purpose This study aims to explore the clinical efficacy of laminospinous process ligament complex reimplantation combined with mini-titanium plate fixation in the treatment of thoracolumbar intraspinal tumors. METHODS A retrospective analysis was performed on 43 cases of intraspinal tumors treated with thoracolumbar intraspinal tumor resection from August 2018 to March 2021, and 27 cases underwent laminospinous process ligament complex reimplantation combined with micro titanium plate shaping. Fixation (laminar replantation group), and 16 patients underwent laminectomy combined with pedicle screw internal fixation (laminectomy group). The operation time, blood loss, drainage tube removal time, cerebrospinal fluid leakage, spinal instability, and the incidence of secondary spinal stenosis were compared between the two groups. The pain VAS score, ODI score, and modified Macnab at the last follow-up were compared between the two groups. And the laminar fusion rate of the laminoplasty group was measured. RESULTS Both groups successfully completed the surgery and obtained complete follow-up. The incidence of cerebrospinal fluid leakage and secondary spinal canal stenosis in the laminectomy group was lower than that in the laminectomy group, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the incidence of spinal instability between the two groups (P > 0.05). The operation time and intraoperative blood loss in the laminectomy group were less than those in the laminectomy group, and the drainage tube removal time was earlier than that in the laminectomy group. The difference was statistically significant (P < 0.05). At the final follow-up, there was no statistically significant difference in the pain VAS score, ODI score, and modified Macnab between the two groups (P > 0.05), but they were all significantly improved compared with preoperative ones. Fusion evaluation was conducted on the laminoplasty group. Two years after surgery, the fusion rate was 97.56% (40/41). CONCLUSIONS The application of laminospinous process ligament complex reimplantation combined with mini titanium plate fixation during thoracolumbar intraspinal tumor resection can effectively reconstruct the spinal canal and posterior column structure, reduce the incidence of cerebrospinal fluid leakage and secondary spinal stenosis. The laminar fusion rate is high.
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Affiliation(s)
- Guohua Dai
- Department of Spine Surgery, Binzhou Medical University Hospital, 661 Second Huanghe road, Bincheng District, Binzhou, Shandong Province, 256600, China
| | - Min Zhang
- Department of Spine Surgery, Binzhou Medical University Hospital, 661 Second Huanghe road, Bincheng District, Binzhou, Shandong Province, 256600, China.
| | - Weiliang Su
- Department of Spine Surgery, Binzhou Medical University Hospital, 661 Second Huanghe road, Bincheng District, Binzhou, Shandong Province, 256600, China
| | - Jiaqing Zhao
- Department of Spine Surgery, Binzhou Medical University Hospital, 661 Second Huanghe road, Bincheng District, Binzhou, Shandong Province, 256600, China
| | - Xiankai Yu
- Department of Spine Surgery, Binzhou Medical University Hospital, 661 Second Huanghe road, Bincheng District, Binzhou, Shandong Province, 256600, China
| | - Zhaozhong Sun
- Department of Spine Surgery, Binzhou Medical University Hospital, 661 Second Huanghe road, Bincheng District, Binzhou, Shandong Province, 256600, China
| | - Yongfeng Dou
- Department of Spine Surgery, Binzhou Medical University Hospital, 661 Second Huanghe road, Bincheng District, Binzhou, Shandong Province, 256600, China
| | - Xiaopeng Geng
- Department of Spine Surgery, Binzhou Medical University Hospital, 661 Second Huanghe road, Bincheng District, Binzhou, Shandong Province, 256600, China.
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Nonaka M, Komori Y, Isozaki H, Ueno K, Kamei T, Takeda J, Nonaka Y, Yabe I, Zaitsu M, Nakashima K, Asai A. Current status and challenges of neurosurgical procedures for patients with myelomeningocele in real-world Japan. Childs Nerv Syst 2023; 39:3137-3145. [PMID: 35907006 DOI: 10.1007/s00381-022-05613-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the real-world status of neurosurgical treatment of myelomeningocele patients. OBJECTIVE To investigate the real-world status of neurosurgical treatment of myelomeningocele patients, medical claims data provided by the Japan Medical Data Center (JMDC) were analyzed. METHODS The health claims data of 556 patients with myelomeningoceles from January 2005 to March 2020 were examined. The number of neurosurgical procedures, including myelomeningocele repair, tethered cord release, cerebrospinal fluid (CSF) shunt, CSF drainage, and endoscopic third ventriculostomy (ETV), was determined. RESULTS A total of 313 neurosurgical procedures were performed for 135 patients in 74 institutions during the study period. The shunt survival rate was most affected by shunts that were revised when the patient was less than 1 year old, which had a significantly lower survival rate than all of the initial shunts performed when the patient was less than on1 year old; the 1-year shunt survival rate was 35 vs 64% (P = 0.0102). The survival rate was significantly lower in patients younger than 1 year who had CSF drainage before shunting compared to those younger than 1 year who did not have CSF drainage before shunting; the 1-year shunt survival rate was 27 vs 59% (P = 0.0196), and 81% of patients remained free of tethered cord release 10 years later. CONCLUSIONS In this study, a revised shunt of less than 1 year of age and CSF drainage before shunting were the factors that lowered the shunt survival rate in the real world for CSF shunts for hydrocephalus associated with myelomeningocele.
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Affiliation(s)
- Masahiro Nonaka
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
| | - Yumiko Komori
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Haruna Isozaki
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Katsuya Ueno
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Takamasa Kamei
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Junichi Takeda
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Yuichiro Nonaka
- Department of Neurosurgery, Jikei Medical University, Minato-Ku, Tokyo, Japan
| | - Ichiro Yabe
- Department of Neurology, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Masayoshi Zaitsu
- Center for Research of the Aging Workforce, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Kenji Nakashima
- National Hospital Organization, Matsue Medical Center, Matsue, Shimane, Japan
| | - Akio Asai
- Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
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Liu J, Li R, Zhao J, Zhao Y, Wang Y, Yang D, Yu Y. Application of a Novel Versatile Mini Posterior Nasoseptal Graft in Endoscopic Transsphenoidal Pituitary Adenoma Surgery. J Craniofac Surg 2023; 34:2488-2491. [PMID: 37522424 PMCID: PMC10597421 DOI: 10.1097/scs.0000000000009573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/24/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Skull base reconstruction is a key technique in patients undergoing endoscopic transnasal skull base surgery. Although a pedicled nasoseptal flap (PNSF) is often used to repair large skull base defects with high-flow cerebrospinal fluid leakage, bone exposure of the donor site of the PNSF can result in long-term crusting. OBJECTIVE To design a novel and versatile mini posterior nasoseptal graft for the reconstruction of defects in the sellar floor or PNSF or pedicled nasoseptal rescue flap (PNSRF) donor site in patients undergoing pituitary adenoma surgery. METHODS Patients who underwent pituitary adenoma removal through an endoscopic endonasal approach and repair of a sellar defect or PNSF/PNSRF donor site using the mini posterior nasoseptal graft technique from January 2019 to January 2020 were retrospectively evaluated. Pituitary adenomas were removed using a binostril 4-hand technique through a transnasal transsphenoidal transsellar approach or an expanded transsellar approach. RESULTS Mini posterior nasoseptal grafts were successfully used in 70 patients who underwent pituitary adenoma removal through an endoscopic transsphenoidal sellar approach. Mini posterior nasoseptal grafts repaired sellar defects in 40 patients and donor site defects of the contralateral PNSF/PNSRF in 30 patients. None of these patients experienced cerebrospinal fluid leakage or major complications. CONCLUSIONS A mini posterior nasoseptal graft is a safe and effective technique for repairing sellar defects after endoscopic transnasal pituitary adenoma surgery. This technique can also be used to repair defects in PNSF/PNSRF donor sites.
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Affiliation(s)
- Jianfeng Liu
- Department of Otolaryngology-Head and Neck Surgery, China-Japan Friendship Hospital
| | - Rui Li
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Jianhui Zhao
- Department of Otolaryngology-Head and Neck Surgery, China-Japan Friendship Hospital
| | - Yu Zhao
- Department of Otolaryngology-Head and Neck Surgery, China-Japan Friendship Hospital
| | - Yibei Wang
- Department of Otolaryngology-Head and Neck Surgery, China-Japan Friendship Hospital
| | - Dazhang Yang
- Department of Otolaryngology-Head and Neck Surgery, China-Japan Friendship Hospital
| | - Yanbing Yu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
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Munthe S, Pedersen CB, Poulsen FR, Andersen MS, Børgesen SE. Ventriculosinus shunt: a pilot study to investigate new technology to treat hydrocephalus and mimic physiological principles of cerebrospinal fluid drainage. J Neurosurg 2023; 139:1412-1419. [PMID: 37086160 DOI: 10.3171/2023.3.jns222858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/06/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE Devices draining CSF to the intracranial venous sinus for the treatment of hydrocephalus have been tested in the past, and while clinically effective, have not shown efficacy in the long term. The majority of these devices become obstructed within 3 months due to endothelial overgrowth. In this study, the authors investigated a newly developed ventriculosinus (VS) shunt outlet device with the objective of showing it would remain patent for at least 6 months. METHODS Twelve patients in need of shunting for hydrocephalus underwent an operation using the investigational device and were followed for 6 months to record patency of the shunt. RESULTS In 10 patients, the shunt was patent at 6 months, with the outlet device remaining unobstructed. In the remaining 2 patients, one died just before reaching the 6-month endpoint, and in the other the outlet was misplaced during surgery and therefore ceased to function after 3 months. No occlusion of the internal jugular vein or thrombus formation was noted in any of the 12 cases. CONCLUSIONS These findings indicate that the outlet device can remain patent and has the capability to mimic physiological drainage by diverting CSF to the intracranial sinus. Additional confirmation of its potential as part of a new VS shunt system and ultimately as a viable alternative for ventriculoperitoneal and ventriculoatrial shunting to reduce complication rates requires further clinical trials.
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Affiliation(s)
- Sune Munthe
- 1Department of Neurosurgery, Odense University Hospital, Odense
- 2Department of Clinical Research and BRIDGE (Brain Research Inter-Disciplinary Guided Excellence), University of Southern Denmark, Odense; and
| | - Christian Bonde Pedersen
- 1Department of Neurosurgery, Odense University Hospital, Odense
- 2Department of Clinical Research and BRIDGE (Brain Research Inter-Disciplinary Guided Excellence), University of Southern Denmark, Odense; and
| | - Frantz Rom Poulsen
- 1Department of Neurosurgery, Odense University Hospital, Odense
- 2Department of Clinical Research and BRIDGE (Brain Research Inter-Disciplinary Guided Excellence), University of Southern Denmark, Odense; and
| | - Mikkel Schou Andersen
- 1Department of Neurosurgery, Odense University Hospital, Odense
- 2Department of Clinical Research and BRIDGE (Brain Research Inter-Disciplinary Guided Excellence), University of Southern Denmark, Odense; and
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Jin JY, Yu M, Xu RF, Sun Y, Li BH, Zhou FF. Risk Factors for Cerebrospinal Fluid Leakage After Extradural Spine Surgery: A Meta-Analysis and Systematic Review. World Neurosurg 2023; 179:e269-e280. [PMID: 37625633 DOI: 10.1016/j.wneu.2023.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage is 1 of the common complications of spine surgery and is largely caused by intraoperative or postoperative dural tears. Associations of different factors with postoperative CSF leakage have not been consistent. In this study we aimed to identify demographic, disease-related, and surgical risk factors for CSF leakage after extradural spine surgery in a systematic review and meta-anlysis. METHODS The PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Wanfang data, Chinese Weipu Database, and SinoMed databases were searched from inception until October 24, 2022. Fixed-effects or random-effects models were used to calculate odds ratios and 95% confidence intervals. The quality of observational studies was evaluated using the Newcastle-Ottawa scale instrument. RESULTS A total of 15 observational studies with 1,719,923 participants were included in this systematic review. All studies had a Newcastle-Ottawa scale score greater than or equal to 6. Age older than 70 years, smoking, ossification of the posterior longitudinal ligament, adhesion of spinal dura, spinal canal stenosis, cervical fracture, spondylolisthesis, revision surgery, and multiple surgical segments were all related to CSF leakage in the pooled analysis. Obesity and disease duration>1 year were not associated with the leakage of CSF. CONCLUSIONS This study will provide a reference for the identification of patients at high risk of developing CSF leakage, which suggests clinicians to strengthen the observation of drainage fluid in high-risk groups.
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Affiliation(s)
- Ji-Yan Jin
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China
| | - Miao Yu
- Department of Nursing, Peking University Third Hospital, Beijing, PR China
| | - Rui-Feng Xu
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China
| | - Yu Sun
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China
| | - Bao-Hua Li
- Department of Neurology, Peking University Third Hospital, Beijing, PR China
| | - Fei-Fei Zhou
- Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, PR China.
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Frankort J, Mees B, Doukas P, Keszei A, Kontopodis N, Antoniou GA, Jacobs MJ, Gombert A. Systematic Review of the Effect of Cerebrospinal Fluid Drainage on Outcomes After Endovascular Descending Thoracic/Thoraco-Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2023; 66:501-512. [PMID: 37182608 DOI: 10.1016/j.ejvs.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/07/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE This study aimed to investigate whether prophylactic use of cerebrospinal fluid (CSF) drainage in endovascular descending thoracic aortic aneurysm (DTAA) and thoraco-abdominal aortic aneurysm (TAAA) repair contributes to a lower rate of post-operative spinal cord ischaemia (SCI). DATA SOURCES MEDLINE, Embase, and CINAHL. REVIEW METHODS A literature review was conducted in accordance with PRISMA guidelines (PROSPERO registration no. CRD42021245893). Risk of bias was assessed through the Newcastle-Ottawa scale (NOS), and the certainty of evidence was graded using the GRADE approach. A proportion meta-analysis was conducted to calculate the pooled rate and 95% confidence interval (CI) of both early and late onset SCI. Pooled outcome estimates were calculated using the odds ratio (OR) and associated 95% CI. The primary outcome was SCI, both early and lateonset. Secondary outcomes were complications of CSF drainage, length of hospital stay, and peri-operative (30 day or in hospital) mortality rates. RESULTS Twenty-eight observational, retrospective studies were included, reporting 4 814 patients (2 599 patients with and 2 215 without CSF drainage). The NOS showed a moderate risk of bias. The incidence of SCI was similar in patients with CSF drainage (0.05, 95% CI 0.03 ‒ 0.08) and without CSF drainage (0.05, 95% CI 0.00 ‒ 0.14). No significant decrease in SCI was found when using CSF drainage (OR 0.67, 95% CI 0.29 ‒ 1.55, p = .35). The incidence rate of CSF drainage related complication was 0.10 (95% CI 0.04 ‒ 0.19). The 30 day and in hospital mortality rate with CSF drainage was 0.08 (95% CI 0.05 ‒ 0.12). The 30 day and in hospital mortality rate without CSF drainage and comparison with late mortality and length of hospital stay could not be determined due to lack of data. The quality of evidence was considered very low. CONCLUSION Pre-operative CSF drainage placement was not related to a favourable outcome regarding SCI rate in endovascular TAAA and DTAA repair. Due to the low quality of evidence, no clear recommendation on pre-operative use of CSF drainage placement can be made.
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Affiliation(s)
- Jelle Frankort
- Department of Vascular Surgery, European Vascular Centre Aachen-Maastricht, RWTH Aachen, Aachen, Germany; Department of Vascular Surgery, European Vascular Centre Maastricht-Aachen, MUMC Maastricht, Maastricht, The Netherlands.
| | - Barend Mees
- Department of Vascular Surgery, European Vascular Centre Maastricht-Aachen, MUMC Maastricht, Maastricht, The Netherlands
| | - Panagiotis Doukas
- Department of Vascular Surgery, European Vascular Centre Aachen-Maastricht, RWTH Aachen, Aachen, Germany
| | - Andràs Keszei
- Centre for Translational & Clinical Research Aachen (CTC-A), University Hospital RWTH Aachen, Aachen, Germany
| | - Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Michael J Jacobs
- Department of Vascular Surgery, European Vascular Centre Aachen-Maastricht, RWTH Aachen, Aachen, Germany; Department of Vascular Surgery, European Vascular Centre Maastricht-Aachen, MUMC Maastricht, Maastricht, The Netherlands
| | - Alexander Gombert
- Department of Vascular Surgery, European Vascular Centre Aachen-Maastricht, RWTH Aachen, Aachen, Germany
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Gazzeri R, Galarza M, Callovini G. Use of tissue sealant patch (TachoSil) in the management of cerebrospinal fluid leaks after anterior cervical spine discectomy and fusion. Br J Neurosurg 2023; 37:1406-1409. [PMID: 33538190 DOI: 10.1080/02688697.2021.1881444] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to evaluate a fast, sutureless technique to repair anterior cervical dural tears. Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for the treatment of cervical degenerative diseases. Although uncommon, incidental durotomy with cerebrospinal fluid (CSF) leak during ACDF is a potentially serious complication. Yet, its technical management for the prevention of CSF leak is controversial. METHODS Between September 2012 and June 2018 we encountered seven cases (2 female/5 male) presenting with intraoperative CSF leaks secondary to incidental dural tears during ACDF surgery. All the cases were surgically treated using a topical fibrin sealant patch (TachoSil) with high adesive strength and fibrin glue (Tisseel). Intraoperative source of leakage, time to leakage control, quantity of Sealant Sponge used and postoperative complications were evaluated. RESULTS Dural tears were tipically the result of dissection of adherent posterior longitudinal ligament and/or calcified disc from the cervical dural sac to allow full decompression of the spinal cord. Effective repair of dural tear defined as cessation of CSF leak after topical sealant agents application was achieved no later than one minute in all cases. Evident clinical and/or radiological postoperative CSF leak was used to determine the patient's postoperative result. Postoperative CSF leak was not evident during a minimum 6 months follow up. CONCLUSIONS In the present study, we have reported our experience with a new sealing technique to manage CSF leaks from iatrogenic cervical dural lacerations. Tachosil tissue sealant patch is a rapid sutureless technique that may help in repairing introperatively incidental dural tears, thus reducing the risk of postoperative CSF leaks. To our knowledge, this is the first series to report the use of Tachosil adhesive sealant patch for the treatment of incidental dural tears during anterior cervical discectomy.
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Affiliation(s)
- Roberto Gazzeri
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy
- Department of Neurosurgery, Istituto Nazionale Tumori "Regina Elena", Rome, Italy
| | - Marcelo Galarza
- Regional Service of Neurosurgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | - Giorgio Callovini
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy
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50
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Miller EM, Raymond MJ, Ottinger AM, Yazdani M, Meyer TA. Outcomes of Spontaneous Cerebrospinal Fluid Leak Repair With Concurrent Eustachian Tube Dysfunction. Otol Neurotol 2023; 44:896-902. [PMID: 37590873 DOI: 10.1097/mao.0000000000003992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To compare the presentation and outcomes of patients with and without obstructive eustachian tube dysfunction (oETD) undergoing repair of lateral skull base spontaneous cerebrospinal fluid (sCSF) leaks. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Adults with lateral skull base sCSF leaks who underwent repairs from January 1, 2011, to December 31, 2020, were collected. MAIN OUTCOME MEASURE Comparative statistics and effect sizes were used to compare clinical features, operative findings, and outcomes between groups. RESULTS Of 92 ears from 89 patients included, 51.1% (n = 47) had oETD. There were no differences in demographics between patients with and without oETD. Mean age was 60.7 ± 13.1 versus 58.5 ± 12.8 years ( d = -0.17 [-0.58 to 0.24]), mean body mass index was 33.8 ± 8.5 versus 36.0 ± 8.0 kg/m 2 ( d = 0.27 [-0.14 to 0.68]), and female sex preponderance was 59.6% (n = 28) versus 68.8% (n = 31; Φ = -0.09), respectively. There were no differences in the radiologic number, size, and locations of defects. Patients with oETD had less pneumatized mastoids than those without oETD ( p = 0.001; Φ = 0.43). Mean change from preoperative to postoperative air pure-tone average for those with and without oETD was -1.1 ± 12.6 versus 0.1 ± 17.2 dB ( d = 0.09 [-0.04 to 0.58]), respectively. Six ears (6.5%; three with and three without oETD) underwent revisions for rhinorrhea/otorrhea between 5 and 28 months postoperatively, during which four leaks were found, the two patients without leaks had oETD. CONCLUSIONS The presentation of sCSF leaks and outcomes of repairs in patients with oETD do not differ from those without oETD. Although postoperative otorrhea might represent an inflammatory or infectious process in patients with oETD, reexploration is warranted if patients do not improve with conservative treatment.
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Affiliation(s)
- Emma Marin Miller
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - Allie M Ottinger
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Milad Yazdani
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Ted A Meyer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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