Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Leaks Using Multilayer Composite Graft and Vascularized Pedicled Nasoseptal Flap Technique

Kim-Orden, Natalie; Shen, Jasper; Or, Maya; Hur, Kevin; Zada, Gabriel; Wrobel, Bozena

doi:10.1177/2152656719888622

Cited by 12 publications

(12 citation statements)

References 45 publications

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“…The complica ons are persistent lumbar leak, over drainage and retained catheter. 15,37 It adds financial burden and length of hospital stay. A retrospec ve study by Casiano et al reported that there was greater than 95% success rate in endoscopic repair of CSF rhinorrhea with defect size varied from a micro to 3-cm 38 defects in first a empt without use of lumbar drain.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Repair of Cerebrospinal Fluid (CSF) Rhinorrhea with Multilayer Grafts

Manandhar

Meghanadh²,

Reddy

2021

Birat J. Health Sci.

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Introduction: Endoscopic repair of Cerebrospinal fluid (CSF) rhinorrhea has been the most popular and the most accepted among the Otorhinolaryngologists. The advancement in the endoscopes enable surgeons to manage cerebrospinal fluid rhinorrhea adequately with good result. Objective: The aim of this study was to evaluate the outcome of endoscopic CSF rhinorrhea repair with multilayer grafts. Outcome was identified in terms of postoperative complications like infection (mainly meningitis), nasal bleeding, graft failure and CSF leak, revision surgery. Methodology: A retrospective prospective study was conducted in 21 patients who had undergone endoscopic CSF rhinorrhea repair with use of multilayer grafts in a period of January 2016 to December 2018 in Department of ENT and Head and Neck Surgery in MAA ENT HOSPITAL, HYDERABAD, INDIA. All the patients were diagnosed according to history, clinical examination, diagnostic nasal endoscopy, CSF fluid analysis and radiological investigation. The materials used for the repair of CSF rhinorrhea were surgicel, temporalis fascia, conchal chondroperichrondrium, middle turbinate free mucoperiosteum graft, thigh fat and fascia lata. The follow up period of patients range from 14-44 months. The outcome of endoscopic CSF repair with use of multilayer grafts was evaluated by electronic records regarding recurrence of CSF rhinorrhea post-surgery, hospital admission, revision surgery and digital record of rigid endoscopic findings for the status of graft uptake and CSF leak. Results: In all patients, CSF leak was successfully repaired with use of multilayer grafts in first attempt without any complication. There was female predominance with male to female ratio of 1:6.The mean age of presentation was 43.09years. All 21 patients were presented with spontaneous CSF leak with unknown cause. In 21 patients only one patient presented with bilateral cerebrospinal fluid leak. Cribri form plate was the commonest site of defect in which defect medial to middle turbinate was the commonest followed by ethmoid roof and lateral wall of sphenoid. None of the patients developed meningitis after surgery. None of the patients required lumbar drain. None of the patients presented with cerebrospinal fluid rhinorrhea postoperatively. Conclusions: Endoscopic repair of Cerebrospinal fluid rhinorrhea with the use of multilayer grafts is the safer and effective method with good outcome.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Repair of Cerebrospinal Fluid (CSF) Rhinorrhea with Multilayer Grafts

Manandhar

Meghanadh²,

Reddy

2021

Birat J. Health Sci.

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“…This local packing mechanism acts like a thumb pressing continually, Figs. (4,5) creating persistent low grade positive pressure over the graft, blocking any leak until proper adhesions and healing to be established and at the same time the pressure will not interfere with blood supply and capillary circulation at the area of healing.…”

Section: Discussionmentioning

confidence: 99%

“…Some cases of spontaneous, or primary CSF rhinorrhea are now thought actually to be secondary to elevations in Intracranial Pressure (ICP) that might be seen in patients with Idiopathic Intracranial Hypertension (IIH). Congenital skull base defects and certain tumors can also lead to CSF rhinorrhea [4] .…”

Section: Introductionmentioning

confidence: 99%

The Key Role of Packing Technique for Successful Endoscopic Repair of CSF Rhinorhea

Alzamil

Wael²

2021

The Medical Journal of Cairo University

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Background: Spontaneous CSF leaks are rare, their diagnosis is often delayed, and they can precipitate meningitis. Craniotomy and intracranial approach is the historical "gold standard" repair for these leaks [1] . Anendonasal endoscopic approach offers potentially less invasiveness and lower surgical morbidity than a traditional craniotomy but must yield the same surgical success [2] . Recurrence of these leaks is not uncommon. One of the most important factors of this recurrence is inadequate support of the flaps or grafts or loose cooptation of raw surfaces which may be unable to resist the normotensive CSF leak. Maintaining adequate continuous low grade pressure intraoperativelyand two weeks postoperatively may optimize the best chance for raw areas to heal properly with minimal recurrence. Aim of Study:The aim of this study is to identify and discuss the pivotal role of intraoperative packing and its technique to obtain a successful repair of CSF rhinorrhea. Patients and Methods:A prospective randomized study conducted on 14 patients suffering spontaneous CSF rhinorrhea, from March 2018 to April 2020 in Hearing and Speech Institute. The 14 patients have been divided into two equal groups 7 patients each, group A and group B. In group A, traditional nasal packing was done, whoever, in group B, the special packing was done in the form two packs, the first pack over the grafted area was two layered composed of 1mm thickness silasticsheet over the graft and raw area and a piece of Merocel 1 by 1.5cmms supporting the silastic sheet. The second pack was placed in the nasal cavity. The first pack has been changed weekly to two or three weeks then removed finally.Results: All patients were doing well throughout the follow-up period. In group A, there was recurrence in fourpatients, two after six months and two after one year. In group B there was one recurrence after one year of follow-up.

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“…1 For both low-flow and high-flow sites, use of a multilayer closure has demonstrated higher success rates than single layer reconstructive techniques. [5][6][7][8][9][10][11][12] Additional, selection criteria for a repair technique include the anterior-posterior location ( Figure 1) and the size of the defect. Several classification systems have been developed to incorporate these variables in an effort to accurately describe skull base defects and facilitate treatment standardization.…”

Section: General Principles Of Repairsmentioning

confidence: 99%

“…High‐flow sites (where a direct communication exists between brain cisterns/ventricles and an arachnoid membrane defect) are most successfully reconstructed using vascular pedicled flaps 1 . For both low‐flow and high‐flow sites, use of a multilayer closure has demonstrated higher success rates than single layer reconstructive techniques 5‐12 …”

Section: General Principles Of Repairsmentioning

confidence: 99%

Vascular pedicled flaps for skull base defect reconstruction

Gutierrez

Bennion

Walsh

et al. 2020

Laryngoscope Investig Oto

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Objective: Techniques for reconstruction of skull base defects have advanced greatly since the introduction of the vascular pedicled nasoseptal flap in 2006. The objective of this review is to assess the current state of the field by examining both intranasal and extranasal techniques of vascular pedicled skull base defect repair, their indications and success rates, and novel techniques that are currently under investigation. Methods: A review of the literature describing the use of vascular pedicled flaps in skull base defect reconstruction was conducted using PubMed and Google Scholar. Results: The nasoseptal flap remains the most widely used vascular pedicled flap for endoscopic repair of skull base defects. Its ease of harvest, wide arch of rotation, and high success rates make it a popular choice among surgeons. Several variations including a "rescue" nasopseptal flap have been developed. Other less commonly used pedicled intranasal flaps include the middle turbinate flap and the posterior pedicled inferior turbinate flap. Additionally, several novel vascular pedicled flaps have been developed and tested in small cohorts of patients. Extranasal flaps such as the pericranial flap and the temporoparietal fascia flap are used less frequently than intranasal flaps. However, they remain valuable options for reconstruction in certain situations. Conclusion: Advancements continue to be made in the field of skull base defect reconstruction using vascular pedicled flaps. Though the nasoseptal flap remains the most widely utilized option, additional intranasal techniques continue to be developed and tested to optimize surgical outcomes and patient care.

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Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Leaks Using Multilayer Composite Graft and Vascularized Pedicled Nasoseptal Flap Technique

Cited by 12 publications

References 45 publications

Endoscopic Repair of Cerebrospinal Fluid (CSF) Rhinorrhea with Multilayer Grafts

Endoscopic Repair of Cerebrospinal Fluid (CSF) Rhinorrhea with Multilayer Grafts

The Key Role of Packing Technique for Successful Endoscopic Repair of CSF Rhinorhea

Vascular pedicled flaps for skull base defect reconstruction

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