Endoscopic pedicled nasoseptal flap repair of spontaneous sphenoid sinus cerebrospinal fluid leaks

Gunaratne, Dakshika A.; Singh, Narinder

doi:10.1136/bcr-2014-209157

Cited by 3 publications

(5 citation statements)

References 22 publications

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“…With regard to the placement of the nasal septum mucosal flap into the posterior nostril for preparation, it was performed based on previous literature reporting the repair of spontaneous CSF leakage by taking a nasal septal pedicled skin flap under the nasal endoscope. [ 10 ] Nasal septal flap is a mucoperiosteum or mucoperichondrium that is connected to the arteria nasalis posterior septi. The nasal septum mucosal flap, used for repair of the spontaneous sphenoid cerebrospinal fluid leakage in the present study, may represent an important progress in the development of endoscopic CSF rhinorrhea repair technology.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous cerebrospinal fluid rhinorrhea

Chen¹,

Ma²,

Xu³

et al. 2018

Medicine

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Introduction:Spontaneous cerebrospinal fluid leakage is usually caused by developmental abnormalities and is rare, accounting for approximately 5% of the cases of cerebrospinal fluid (CSF) leakage.[1] To the best of our knowledge, clival dysplasia-caused CSF rhinorrhea has never been reported in the neurosurgical field.Conclusion:Spontaneous cerebrospinal fluid rhinorrhea is often treated by surgery, and a transsphenoidal approach repair is the main surgical method used, offering the advantages of less trauma, fewer complications, rapid postoperative recovery, and low recurrence rate.

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Section: Discussionmentioning

confidence: 99%

Spontaneous cerebrospinal fluid rhinorrhea

Chen¹,

Ma²,

Xu³

et al. 2018

Medicine

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“…There were no failures after primary surgery with a mean follow-up time of 14.9 months. And finally, Gunaratne and Singh 33 reported a case series of 3 patients, without LD placement, who underwent sCSF leak repair with DuraGen (Integra, Plainsboro, NJ), septal cartilage or middle turbinate bone, layered with unilateral or bilateral NSF. No patients had recurrence with a mean follow-up period of 30 months.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16][21][22][23]34,35 Recent evidence-based algorithms have established NSFs as the primary workhorse for larger defects and high-flow leaks. 17,[29][30][31][32][33][34] One review showed an overall success rate of 94% for all CSF leaks while free grafts provided an 82% success rate. 34 In addition, fascia lata, as opposed to temporalis fascia, offers a very durable, bountifully available material with minimal harvest morbidity that can be harvested by a second team simultaneously.…”

Section: Scsf Leak Repair Graftsmentioning

confidence: 99%

“…29 Multiple studies have reported success rates of closure ranging from 90% to 95% of large skull base defects, high-flow CSF leaks, and clival defects with the addition of the NSF. 17,[29][30][31][32][33][34] However, this literature analyzed all etiologies of CSF leak or focused on repair of iatrogenic leaks. The most effective surgical technique is undetermined and varies widely because of limited evidence-based guidance.…”

Section: Introductionmentioning

confidence: 99%

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

Kim-Orden

Shen

et al. 2019

Allergy�Rhinol (Providence)

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BackgroundEndoscopic repair of cerebrospinal fluid (CSF) fistulas is a fundamental practice in anterior skull base surgery due to high success rates and low morbidity profile. However, spontaneous CSF (sCSF) leaks have the highest recurrence rate compared to other etiologies. The most effective management is undetermined due to variations in graft materials and limited evidence.ObjectiveWe present the largest study of a standardized endoscopic repair technique for sCSF leaks.MethodsSingle-institution retrospective review of patients who underwent endoscopic sCSF leak repair between October 2011 and January 2018. All patients underwent repair using a temporary lumbar drain, intrathecal fluorescein, and multilayer reconstruction using bilayered fascia lata autograft and vascularized nasoseptal flap.ResultsTwenty patients (100% female, mean age: 53.2 years) with 25 separate sCSF leak sites were included. Obesity was present in 15 of 20 patients (mean body mass index [BMI] = 35.3). No patients had previous sinus surgery. Locations of skull base defects included: cribriform plate (44%), ethmoid (32%), lateral sphenoid (12%), and planum sphenoidale (12%). The mean follow-up was 22.8 months and 92% of the leak sites (23/25) were successfully repaired primarily. There were no neurological complications or cases of meningitis. Two patients (mean BMI = 52) with persistent postoperative CSF leaks and elevated intracranial pressure were successfully managed with ventriculoperitoneal shunt placement. BMI was associated with likelihood of repair failure (P = .003).ConclusionsAt our institution, endoscopic repair of sCSF leaks using a composite autograft of fascia and a nasoseptal flap demonstrates high success rates. Elevated BMI was a statistically significant risk factor for revision.

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“…Without intervention, the risk of developing meningitis is estimated to be 10% annually and 40% in the long term [10]. Surgical intervention remains the panacea for managing iatrogenic CSF leakages [11].…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Leakage During Temporal Bone Surgery: Selecting Intra-operative Dural Closure with a Dumbbell-Shaped Muscle Graft as a Surgical Approach

Yazdani

Khorsandi-Ashtiani

Tashakorinia

et al. 2017

Indian J Otolaryngol Head Neck Surg

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Cerebrospinal fluid (CSF) leakages of the temporal bone may arise during mastoid surgery. The leakages can have multiple potential etiologies, for instance, using a cutting burr near the bony tegmen or monopolar electrocautery on the surface of the dura mater. In this paper, we introduced an effective and simple technique for the management of CSF leakages of the temporal bone. In a prospective case series, 36 patients (16 males and 20 females) who have had an experience of incidental or inevitable CSF otorrhea or otorhinorrhea during temporal bone surgery were selected. All patients were treated using a muscle graft in a dumbbell-shaped design through the dura defect at the Amir-Alam University Hospital between April 2005 and November 2008. The mean size of the defects was 5 mm (a range of 2-10 mm). A dumbbell-shaped autologous muscle graft was immediately successful in sealing the leakage in all patients. Only five patients (13.8%) had some evidence of leakage remaining on the day after the operation, which was subsequently resolved by conservative management in four of them (11.1%). Only one patient (2.7%) was subjected to a second operation for a new defect. Recurrence of CSF leakage or other related complications were not observed during about 7 years of follow up. A free autologous muscle graft, using the dumbbell technique through a small to moderate dura defect is an effective, easily performed, and safe method to seal iatrogenic leakages of the temporal bone.

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Endoscopic pedicled nasoseptal flap repair of spontaneous sphenoid sinus cerebrospinal fluid leaks

Cited by 3 publications

References 22 publications

Spontaneous cerebrospinal fluid rhinorrhea

Spontaneous cerebrospinal fluid rhinorrhea

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

Cerebrospinal Fluid Leakage During Temporal Bone Surgery: Selecting Intra-operative Dural Closure with a Dumbbell-Shaped Muscle Graft as a Surgical Approach

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