Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model

Chitguppi, Chandala; Rimmer, Ryan; Garcia, Hermes; Koszewski, Ian J.; Fastenberg, Judd H.; Nyquist, Gurston; Rosen, Marc; Huntley, Colin; Rabinowitz, Mindy; Evans, James J.

doi:10.1002/alr.22313

Cited by 15 publications

(23 citation statements)

References 13 publications

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“…Our group has previously taken initial steps to determine the safety of CPAP use post‐ETS for pituitary adenoma. In a 2019 study, Chitguppi et al used pressure sensors in cadaveric head models and found that NSF reconstruction was able to withstand CPAP pressure of 20 cmH 2 O 11 . Future studies in healthy volunteers and eventually patients undergoing ETS for pituitary adenoma may determine the feasibility of restarting CPAP early in these patients with an aim to mitigate the risk of PLS.…”

Section: Discussionsupporting

confidence: 77%

Predicting prolonged length of stay after endoscopic transsphenoidal surgery for pituitary adenoma

Vimawala

Chitguppi

Reilly

et al. 2020

Int Forum Allergy Rhinol

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Background: Endoscopic transsphenoidal surgery (ETS) for the resection of pituitary adenoma has become more common throughout the past decade. Although most patients have a short postoperative hospitalization, others require a more prolonged stay. We aimed to identify predictors for prolonged hospitalization in the se ing of ETS for pituitary adenomas. Methods: A retrospective chart review as performed on 658 patients undergoing ETS for pituitary adenoma at a single tertiary care academic center from 2005 to 2019. Length of stay (LoS) was defined as date of surgery to date of discharge. Patients with LoS in the top 10th percentile (prolonged LoS [PLS] >4 days, N = 72) were compared with the remainder (standard LoS [SLS], N = 586). Results:The average age was 54 years and 52.5% were male. The mean LoS was 2.1 days vs 7.5 days (SLS vs PLS). On univariate analysis, atrial fibrillation (p = 0.002), hypertension (p = 0.033), partial tumor resection (p < 0.001), apoplexy (p = 0.020), intraoperative cerebrospinal fluid (ioCSF) leak (p = 0.001), nasoseptal flap (p = 0.049), postoperative diabetes insipidus (DI) (p = 0.010), and readmis-sion within 30 days (p = 0.025) were significantly associated with PLS. Preoperative continuous positive airway pressure (CPAP) (odds ratio, 15.144; 95% confidence interval, 2.596-88.346; p = 0.003) and presence of an ioCSF leak (OR, 10.362; 95% CI,; p = 0.004) remained significant on multivariable analysis. Conclusion:For patients undergoing ETS for pituitary adenomas, an ioCSF leak or preoperative use of CPAP predicted PLS. Additional common reasons for PLS included postoperative CSF leak (10 of 72), management of DI or hypopituitarism (15 of 72), or reoperation due to surgical or medical complications (14 of 72). C 2020 ARS-AAOA, LLC.

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Section: Discussionsupporting

confidence: 77%

Predicting prolonged length of stay after endoscopic transsphenoidal surgery for pituitary adenoma

Vimawala

Chitguppi

Reilly

et al. 2020

Int Forum Allergy Rhinol

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“…Chitguppi et al used the same cadaveric model and showed that the reconstruction of a sellar defect with a nasoseptal flap was able to withstand breach at all delivered CPAPs. 22 Furthermore, the weakest repair with an onlay of oxidized cellulose was able to withstand up to 12 cmH 2 O of pressure. The mean CPAP required for most people is 9.7 AE 2.6 cmH 2 O, which suggests that CPAP may be safe in selected patients based on the reconstructive algorithm used.…”

Section: Discussionmentioning

confidence: 97%

Qualitative Assessment of the Effect of Continuous Positive Airway Pressure on the Nasal Cavity

Reilly

Huntley

Boon

et al. 2020

Am J Rhinol�Allergy

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Background For patients with obstructive sleep apnea (OSA), there is a lack of knowledge regarding the impact of continuous positive airway pressure (CPAP) on the nasal cavity. There is a significant need for evidence-based recommendations regarding the appropriate use of CPAP following endoscopic sinus and skull base surgery. Objective The goal of this study is to translate a previously developed cadaveric model for evaluating CPAP pressures in the sinonasal cavity by showing safety in vivo and quantifying the effect of positive pressurized air flow on the nasal cavity of healthy individuals where physiologic effects are at play. Methods A previously validated cadaveric model using intracranial sensor catheters has proved to be a reliable technique for measuring sinonasal pressures. These sensors were placed in the nasal cavity of 18 healthy individuals. Pressure within the nose was recorded at increasing levels of CPAP. Results Overall, nasal cavity pressure was on average 85% of delivered CPAP. The amount of pressure delivered to the nasal cavity increased as the CPAP increased. The percentage of CPAP delivered was 77% for 5 cmH2O and increased to 89% at 20 cmH2O. There was a significant difference in mean intranasal pressures between all the levels of CPAP except 5 cmH2O and 8 cmH2O ( P < .001). Conclusion On average, only 85% of the pressure delivered by CPAP is transmitted to the nasal cavity. Higher CPAP pressures delivered a greater percentage of pressurized air to the nasal cavity floor. Our results are comparable to the cadaver model, which demonstrated similar pressure delivery even in the absence of anatomic factors such as lung compliance, nasal secretions, and edema. This study demonstrates the safety of using sensors in the human nasal cavity. This technology can also be utilized to evaluate the resiliency of various repair techniques for endoscopic skull base surgery with CPAP administration.

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“…In patients with known OSA, multi-layer skull base reconstruction with a nasoseptal flap may provide more robust resistance to postoperative CPAP and prevent postoperative complications. 12,21 Furthermore, 76% of respondents agreed that when OSA is suspected, a preoperative polysomnogram should be obtained.…”

Section: Discussionmentioning

confidence: 99%

“…10 Positive airway pressure may present risks to postoperative patients with skull base defects and most recent research has focused on postoperative management of OSA in patients undergoing endoscopic skull base surgeryfrom timing of CPAP initiation to modification of skull base reconstruction. 7,[11][12][13][14][15] Preoperative screening of surgical patients for OSA has been identified as a way to anticipate and mitigate potential postoperative risks posed by OSA. 6,16,17 However, little is currently known about practice patterns by endoscopic skull base surgeons to screen for OSA in this patient population.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Screening for Obstructive Sleep Apnea Prior to Endoscopic Skull Base Surgery: A Survey of the North American Skull Base Society

Rimmer

Chitguppi

D’Souza

et al. 2020

Allergy�Rhinol (Providence)

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Background Obstructive sleep apnea (OSA) is a commonly seen comorbidity in patients undergoing endoscopic skull base surgery and its presence may influence perioperative decision-making. Current practice patterns for preoperative screening of OSA are poorly understood. Objective The objective of this study was to assess how endoscopic skull base surgeons screen for OSA, and how knowledge of OSA affects perioperative decision-making. Methods Seven question survey distributed to members of the North American Skull Base Society. Results Eighty-eight responses (10% response rate) were received. 60% of respondents were from academic centers who personally performed >50 cases per year. Most respondents noted that preoperative knowledge of OSA and its severity affected postoperative care and increased their concern for complications. Half of respondents noted that preoperative knowledge of OSA and its severity affects intraoperative skull base reconstruction decision-making. 70% of respondents did not have a preoperative OSA screening protocol. Body mass index and patient history were most frequently used by those who screened. Validated screening questionnaires were rarely used. 76% of respondents agreed or somewhat agreed that a preoperative polysomnogram should ideally be performed for patients with suspected OSA; however, 50% of respondents reported that <20% of their patients with suspected OSA are advised to obtain a preoperative polysomnogram. Conclusion This study reveals that most endoscopic skull base surgeons agree that OSA affects postoperative patient care, but only a minority have a preoperative screening protocol in place. Additional study is needed to assess the most appropriate screening methods and protocols for OSA patients undergoing endoscopic skull base surgery.

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Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model

Cited by 15 publications

References 13 publications

Predicting prolonged length of stay after endoscopic transsphenoidal surgery for pituitary adenoma

Predicting prolonged length of stay after endoscopic transsphenoidal surgery for pituitary adenoma

Qualitative Assessment of the Effect of Continuous Positive Airway Pressure on the Nasal Cavity

Preoperative Screening for Obstructive Sleep Apnea Prior to Endoscopic Skull Base Surgery: A Survey of the North American Skull Base Society

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