Graded Repair of Cranial Base Defects and Cerebrospinal Fluid Leaks in Transsphenoidal Surgery

Esposito, Felice; Dusick, Joshua R.; Fatemi, Nasrin; Kelly, Daniel F.

doi:10.1227/01.neu.0000255354.64077.66

Cited by 282 publications

(330 citation statements)

References 44 publications

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“…It enhances adhesion of the graft, when used, avoiding the need for nasal packing 10 . Esposito et al 3 describe a grading system of transsphenoidal CSF fistula from zero to four (based on the size of the CSF fistula) and respective treatment according to the classification. This author indicates a reduction in the postoperative CSF fistula as a result of three modifications, including the use of biological glue.…”

Section: Discussionmentioning

confidence: 99%

“…Schloffer and Harvey Cushing proposed a transseptal transsphenoidal approach to the pituitary gland in the beginning of 1900s. After removing the tumor, a strategy is needed to avoid the postoperative cerebrospinal fluid (CSF) fistula and related complications like meningitis, abscess, subdural hematoma and pneumoencephalus 3,4 . The postoperative CSF fistula remains the most serious complication after transsphenoidal surgery 5 .…”

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confidence: 99%

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Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Romero

Nora

Topczewski

et al. 2010

Arq. Neuro-Psiquiatr.

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background: Postoperative cerebrospinal fluid (CSF) fistula is the most serious complication after transsphenoidal surgery. Objective: To analyze the incidence of CSF fistula after endoscopic transsphenoidal surgery for tumor removal in sellar region; to discuss associated factors and methods used for sellar closure. Method: Retrospective study of 67 patients (73 surgeries) operated via transsphenoidal endoscopy at Hospital Vall D'Hebron and Hospital Clinic of the Universidad de Barcelona, Spain. The data collected included: age, sex, hospitalization stay, suprasellar extension of the lesion, type of tumor, evidence of intraoperative CSF fistula, complications of postoperative CSF fistula, previous surgery and radiotherapy. results: Six patients (8.2%) had postoperative CSF fistula, and their average hospitalization was 5 days longer with resulting complications: two of whom had pneumoencephalus and two with meningitis. No association was found between the data collected and postoperative CSF fistula. conclusion: The rate of CSF fistula after endoscopic transsphenoidal surgery from the present study is contained within the literature. Unlike other reports, no association between the variables and postoperative CSF fistula was found in this report. Key words: cerebrospinal rhinorrhea, endoscopy, pituitary neoplasms.Fístula liquórica após cirurgia transesfenoidal endoscópica: experiência de um centro espanhol resuMO A fístula liquórica pós-operatória é a complicação mais séria após cirurgia transesfenoidal. Objetivo: Analisar a incidência de fístula liquórica após cirurgia endoscópica transesfenoidal para remoção de tumores selares, discutir fatores associados e método utilizado para fechamento selar. Método: Estudo retrospectivo de 67 pacientes (73 cirurgias) operados via endoscopia transesfenoidal no Hospital Vall D'Hebron e Hospital Clínic da Universidad de Barcelona, Espanha. Os dados coletados foram: idade, sexo, dias de internação, extensão supra-selar da lesão, tipo de tumor, evidência de fístula liquórica intra-operatória, complicações da fístula liquórica pós-operatória, cirurgia e radioterapia prévias. resultados: Seis pacientes (8.2%) tiveram fístula liquórica pós-operatória. Nestes a média de internação hospitalar foi 5 dias maior e tendo complicações decorrentes: dois com pneumoencéfalo e dois com meningite. Não se encontrou associação entre os dados coletados e fístula liquórica pós-operatória. conclusão: A taxa de fistula liquórica após cirurgia transesfenoidal endoscópica do presente estudo está dentro da literatura. Ao contrário de outros relatos, nesta pesquisa não foi encontrada associação entre as variáveis e fístula liquórica pós-operatória. Palavras-chave: endoscopia, neoplasias hipofisárias, rinorreia de líquido cefalorraquidiano.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Romero

Nora

Topczewski

et al. 2010

Arq. Neuro-Psiquiatr.

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“…The type of skull base reconstruction performed depends primarily on whether or not a CSF leak is present and, if so, on the size, location and severity of the leak [ 35 ]. All repairs involve the use of collagen sponge (Helistat, Integra, Plainsboro, NJ, USA) as part of the reconstruction which acts as a scaffolding for fibroblast in-growth and, ultimately, a vascularized dural replacement [ 81 ].…”

Section: Skull Base Reconstruction and Csf Leak Repairmentioning

confidence: 99%

Transsphenoidal endoscopic skull base surgery: state of the art and future perspective

Cutler

Barkhoudarian

Griffiths³

et al. 2013

Innovative Neurosurgery

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Given refinements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques and anatomical understanding, the endonasal endoscopic approach is now a well-accepted and widely utilized technique for removal of many if not most midline ventral skull base tumors. Pituitary adenomas and Rathke ' s cleft cysts (RCCs) constitute the majority of lesions removed via this route; however, craniopharyngiomas, clival chordomas, midline meningiomas and other benign and malignant skull base tumors are now increasingly removed by this approach. Herein we describe the evolution of the endonasal endoscopic technique, its current use for sellar and midline skull base tumors and potential for future innovation.

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“…For example, various methods for sellar floor repair have been devised [17][18][19][20][21]. The nasoseptal flap has significantly reduced the incidence of CSF leaks [10].…”

Section: Management Of Csf Leaksmentioning

confidence: 99%

“…Two reported cases of herniation after intraoperative lumbar drainage recovered with the use of an epidural blood patch [41]. In another documented case of transtentorial herniation following LD [18], the patient was able to follow commands after the LD was clamped for eight hours. Thus, they suggested that the removal of CSF below the tentorium augmented the pressure gradient between the supratentorial and lumbar cistern promoting tentorial herniation [42].…”

Section: Major Complicationsmentioning

confidence: 99%

Perioperative Cerebrospinal Fluid Diversion Utilizing Lumbar Drains in Transsphenoidal Surgery

Shah¹

2013

J Neurol Disord

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Graded Repair of Cranial Base Defects and Cerebrospinal Fluid Leaks in Transsphenoidal Surgery

Cited by 282 publications

References 44 publications

Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Transsphenoidal endoscopic skull base surgery: state of the art and future perspective

Perioperative Cerebrospinal Fluid Diversion Utilizing Lumbar Drains in Transsphenoidal Surgery

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