Intracranial Complications before and after Endoscopic Skull Base Reconstruction

Harvey, Richard J.; Smith, Jacob E.; Wise, Sarah K.; Patel, Sunil; Frankel, Bruce; Schlosser, Rodney J.

doi:10.2500/ajr.2008.22.3223

Cited by 72 publications

(53 citation statements)

References 26 publications

(54 reference statements)

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“…This fact led, amongst others, to the introduction of the vascular pedicle intranasal mucoperiosteal flaps and to a consistently multilayered defect closure. The result was a reduction to less than 5% cerebrospinal fluid fistulas (in individual cases to no less than 20%) [70], [102], [182], [223], [248], [249], [250]. …”

Section: “Minor” Complicationsmentioning

confidence: 99%

“…In most cases this is decided individually, supporting a drainage in cases of large defects, heavy cerebrospinal fluid flow or increased cerebrospinal fluid pressure, history of radiotherapy or already preoperatively existing liquorrhea [182], [248]. An early drainage can help to relieve pressure variations within the area of transplantation during extubation [233].…”

Section: “Minor” Complicationsmentioning

confidence: 99%

“…In rhino-neurosurgical procedures, the postoperative rate of meningitis is about 1–3% [102], [237], [248], [501], [502]. Risk factors are: a history of craniotomy or endonasal surgery, surgery with high degree of difficulty, preexisting external ventricular drainage or ventriculoperitoneal shunt, cerebrospinal fluid fistula postoperatively.…”

Section: Severe or Threatening Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

Danger points, complications and medico-legal aspects in endoscopic sinus surgery

Hosemann

Draf

2013

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 12:Doc06; ISSN 1865-1011

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Section: “Minor” Complicationsmentioning

confidence: 99%

Section: “Minor” Complicationsmentioning

confidence: 99%

Section: Severe or Threatening Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Danger points, complications and medico-legal aspects in endoscopic sinus surgery

Hosemann

Draf

2013

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 12:Doc06; ISSN 1865-1011

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“…When there are reasons that preclude the use of autologous transplants, several alloplastic materials can be applied [51], [52], [53], [54], [55]. A uniform opinion on their suitability does not exist [40].…”

Section: Techniques and Executionmentioning

confidence: 99%

The transnasal approach to the skull base. From sinus surgery to skull base surgery

Wagenmann,

Schipper

2011

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 10:Doc08; ISSN 1865-1011

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“…10,19,35 While the incidence of CSF leaks after transsphenoidal surgery ranges from 1.5% to 10.3%, 43 rates associated with extended approaches for invasive skull base lesions have been reported to be as high as 19.4% in large series. 19 More recently, with the development of novel closure techniques, the leak rates have declined to less than 3%.…”

Section: Risk Of Csf Leaks Associated With Esbsmentioning

confidence: 99%

Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

Banu

Szentirmai

Mascarenhas

et al. 2014

JNS

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Object Postoperative pneumocephalus is a common occurrence after endoscopic endonasal skull base surgery (ESBS). The risk of cerebrospinal fluid (CSF) leaks can be high and the presence of postoperative pneumocephalus associated with serosanguineous nasal drainage may raise suspicion for a CSF leak. The authors hypothesized that specific patterns of pneumocephalus on postoperative imaging could be predictive of CSF leaks. Identification of these patterns could guide the postoperative management of patients undergoing ESBS. Methods The authors queried a prospectively acquired database of 526 consecutive ESBS cases at a single center between December 1, 2003, and May 31, 2012, and identified 258 patients with an intraoperative CSF leak documented using intrathecal fluorescein. Postoperative CT and MRI scans obtained within 1–10 days were examined and pneumocephalus was graded based on location and amount. A discrete 0–4 scale was used to classify pneumocephalus patterns based on size and morphology. Pneumocephalus was correlated with the surgical approach, histopathological diagnosis, and presence of a postoperative CSF leak. Results The mean follow-up duration was 56.7 months. Of the 258 patients, 102 (39.5%) demonstrated pneumocephalus on postoperative imaging. The most frequent location of pneumocephalus was frontal (73 [71.5%] of 102), intraventricular (34 [33.3%]), and convexity (22 [21.6%]). Patients with craniopharyngioma (27 [87%] of 31) and meningioma (23 [68%] of 34) had the highest incidence of postoperative pneumocephalus compared with patients with pituitary adenomas (29 [20.6%] of 141) (p < 0.0001). The incidence of pneumocephalus was higher with transcribriform and transethmoidal approaches (8 of [73%] 11) than with a transsellar approach (9 of [7%] 131). There were 15 (5.8%) of 258 cases of postoperative CSF leak, of which 10 (66.7%) had pneumocephalus, compared with 92 (38%) of 243 patients without a postoperative CSF leak (OR 3.3, p = 0.027). Pneumocephalus located in the convexity, interhemispheric fissure, sellar region, parasellar region, and perimesencephalic region was significantly correlated with a postoperative CSF leak (OR 4.9, p = 0.006) and was therefore termed “suspicious” pneumocephalus. In contrast, frontal or intraventricular pneumocephalus was not correlated with postoperative CSF leak (not significant) and was defined as “benign” pneumocephalus. The amount of convexity pneumocephalus (p = 0.002), interhemispheric pneumocephalus (p = 0.005), and parasellar pneumocephalus (p = 0.007) (determined using a scale score of 0–4) was also significantly related to postoperative CSF leaks. Using a series of permutation-based multivariate analyses, the authors established that a model containing the learning curve, the transclival/transcavernous approach, and the presence of “suspicious” pneumocephalus provides the best overall prediction for postoperative CSF leaks. Conclusions Postoperative pneumocephalus is much more common following extended approaches than following transsellar surgery. Merely the presence of pneumocephalus, particularly in the frontal or intraventricular locations, is not necessarily associated with a postoperative CSF leak. A “suspicious” pattern of air, namely pneumocephalus in the convexity, interhemispheric fissure, sella, parasellar, or perimesencephalic locations, is significantly associated with a postoperative CSF leak. The presence and the score of “suspicious” pneumocephalus on postoperative imaging, in conjunction with the learning curve and the type of endoscopic approach, provide the best predictive model for postoperative CSF leaks.

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Intracranial Complications before and after Endoscopic Skull Base Reconstruction

Cited by 72 publications

References 26 publications

Danger points, complications and medico-legal aspects in endoscopic sinus surgery

Danger points, complications and medico-legal aspects in endoscopic sinus surgery

The transnasal approach to the skull base. From sinus surgery to skull base surgery

Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

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