Role of Anterior Nasal Packing in Endoscopic Skull Base Surgery: Italian Survey

Ceraudo, Marco; Cavallo, Luigi Maria; Rossi, Diego Criminelli; Solari, Domenico; Anania, Pasquale; Canevari, Frank Rikki; Prior, Alessandro; Cappabianca, Paolo; Zona, Gianluigi

doi:10.1016/j.wneu.2021.07.031

Cited by 4 publications

(10 citation statements)

References 32 publications

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“…When approaching the technique for inset of the free flap at the skull base, principles of ESBS were considered including techniques in endoscopic skull base reconstruction. Modern reconstructive techniques employ various forms of absorbable and non‐absorbable sinonasal packing 44–46 . Thus, in all patients, a technique of absorbable sinonasal packing with tissue sealant at the superior flap margin and nasal trumpets at the inferior edge were employed for reinforcing and securing the flap at the skull base, which achieved flap integration at the region of ORN debridement.…”

Section: Discussionmentioning

confidence: 99%

“…Modern reconstructive techniques employ various forms of absorbable and non-absorbable sinonasal packing. [44][45][46] Thus, in all patients, a technique of absorbable sinonasal packing with tissue sealant at the superior flap margin and nasal trumpets at the inferior edge were employed for reinforcing and securing the flap at the skull base, which achieved flap integration at the region of ORN debridement. Last, through the utilization of a limited pharyngeal incision for microvascular anastomosis, we were able to achieve skull base and cervical spinal reconstruction without risk of airway compromise or swallowing dysfunction, eliminating requirement for a tracheostomy or feeding tube in the post-op setting.…”

Section: Discussionmentioning

confidence: 99%

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Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era

et al. 2022

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Objectives Osteoradionecrosis (ORN) of the skull base and craniovertebral junction is a challenging complication of radiation therapy (RT). Severe cases often require surgical intervention through a multi‐modal approach. With the evolution in endoscopic surgery and advances in skull base reconstruction, there is an increasing role for microvascular free tissue transfer (MFTT). We describe an endoscopic‐assisted approach for the management of ORN of the skull base using fascia lata for MFTT. Study Design Retrospective case series. Methods Between 2017 and 2021, a review of all cases in which fascia lata MFTT was utilized for skull base ORN was performed. Patient demographics, preoperative characteristics, and postoperative outcomes with long‐term follow‐up were reviewed. Results Five patients were identified. Mean duration to onset of ORN was 17 months following RT. A trial of antibiotics, hyperbaric oxygen (HBO), and/or limited debridement was attempted without success. Refractory pain and progressive osteomyelitis were unifying symptoms. All patients underwent endoscopic debridement of the affected region of ORN prior to MFTT. Vascularized fascia lata was inset through a combined endonasal and transoral corridor. There was improvement in chronic pain in the postop setting with no patients requiring continued antibiotics or HBO therapy. Mean post‐op follow‐up was 23 months. Conclusions With continued evolution in endoscopic, minimally invasive approaches, there is an expanding indication for early surgical management in refractory ORN. Fascia lata MFTT is a novel and effective strategy for the management of ORN of the skull base and upper cervical spine with excellent postoperative outcomes and limited patient morbidity. Level of Evidence 4 Laryngoscope, 133:562–568, 2023

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era

et al. 2022

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“…However, complementary outcomes, such as postoperative bleeding and CSF leak, were not considered in this analysis. More recently, a 2021 Italian survey of 39 neurosurgeons reported that 84% of participants considered anterior nasal packing to be useful, especially in the context of extensive nasal dissection or epistaxis prophylaxis; though nasal discomfort was widely reported to be a major disadvantage 86 . In a recent meta‐analysis of ESBS reconstruction strategies for intraoperative CSF leaks, where nasal packing was removed, on average, 3‐7 days after surgery, no significant improvements in postoperative CSF leaks were observed in patients who received nasal packing 70 .…”

Section: Resultsmentioning

confidence: 99%

“…More recently, a 2021 Italian survey of 39 neurosurgeons reported that 84% of participants considered anterior nasal packing to be useful, especially in the context of extensive nasal dissection or epistaxis prophylaxis; though nasal discomfort was widely reported to be a major disadvantage. 86 In a recent meta-analysis of ESBS reconstruction strategies for intraoperative CSF leaks, where nasal packing was removed, on average, 3-7 days after surgery, no significant improvements in postoperative CSF leaks were observed in patients who received nasal packing. 70 However, for low-flow intraoperative CSF leaks, opting for nasal tampon instead of balloon for nasal packing was associated with reduced postoperative CSF leaks (1.0% vs. 10.5%).…”

Section: Nasal Packingmentioning

confidence: 98%

Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

Abiri

Patel

Nguyen

et al. 2022

Int Forum Allergy Rhinol

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Background Postoperative management strategies for endoscopic skull base surgery (ESBS) vary widely because of limited evidence‐based guidance. Methods The PubMed, EMBASE, and Cochrane databases were systematically reviewed from January 1990 through February 2022 to examine 18 postoperative considerations for ESBS. Nonhuman studies, articles written in a language other than English, and case reports were excluded. Studies were assessed for levels of evidence, and each topic's aggregate grade of evidence was evaluated. Results A total of 74 studies reporting on 18 postoperative practices were reviewed. Postoperative pain management, prophylactic antibiotics, and lumbar drain use had the highest grades of evidence (B). The literature currently lacks high quality evidence for a majority of the reviewed ESBS precautions. There were no relevant studies to address postoperative urinary catheter use and medical intracranial pressure reduction. Conclusion The evidence for postoperative ESBS precautions is heterogeneous, scarce, and generally of low quality. Although this review identified the best evidence available in the literature, it suggests the urgent need for more robust evidence. Therefore, additional high‐quality studies are needed in order to devise optimal postoperative ESBS protocols.

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“…2,3 Although nasal packing facilitates hemostasis, supports the reconstruction site, and prevents synechiae formation, it is also associated with patient discomfort and a risk for infection and compromised reconstruction integrity during removal. 4 Given advancements in packing materials and the advent of dissolvable (i.e., bioabsorbable) nasal packing, it is unclear how nasal packing type influences reconstruction success and patient experience. 2,3 We evaluated surgical and quality-of-life (QOL) outcomes in ESBS patients who received nasal packing and assess for differences associated with packing type.…”

Section: Introductionmentioning

confidence: 99%

The impact of nasal packing on skull base reconstruction and quality‐of‐life outcomes following endoscopic skull base surgery

Abiri

Nguyen

et al. 2023

Int Forum Allergy Rhinol

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Role of Anterior Nasal Packing in Endoscopic Skull Base Surgery: Italian Survey

Cited by 4 publications

References 32 publications

Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era

Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era

Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

The impact of nasal packing on skull base reconstruction and quality‐of‐life outcomes following endoscopic skull base surgery

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