Role of galeal–pericranial flap in reducing postoperative CSF leak in patients with intracranial endoscopic procedures

Mohanty, Aaron; Suman, Ravi

doi:10.1007/s00381-008-0594-8

Cited by 18 publications

(13 citation statements)

References 5 publications

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“…Post-operative CSF leak can also be reduced by galealpericranial flap. [92] Subdural hematoma could be prevented by making burr hole at highest point by flexing the neck, proper hemostasis at burr hole site and by preventing brain collapse using constant fluid irrigation.…”

Section: Complication Avoidancementioning

confidence: 99%

Endoscopic third ventriculostomy

Yadav

Parihar

Pande

et al. 2012

Journal of Neurosciences in Rural Practice

101

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Endoscopic third ventriculostomy (ETV) is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intra-operative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post-operative, but fatal complications can develop late which indicate an importance of long term follow up.

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Section: Complication Avoidancementioning

confidence: 99%

Endoscopic third ventriculostomy

Yadav

Parihar

Pande

et al. 2012

Journal of Neurosciences in Rural Practice

101

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“… 10) The use of perfectly vascularized flap is idealistic to increase neo-vascularity, immunity, and the isolation and protection of the intracranial space from contaminated spaces such as the paranasal sinuses or air cells. This technique is used in many occasions including face 11) and neck 12) reconstruction, paranasal sinuses reconstruction, 13) anterior skull base reconstruction, 14 , 15) with endoscopic procedures, 16) one-stage reconstruction of chronic dermal ulcer after cranioplasty, 17) or in a secondary cranial reconstruction in a multi-disciplinary approach. 18) …”

Section: Discussionmentioning

confidence: 99%

Pedicle Galeo-pericranial Flap Augmentation in Salvage Frontotemporal Cranioplasty: Additional ‘Neurosurgeon-friendly’ Reconstruction Technique of Aesthetic Neurosurgery in Superficial Temporal Artery Branch Compromised Host

Takumi

Akimoto

Hironaka

et al. 2018

Neurol. Med. Chir.(Tokyo)

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This technical note aims to demonstrate the usefulness, indications and its limitations of augmentation technique by bipedicle galeo-pericranial rotation flap and by monopedicle galeo-pericranial flap, both in STA (superficial temporal artery) branch compromised hosts in salvage frontotemporal cranioplasty. Although these flaps are not always idealistically vascularized owing to accidental injuries to the STA branches during previous surgeries, they are properly augmenting after salvage frontotemporal craniotomy when infection is not active. The procedure is indicated for salvage frontotemporal craniotomy when vasculature is needed at the surgical site, such as beneath the skin incision line in a thin injured scalp, onto the titanium plates or beneath the fragile fibrous scar. We do not apply this technique by neurosurgeons alone where infection is active or if the host is irradiated. This technique is recommended as a reconstructive aesthetic neurosurgical procedure. It is a ‘neurosurgeon-friendly’ simple procedure, as it does not require any special tools or complicated techniques.

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“…Postoperative CSF leak can also be reduced by galeal-pericranial flap. 4,22 Incidence of CSF leak after ETV have varied between 2 and 7%. In the series of Yadav et al, CSF leak occurred in 16% patients in whom half of the cases of CSF leak stopped spontaneously.…”

Section: Discussionmentioning

confidence: 99%

Result of Endoscopic Third Ventriculostomy for Hydrocephalus Caused by Cerebral Aqueductal Stenosis in Infant Patients

Chowdhury

Haque

Kawsar

et al. 2017

IJNS

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Background Endoscopic third ventriculostomy (ETV) is one of the important management options for hydrocephalus, especially obstructive hydrocephalus. The result of ETV in different age and etiology is quite variable according to the different authors. The study was carried out to assess the success rate of ETV as a treatment for this type of hydrocephalus in infant age group. Material and Methods The study was done prospectively on infants (age 12 months) admitted in the period from January 2009 to June 2013 suffering from obstructive hydrocephalus due to cerebral aqueductal stenosis (CAS). After making the diagnosis, we counseled the patient party about the probability of high failure rate of ETV in this age group and probable necessity of a second operation. With the informed consent, we performed ETV in these cases and followed up regularly in postoperative period. Control neuroimaging studies were done whenever needed (suspected failure of ETV and suspected stomal block). Results Total 17 infants were studied. Average follow-up was 18.7 months. Twelve infants were between the age group of six and under six months while five were above six months to one year old. Fourteen (82.35%) out of 17 patients showed overall clinical improvement. Clinical improvement was seen in two (66.6%) infants aged 2 months or younger, three (75%) aged 2 þ to 3 months, five (100%) aged 3 þ to 6 months, and four (80%) aged 6 þ months to 1 year. Two patients had bleeding during surgery. Three developed CSF leak through the burr hole. In one case (the patient's age was 2 months), the stoma was found blocked, and hydrocephalus returned 9 weeks after ETV. In two patients, in whom VP shunt was needed, "failed ETV" was obvious in early postoperative period. In this series, average ETV success score (ETVSS) was 52.35 (range: 40-70) and overall success rate was 82.35%. This indicates that ETVSS does not correlate with the outcome of ETV in infants with CAS. Conclusion Outcome of ETV for hydrocephalus from CAS in infant is quite good and ETVSS does not correlate with the outcome.

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Role of galeal–pericranial flap in reducing postoperative CSF leak in patients with intracranial endoscopic procedures

Abstract: This simple procedural modification is effective in children with thin cortical mantle and large ventricles who are otherwise highly susceptible for CSF leak in the postoperative period.

Cited by 18 publications

References 5 publications

Endoscopic third ventriculostomy

Endoscopic third ventriculostomy

Pedicle Galeo-pericranial Flap Augmentation in Salvage Frontotemporal Cranioplasty: Additional ‘Neurosurgeon-friendly’ Reconstruction Technique of Aesthetic Neurosurgery in Superficial Temporal Artery Branch Compromised Host

Result of Endoscopic Third Ventriculostomy for Hydrocephalus Caused by Cerebral Aqueductal Stenosis in Infant Patients

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