Septal Cartilage Plug Technique in Spontaneous Cerebrospinal Fluid Rhinorrhea Postoperatively Diagnosed With Partial Empty Sella Syndrome

Chang, Chul

doi:10.1097/scs.0000000000000936

Cited by 3 publications

(1 citation statement)

References 4 publications

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“…Many authors indicated the reliable use of the cartilage graft in the anterior skull base defect repair with minor infectious complication rates [24, 25]. However, the studies with the cartilage graft concerning the lateral skull base are relatively limited.…”

Section: Discussionmentioning

confidence: 99%

Is Septal Cartilage Graft via Transmastoid Approach Safe Enough in the Repair of Large Tegmen Defects?

Keseroğlu

Gunay

Tokgöz

et al. 2021

ORL

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Introduction: Tegmen defect (TD) has a potential of intracranial spread of middle ear infection, meningoencephalic herniation (MEH), and cerebrospinal fluid leakage (CSFL). Especially the defects >1 cm with MEH or CSFL are generally repaired via the classical middle fossa or minicraniotomy technique. The aim of this study was to show the efficiency of the intracranial, extradural placement of the septal cartilage graft in the closure of the TD larger than 1 cm via the transmastoid (TM) approach. Methods: The demographic, preoperative, intraoperative, and postoperative data of 11 patients with chronic otitis media (COM) who had TD larger than 1 cm were reviewed retrospectively. Hospitalization time and hearing preservation with respect to MEH or CSFL were analyzed. Results: The most common etiology of TD was cholesteatoma (82%), and 91% of the patients had multiple COM surgery history. The mean TD size was 15.4 (10–25) mm. Fifty-five percent of the patients presented with either MEH or CSFL. The mean follow-up of the patients was 22.5 (8–42) months. There was no significant difference between preoperative and postoperative mean bone conduction thresholds. Mean hospitalization time was 5.2 (3–10) days. There was no significant difference in the hospitalization time between patients with MEH or CSFL and without MEH or CSFL. Neither recurrence nor graft infection was encountered. Conclusion: Extradural grafting with the septal cartilage in the large TD up to 25 mm can be repaired efficiently via the TM approach without application of a lumbar drainage.

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Section: Discussionmentioning

confidence: 99%

Is Septal Cartilage Graft via Transmastoid Approach Safe Enough in the Repair of Large Tegmen Defects?

Keseroğlu

Gunay

Tokgöz

et al. 2021

ORL

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Endoscopic repair of cribriform plate cerebrospinal fluid leaks: An easy and reproducible technique sparing the middle turbinate

Ito

May

Kountakis

2020

American Journal of Otolaryngology

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A Unique Subset: Idiopathic Intracranial Hypertension Presenting as Spontaneous CSF Leak of the Anterior Skull Base

Hong

Kundishora

Elsamadicy

et al. 2021

J Neurol Surg B Skull Base

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Background Spontaneous cerebrospinal fluid (CSF) leaks represent a unique clinical presentation of idiopathic intracranial hypertension (IIH), lacking classical features of IIH, including severe headaches, papilledema, and markedly elevated opening pressures. Methods Following a single-institution retrospective review of patients undergoing spontaneous CSF leak repair, we performed a literature review of spontaneous CSF leak in patients previously undiagnosed with IIH, querying PubMed. Results Our literature review yielded 26 studies, comprising 716 patients. Average age was 51 years with 80.8% female predominance, and average body mass index was 35.5. Presenting symptoms included headaches (32.5%), visual disturbances (4.2%), and a history of meningitis (15.3%). Papilledema occurred in 14.1%. An empty sella was present in 77.7%. Slit ventricles and venous sinus stenosis comprised 7.7 and 31.8%, respectively. CSF leak most commonly originated from the sphenoid sinus (41.1%), cribriform plate (25.4%), and ethmoid skull base (20.4%). Preoperative opening pressures were normal at 22.4 cm H2O and elevated postoperatively to 30.8 cm H2O. 19.1% of patients underwent shunt placement. CSF leak recurred after repair in 10.5% of patients, 78.6% involving the initial site. A total of 85.7% of these patients were managed with repeat surgical intervention, and 23.2% underwent a shunting procedure. Conclusion Spontaneous CSF leaks represent a distinct variant of IIH, distinguished by decreased prevalence of headaches, lack of visual deficits, and normal opening pressures. Delayed measurement of opening pressure after leak repair may be helpful to diagnose IIH. Permanent CSF diversion may be indicated in patients exhibiting significantly elevated opening pressures postoperatively, refractory symptoms of IIH, or recurrent CSF leak.

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Septal Cartilage Plug Technique in Spontaneous Cerebrospinal Fluid Rhinorrhea Postoperatively Diagnosed With Partial Empty Sella Syndrome

Cited by 3 publications

References 4 publications

Is Septal Cartilage Graft via Transmastoid Approach Safe Enough in the Repair of Large Tegmen Defects?

Is Septal Cartilage Graft via Transmastoid Approach Safe Enough in the Repair of Large Tegmen Defects?

Endoscopic repair of cribriform plate cerebrospinal fluid leaks: An easy and reproducible technique sparing the middle turbinate

A Unique Subset: Idiopathic Intracranial Hypertension Presenting as Spontaneous CSF Leak of the Anterior Skull Base

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