Simple closure following transsphenoidal surgery

Couldwell, William T.; Kan, Peter; Weiss, Martin H.

doi:10.3171/foc.2006.20.3.12

Cited by 65 publications

(53 citation statements)

References 19 publications

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“…Other groups use a various combination of fat, fascia, and muscle in addition to other types of synthetic materials to reconstruct the sella. 7 Some have used a dural suture 34 for closure of the sella as well as various other techniques, including incorporation of rigid buttresses such as titanium, 3 bone, 9 or cartilage to hold the sellar packing in place. 7 For larger sellar defects often encountered after extended transsphenoidal approaches, Hadad et al 14 used the combination of fascia lata, abdominal fat, mucoperiosteum, and fibrin sealants followed by a vascularized nasal septal mucosal flap as a final layer, with reinforcement of this construct via an inflated Foley catheter balloon.…”

Section: Discussionmentioning

confidence: 99%

Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

Dlouhy¹,

Madhavan²,

Clinger³

et al. 2012

JNS

119

145

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ObjectPostoperative CSF leakage can be a serious complication after a transsphenoidal surgical approach. An elevated body mass index (BMI) is a significant risk factor for spontaneous CSF leaks. However, there is no evidence correlating BMI with postoperative CSF leak after transsphenoidal surgery. The authors hypothesized that patients with elevated BMI would have a higher incidence of CSF leakage complications following transsphenoidal surgery.MethodsThe authors conducted a retrospective review of 121 patients who, between August 2005 and March 2010, underwent endoscopic endonasal transsphenoidal surgeries for resection of primarily sellar masses. Patients requiring extended transsphenoidal approaches were excluded. A multivariate statistical analysis was performed to investigate the association of BMI and other risk factors with postoperative CSF leakage.ResultsIn 92 patients, 96 endonasal endoscopic transsphenoidal surgeries were performed that met inclusion criteria. Thirteen postoperative leaks occurred and required subsequent treatment, including lumbar drainage and/or reoperation. The average BMI of patients with a postoperative CSF leak was significantly greater than that in patients with no postoperative CSF leak (39.2 vs 32.9 kg/m2, p = 0.006). Multivariate analyses indicate that for every 5-kg/m2increase in BMI, patients undergoing a transsphenoidal approach for a primarily sellar mass have 1.61 times the odds (95% CI 1.10–2.29, p = 0.016, by multivariate logistic regression) of having a postoperative CSF leak.ConclusionsElevated BMI is an independent predictor of postoperative CSF leak after an endonasal endoscopic transsphenoidal approach. The authors recommend that patients with BMI greater than 30 kg/m2have meticulous sellar reconstruction at surgery and close monitoring postoperatively.

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Section: Discussionmentioning

confidence: 99%

Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

Dlouhy¹,

Madhavan²,

Clinger³

et al. 2012

JNS

119

145

View full text Add to dashboard Cite

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“…Of these cases, rhinorrhea was ultimately resolved with a transsphenoidal approach in 3 patients, a transfrontal approach in 1 patient, lumboperitoneal shunt placement in 1 patient, and craniotomy in 1 patient, and it subsided without treatment in 1 patient. 10,13,17,24,25,28 In 2 cases, the rhinorrhea initially subsided with bed rest. Of these cases, the first recurred 3 three years later, even though treatment was uneventfully reinstated a month after the initial rhinorrhea episode ceased, and the recurrence subsided again with bed rest.…”

Section: Treatment Characteristics In Patients With Csf Leaks and Undmentioning

confidence: 99%

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Lam¹,

Mehta²,

Zada³

2012

FOC

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Object Spontaneous and medically induced CSF leaks are uncommonly associated with pituitary adenomas. The aim of this study was to further characterize the clinical scenarios most closely associated with this phenomenon. Methods A review of the literature was conducted to identify all cases of nonsurgical CSF leaks associated with pituitary adenomas. The authors aimed to identify associated risk factors and management strategies used to treat these tumors and repair the CSF leak site. Results Fifty-two patients with spontaneous or medically induced CSF leaks in the setting of a pituitary adenoma were identified from 29 articles published from 1980 through 2011. In 38 patients (73%), CSF rhinorrhea developed following initiation of medical therapy, whereas spontaneous CSF leakage developed as the presenting symptom in 14 patients (27%). The patients' mean age was 42.8 years (range 23–68 years). There were 35 males and 17 females. Forty-two patients (81%) had a prolactinoma, with the remaining patients having the following tumors: nonfunctioning pituitary adenoma (6 patients), growth hormone–secreting adenoma (2 patients), mammosomatotroph cell adenoma (1 patient), and ACTH-secreting adenoma (1 patient). Infrasellar tumor invasion into the paranasal sinuses was specifically reported in 56% of patients. The medical agents associated with CSF leakage were dopamine agonists (97%) and somatostatin analogs (3%). The average time from initialization of medical treatment to onset of rhinorrhea was 3.3 months (range 3 days–17 months). Nonsurgical management was successful in 4 patients, including 1 who had successful resolution with a temporary lumbar drain. Forty-six patients (88%) underwent surgical intervention to treat the CSF leak and/or resect the tumor. In 2 patients, surgery was not performed due to medical contraindications or patient preference. Conclusions Nonsurgical development of CSF rhinorrhea may occur in the setting of pituitary adenomas, especially following favorable response of invasive prolactinomas to initiation of dopamine agonist therapy. Additional cases have been reported as the presenting symptom of a pituitary adenoma and are likely to be related to decreased tumor volume due to intrinsic infarction or hemorrhage, ongoing invasion, and/or increases in intracranial pressure. Surgical repair, preferentially via a transsphenoidal approach, is the recommended initial treatment for definitive repair of the CSF leak and achievement of maximal tumor resection.

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“…A variety of techniques are available for closure of skull base defects (Burns et al, 1996;Burkey et al, 1999;Couldwell et al, 2006;Esposito et al, 2007;Hadad et al, 2006;Kitano and Taneda, 2004;Leng et al, 2008;McCabe, 1976;Normington et al, 1996;Seda et al, 2006;Seiler and Mariani, 2000;Shiley et al, 2003;Snyderman et al, 2007;Wormaldi and McDonogh, 2003;Yano et al, 2007). The concept of a layered closure is the key to reconstructive success, with the addition of a vascularized nasal mucosal flap as needed for large defects.…”

Section: Orbitmentioning

confidence: 98%

Transorbital and Transnasal Endoscopic Repair of a Meningoencephalocele

Schaberg

Murchison

Rosen

et al. 2011

Orbit

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A 71-year-old female with a history of thyroid eye disease (TED) presented for evaluation of a skull base mass noted on neuroimaging. She had previously undergone bilateral orbital decompressions and strabismus surgery and had no neurologic symptoms. Successful resection of the menigoencephalocele and repair of the skull base defect was performed through a combined transnasal endoscopic and transorbital approach, obviating the need for craniotomy.

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Simple closure following transsphenoidal surgery

Cited by 65 publications

References 19 publications

Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Transorbital and Transnasal Endoscopic Repair of a Meningoencephalocele

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