Surgical Repair of Persisting CSF Leaks Following Standard or Extended Endoscopic Transsphenoidal Surgery for Pituitary Tumor

Sciarretta, Vittorio; Mazzatenta, Diego; Ciarpaglini, Riccardo; Pasquini, Ernesto; Farneti, Giovanni; Günther, Frank

doi:10.1055/s-0029-1246161

Cited by 45 publications

(52 citation statements)

References 22 publications

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“…Surgical repair of skull base defects during the EETS procedure is an important and necessary step to prevent postoperative complications, and to provide anatomic integrity (23). The most common serious potential complication of EETS is cerebrospinal fluid (CSF) leakage that could result in disasterous intracranial complications such as meningitis or pneumocephalus (28,33). A history of previous surgery or radiation exposure, obesity, a large duramater defect, opening of cisterns or ventricles during the surgery, a large volume of tumor resection, leaving a residual tumor and incompliance of the patient during the postoperative period are factors that may increase the risk of postoperative CSF leakage (33).…”

Section: Introductionmentioning

confidence: 99%

Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Yıldırım

Dursun²,

Özdöl³

et al. 2013

Turkish Neurosurgery

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AIm: Postoperative cerebrospinal fluid (CSF) leak following endoscopic endonasal transsphenoidal surgery (EETS) is associated with increased morbidity and mortality. This prospective study is the first evaluation of using autologous fibrin sealant for preventing postoperative CSF leak and related complications. mAterIAl and methOds: 200 endoscopic endonasal transsphenoidal approaches were included in the study and reviewed retrospectively from September 2010 to June 2012. A total of 55 patients who have large skull base and diafragma sella defects, connected with basal cisterns or ventricles, were chosen for the study. The patients were operated via extended or classical endoscopic endonasal transsphenoidal approach. The skull base has been repaired using AFS combined with multilayer reconstruction in all cases. The incidence of CSF leak as a complication of EETS was analyzed. results:The ages of the patients ranged from 20 to 83 years (mean 49.3 years). There were 25 (46%) male patients and 30 (54%) females. All patients had tumors with suprasellar or parasellar extension. Postoperative CSF leak was determined in 2 patients (3.6%). There were no complications and allergic reactions associated with the use of AFS.COnClusIOn: Using of AFS combined with multilayer reconstruction technique is a safe and effective method to prevent CSF leak in large defects following EETS.

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Section: Introductionmentioning

confidence: 99%

Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Yıldırım

Dursun²,

Özdöl³

et al. 2013

Turkish Neurosurgery

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“…There have been many reports describing methods and strategies for reconstruction of a dural defect in the sellar floor and the skull base 2,3,4,5,6,7,8 . The utility of a pedicled nasoseptal flap 9 for the reconstruction of a large dural defect has recently become more widely accepted, but reports have included a variety of pathologies, approaches and reconstruction techniques 6,8,10 . To minimize the risk of postoperative CSF fistula, we have used a pedicled nasoseptal flap for pituitary adenomas, as well as for skull base tumors 11,12 .…”

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confidence: 99%

“…Furthermore no studies have directly compared these strategies. Some authors have described their own protocols for reconstruction of the sella according to the tumor extension or intraoperative findings 2,3,4,5,8 ; however, the pedicled nasoseptal flap was not included as an option in these other protocols. Since Hadad et al 9 described vascular pedicle nasoseptal flap as a novel reconstruction technique in 2006 (Hadad-Bassagasteguy flap; HBF), it has been reported that this flap can function well to separate the intradural space from the nasosinusal cavity 6,10,11,12,15 .…”

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confidence: 99%

Endoscopic combined “transseptal/transnasal” approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases

Fujimoto

Balsalobre²,

Santos³

et al. 2015

Arq. Neuro-Psiquiatr.

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ARTICLEEndoscopic combined "transseptal/transnasal" approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases O acesso endoscópico transeptal/transnasal em cirurgias de resseção de adenoma de hipófise: reconstrução da base do crânio combinado com a criação do flap naso-septal pediculado em 91 pacientes consecutivos Transsphenoidal surgery using a microscope is an established, less invasive surgery for pituitary adenomas. The advent of the endoscope for endonasal transsphenoidal surgery has provided a wider and more close-up panoramic view that has made more detailed, delicate procedures feasible and safer. Furthermore, recent advance in high definition (HD) imaging have made it possible to clearly differentiate a cleavage plane between a tumor and the cavernous sinus or the arachnoid membrane, likely contributing to improvements in patient outcomes. However, the ABSTRACT Objective: The purpose of this study was to describe the endoscopic combined "transseptal/transnasal" approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF) fistula. Method: Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined "transseptal/transnasal" approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed. Results: Intra-and postoperative CSF fistulae were observed in 36 (40%) and 4 (4.4%) patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%). Conclusion: The endoscopic combined "transseptal/transnasal" approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.Keywords: cerebrospinal fluid fistula, endoscopic endonasal approach, pedicled nasoseptal flap, pituitary adenoma. RESUMOObjetivo: O objetivo deste estudo foi descrever o acesso endoscópico transeptal/transnasal combinado com a criação do flap nasoseptal pediculado para reconstrução da base do crânio em cirurgias de resseção de adenoma de hipófise, especialmente nos casos que ocorrem fístula líquido cefalorraquidiano (FLC). Método: Noventa e um pacientes consecutivos portadores de adenoma de hipófise foram retrospectivamente revisados. Complicações pós-operatórias relacionadas ao flap foram analisadas. Resultados: Fístulas líquido cefalorraquidiano intra e pós-operatórias foram observadas em 36 (40%) e 4 (4,4%) dos pacientes, respectivamente. Entre os 4 pacientes, drenagem lombar e repouso absoluto foram suficientes para o fechamento da fístula e intervenção cirúrgica foi necessária em apenas um paciente. Outra complicação relacionada ao flap foi o sangramento em 3 (3,3%)...

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“…and/or some form of rigid/semi-rigid buttressing (nasal septum, sphenoid bone, titanium mesh, biodegradable plates or Foley catheter). The use of vascularized mucosal flaps, dural substitutes and tissue sealants are also described (1,2,5,6,8, 18,22). Even primary suturing of the dural defects has been reported (10).…”

Section: Discussionmentioning

confidence: 99%

Unusual posttraumatic delayed cerebrospinal fluid rhinorrhea due to gunshot wound

Yıldırım¹,

Dursun²,

Divanlıoğlu³

et al. 2012

Turkish Neurosurgery

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Delayed posttraumatic cerebrospinal fluid rhinorrhea (CSFr) without meningitis is considered to be relatively rare. However, even years after trauma, recurrence or delayed onset of CSFr and meningitis due to CSFr are possible. In this article, a case of delayed CSFr from the sphenoid sinus without meningitis three years after the transfacial gunshot wound is reported. Plain high-resolution computed tomography sections through the sphenoid sinus showed a bone defect at the roof with CSF-density fluid extending into the sphenoid sinus. Arachnoid membrane herniation into the sphenoid sinus was found and site of CSF fistula confirmed during the surgery. Skull base defect was reconstructed through an endoscopic approach without any complications and the patient was followed up for 12 months without recurrence. The cause, timing, clinical course and location of CSFr make this an apparently unique case. Patients with a skull base defect without CSFr should be closely followed up and may need further evaluation or management due to the possibility of CSFr development. The positive diagnosis of a CSFr raises the matter of choosing the adequate surgical approach for its repair. Endoscopic closure of CSFr is both safe and effective.KeywoRds: Rhinorrhea, Delayed, Posttraumatic, Gunshot wound, Meningitis, Sphenoid sinus ÖZMenenjit olmaksızın geç dönemde gelişen posttravmatik rinore nadir görülen bir durum olmasına rağmen, travmadan sonra yıllar içinde geç dönem rinore ve buna bağlı menenjit gelişmesi mümkündür. Bu makalede, 3 yıl önce yüz bölgesinde ateşli silah yaralanması meydana geldikten sonra, menenjit olmaksızın geç dönemde ortaya çıkan bir rinore olgusu sunulmaktadır. Hastanın yapılan incelemelerinde sfenoid sinüs tavanında kemik defekti ve bu defektten beyin omurilik sıvısı (BOS) kaçışı olduğu gösterilmiştir. Cerrahi sırasında sinüs içerisine araknoid membran herniasyonu izlenmiş olup, defektten BOS kaçağı olduğu da görülmüştür. Kafa tabanındaki defekt endoskopik endonazal transsfenoidal yaklaşım ile hiçbir komplikasyon olmadan tamir edilmiş ve hastanın 12 aylık takiplerinde hiçbir rekürrens izlenmemiştir. Rinorenin nedeni, zamanı, klinik seyri ve lokalizasyonu nedeniyle bu nadir görülen bir olgu olarak kabul edilebilir. Kafa tabanı defekti olan fakat rinore gözlenmeyen hastalar ileride rinore gelişme riski nedeniyle yakın takip edilmelidir. Rinore tanısı kesinleşen hastalarda, cerrahi yaklaşım yolları arasından, endoskopik endonazal yolla yapılan onarım hem efektif hem de güvenli olarak kabul edilmektedir.

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Surgical Repair of Persisting CSF Leaks Following Standard or Extended Endoscopic Transsphenoidal Surgery for Pituitary Tumor

Cited by 45 publications

References 22 publications

Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Endoscopic combined “transseptal/transnasal” approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases

Unusual posttraumatic delayed cerebrospinal fluid rhinorrhea due to gunshot wound

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