Early Postoperative Computed Tomography Scan Air Distribution Predicts Postoperative CSF Leak in Endoscopic Skull Base Surgery

Ajlan, Abdulrazag; Basindwah, Sarah; Hawsawi, Aysha; Omar, Mohammed Ali; Alsaleh, Saad; Al-Rasheed, Abdulaziz; Alroqi, Ahamed; Alqurashi, Ashwag

doi:10.1016/j.wneu.2023.01.096

Cited by 4 publications

(3 citation statements)

References 11 publications

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“… 22 In cases of postoperative/post‐traumatic patients (i.e., after sinus or skull base surgeries or injuries), new or specific patterns of pneumocephalus on CT scan can be suggestive of a CSF leak. 35 , 36 …”

Section: Current Methods In Diagnosismentioning

confidence: 99%

“…Although there is low‐dose radiation associated with CT, if the patient does end up having a true leak, the scan is commonly used for intraoperative surgical navigation 22 . In cases of postoperative/post‐traumatic patients (i.e., after sinus or skull base surgeries or injuries), new or specific patterns of pneumocephalus on CT scan can be suggestive of a CSF leak 35,36 …”

Section: Current Methods In Diagnosismentioning

confidence: 99%

“…22 In cases of postoperative/post-traumatic patients (i.e., after sinus or skull base surgeries or injuries), new or specific patterns of pneumocephalus on CT scan can be suggestive of a CSF leak. 35,36 In cases where CT fails to determine the site of leak, magnetic resonance imaging (MRI) may be obtained. CSF exhibits T2 signal prolongation, allowing for differentiation from other fluids.…”

Section: Localization: Imagingmentioning

confidence: 99%

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Multimodal diagnosis of cerebrospinal fluid rhinorrhea: State of the art review and emerging concepts

Torabi,

Abiri,

Chen

et al. 2024

Laryngoscope Investig Oto

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ObjectiveCurrently, diagnosis of cerebrospinal fluid (CSF) rhinorrhea relies on a multimodal approach, increasing costs and ultimately delaying diagnosis. In the United States and internationally, the crux of such a diagnosis relies on confirmation testing (via biomarkers) and localization (e.g., imaging). Biomarker testing may require analysis at an outside facility, resulting in delays diagnosis and treatment. In addition, specialized imaging may be nonspecific and often requires an active leak for diagnosis. There remains a clear need for innovative new technology.MethodsA comprehensive review was conducted on both foundational and innovative scholarly articles regarding current and emerging diagnosis modalities for CSF.ResultsCurrent modalities in CSF rhinorrhea diagnosis and localization include laboratory tests (namely, B2T immunofixation), imaging (CT and/or MRI) with or without intrathecal administration, and surgical exploration. Each of these modalities carry flaws, risks, and benefits, ultimately contributing to delays in diagnosis and morbidity. Promising emerging technologies include lateral flow immunoassays (LFI) and biologically functionalized field‐effect transistors (BioFET). Nevertheless, these carry some drawbacks of their own, and require further validation.ConclusionCSF rhinorrhea remains a challenging diagnosis, requiring a multimodal approach to differentiate from nonpathologic causes of rhinorrhea. Current methods in diagnosis are imperfect, as the ideal test would be a readily accessible, inexpensive, rapid, highly accurate point‐of‐care test without the need for excess fluid or specialized processing. Critical work is being done to develop promising, new, improved tests, though a clear successor has not yet emerged.Level of EvidenceN/A

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Section: Current Methods In Diagnosismentioning

confidence: 99%

Section: Current Methods In Diagnosismentioning

confidence: 99%

Section: Localization: Imagingmentioning

confidence: 99%

See 1 more Smart Citation

Multimodal diagnosis of cerebrospinal fluid rhinorrhea: State of the art review and emerging concepts

Torabi,

Abiri,

Chen

et al. 2024

Laryngoscope Investig Oto

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Early Displacement of Reconstruction Material is a Predictor of Cerebrospinal Fluid Leak Post Endoscopic Skull Base Surgery

Ajlan,

Basindwah,

Hawsawi

et al. 2024

World Neurosurgery

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Prevalence and Impact of Constipation on Reconstructive Outcomes Following Endoscopic Skull Base Surgery

Nguyen,

Hong,

Bitner

et al. 2024

J Neurol Surg B Skull Base

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Objective Postoperative constipation in endoscopic skull base surgery (ESBS) may provoke undesired straining, which, in theory, may create intracranial pressure shifts and impact skull base reconstruction. The purpose of this study is to assess the prevalence and contributing factors to postoperative constipation after ESBS, and whether this impacts reconstructive outcomes. Methods Patients undergoing ESBS between July 2018 and December 2022 at a single-center, tertiary academic skull base surgery program were retrospectively reviewed. Chart reviews were performed to identify average bowel movements per day, indication for surgery, age, sex, body mass index (BMI), history of chronic pain, length of postoperative bedrest, length of stay (LOS), and postoperative use of opioid analgesics. Additionally, use of a standing stool bowel regimen, as-needed (PRN) stool softeners/laxatives, and enemas were recorded. Constipation was defined as greater than 48 hours without a bowel movement. Results In total, 213 patients (115 with intradural pathologies) were identified, of which 146 (69%) patients had postoperative constipation. Postoperative constipation was associated with longer bedrest (1.86 ± 0.20 vs. 1.06 ± 0.12 days; p = 0.011); increased morphine equivalent dose (MED) during postoperative days 2, 3, 5, and 6 (all p < 0.05); and total postoperative MED (106.70 ± 14.01 vs. 46.88 ± 8.44 mg; p < 0.001). Additionally, postoperative constipation was an independent predictor of LOS (p = 0.009). There were no differences in postoperative cerebrospinal fluid (CSF) leak between the groups (p = 0.622). Conclusion Postoperative constipation rates were high after ESBS and likely causative factors include increased immobilization and postoperative opioid use. Standing bowel regimens should be considered in ESBS patients. However, there was no increased rate of postoperative CSF leaks.

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Early Postoperative Computed Tomography Scan Air Distribution Predicts Postoperative CSF Leak in Endoscopic Skull Base Surgery

Cited by 4 publications

References 11 publications

Multimodal diagnosis of cerebrospinal fluid rhinorrhea: State of the art review and emerging concepts

Multimodal diagnosis of cerebrospinal fluid rhinorrhea: State of the art review and emerging concepts

Early Displacement of Reconstruction Material is a Predictor of Cerebrospinal Fluid Leak Post Endoscopic Skull Base Surgery

Prevalence and Impact of Constipation on Reconstructive Outcomes Following Endoscopic Skull Base Surgery

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