Endonasal Endoscopic Approach in Management of Paediatric CSF Rhinorrhoea Cases

Preetam, Chappity; Thakar, Alok; Verma, Rohit Kumar

doi:10.1007/s12070-014-0795-2

Cited by 8 publications

(3 citation statements)

References 25 publications

(26 reference statements)

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“…Extracranial approach for CSF leak was initiated by Dohlman in 1948 using naso-frontal incision which offered success rate of 60-80% with considerable reduction in risk of complications. 4,7 It was not until 1981 that Wigand described endoscopic repair of CSF rhinorrhoea which led to success rate of 90%. 4 Since then this technique has gained popularity.…”

Section: Discussionmentioning

confidence: 99%

Trans-nasal endoscopic repair of cerebrospinal fluid rhinorrhoea: a retrospective analysis

Singh

Kumar

Grewal

2018

Int J Otorhinolaryngol Head Neck Surg

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Background: The purpose of present study was to assess the management and surgical outcomes of trans-nasal endoscopic repair of CSF rhinorrhoea.Methods: A retrospective study was conducted on the basis of medical records of 8 patients (6 males and 2 females) who had undergone trans-nasal endoscopic reconstructive surgery for CSF leak in a tertiary care hospital. Data so collected was analyzed to determine the demographic and diagnostic factors with surgical outcomes. Rate of success achieved was also assessed. Results: Majority of patients were in the age group of 21-40 years with mean age of 28.50 years. Main cause of leak was trauma (75%) and most common site of defect was found to be the cribriform plate of ethmoid bone (75%). 38% patients suffered from recurrent episodes of meningitis. Repair of dehiscence was done by variety of graft material like fat, fascia, middle turbinate mucosa, septal bone, cartilage or mucosa and fibrin glue. Success rate of 100% was observed. No post-surgical complications were encountered in this series.Conclusions: Trans-nasal endoscopic surgical technique is an effective and atraumatic procedure for repair of CSF rhinorrhoea with minimum morbidity and low post-operative complications.

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Section: Discussionmentioning

confidence: 99%

Trans-nasal endoscopic repair of cerebrospinal fluid rhinorrhoea: a retrospective analysis

Singh

Kumar

Grewal

2018

Int J Otorhinolaryngol Head Neck Surg

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“…Although this technique is less invasive, it has limited application due to complications, such as cerebrospinal fluid (CSF) leakage. Thus, there have been many attempts to overcome this limitation [5,6,15]. In 2006, Hadad reported a nasoseptal flap technique to reduce the chances of CSF leakage [15].…”

Section: Introductionmentioning

confidence: 99%

Pedicled frontal periosteal rescue flap via eyebrow incision for skull base reconstruction (SevEN-002)

et al. 2022

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Purpose Cerebrospinal fluid (CSF) leakage is one of the major complications after endoscopic endonasal surgery. The reconstructive nasoseptal flap is widely used to repair CSF leakage. However, it could not be utilized in all cases; thus, there was a need for an alternative. We developed a pericranial rescue flap that could cover both sellar and anterior skull base defects via the endonasal approach. A modified surgical technique that did not violate the frontal sinus and cause cosmetic problems was designed using the pericranial rescue flap. Methods We performed 12 cadaveric dissections to investigate the applicability of the lateral pericranial rescue flap. An incision was made, extending from the middle to the lateral part of the eyebrow. The pericranium layer was dissected away from the galea layer, from the supraorbital region towards the frontoparietal region. With endoscopic assistance, the periosteal flap was raised, the flap base was the pericranium layer at the eyebrow incision. After a burr-hole was made in the supraorbital bone, the pericranial flap was inserted via the intradural or extradural pathway. Results The mean size of the pericranial flap was 11.5 cm × 3.2 cm. It was large enough to cross the midline and cover the dural defects of the anterior skull base, including the sellar region. Conclusion We demonstrated a modified endoscopic technique to repair the anterior skull base defects. This minimally invasive pericranial flap may resolve neurosurgical complications, such as CSF leakage.

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“…The first line of treatment is surgery in all cases of spontaneous etiology and in most cases of iatrogenic cause of skull base CSF leak (36,38). On the contrary, initial conservative management has been advocated for traumatic CSF leaks (8,12). When conservative management fails, usually at the end of two weeks, surgical management of rhinorrhea is mandatory in traumatic cases (16,28).…”

mentioning

confidence: 99%

Endoscopic endonasal cerebrospinal fluid leak repair on the ventral midline skull base: a single neurosurgical center experience

İşler

Ahmedov²,

Akgün³

et al. 2017

Turkish Neurosurgery

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CSF leaks have been grouped into three distinct etiologic categories, namely, traumatic, spontaneous, and iatrogenic (due to previous operation). Furthermore, each group has been subdivided into acute and delayed types (6). The first line of treatment is surgery in all cases of spontaneous etiology and in most cases of iatrogenic cause of skull base CSF leak (36,38). On the contrary, initial conservative management has been advocated for traumatic CSF leaks (8,12). When conservative management fails, usually at the end of two weeks, surgical management of rhinorrhea is mandatory in traumatic cases (16,28). (7,10,18,19,22,29). A connection to the subarachnoid space, most likely associated with a disruption of the arachnoid and dura mater with accompanying bone defect, is a prerequisite for CSF leak and inevitably carries a risk for ascending infection to the intracranial space (15,25,26,31). AIM:To present the results of endoscopic endonasal repair of ventral midline skull base cerebrospinal fluid (CSF) leak (VMSBL) at our institution and to discuss the technique and results from a neurosurgical perspective. MATERIAL and METHODS:A retrospective analysis of all VMSBL cases that underwent endoscopic endonasal skull base approach (EESBA) for CSF leak repair at a single tertiary neurosurgical center was performed. Twenty six patients with an average age of 44.4 (range: 17-63) years were included in the study. RESULTS:The etiology of VMSBL was spontaneous in 16 patients, traumatic in 7, and iatrogenic in 3. The leakage site was the cribriform plate in 13 patients, ethmoidal cells in 7, and sphenoid sinus in 3. There were multiple leaks in 3 patients. This approach for VMSBL repair was performed 28 times on 26 patients. The success rate was 88.5% (23/26 patients) after primary endoscopic repair and 96% after the second attempt. The location of the leakage site relative to the upper attachment of the middle turbinate played a crucial role in the anteriorly located VMSBL, which made an impact on the surgical repair plan. All the 16 cases with accompanying meningoencephaloceles were treated successfully by EESBA. Use of vascularized pedicled flaps to support the repair site resulted in 100% success after primary repair. CONCLUSION:EESBA is safe and highly effective and can be a first-line surgical treatment option for VMSBL. In addition, it enables adequate reconstruction of ventral midline skull base meningoencephaloceles regardless of size and location.

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Endonasal Endoscopic Approach in Management of Paediatric CSF Rhinorrhoea Cases

Cited by 8 publications

References 25 publications

Trans-nasal endoscopic repair of cerebrospinal fluid rhinorrhoea: a retrospective analysis

Trans-nasal endoscopic repair of cerebrospinal fluid rhinorrhoea: a retrospective analysis

Pedicled frontal periosteal rescue flap via eyebrow incision for skull base reconstruction (SevEN-002)

Endoscopic endonasal cerebrospinal fluid leak repair on the ventral midline skull base: a single neurosurgical center experience

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