Endoscopic endonasal craniotomy in the management of selected ethmoidal malignancies: The University of Pisa experience

Muscatello, Luca; Dallan, Iacopo; Seccia, Veronica; Marchetti, Mirco; Sellari–Franceschini, Stefano; Lenzi, Riccardo

doi:10.1016/j.jcms.2010.10.017

Cited by 16 publications

(21 citation statements)

References 22 publications

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“…Muscatello et al reported only 1 case of pneumocephalus associated with a CSF leak in a 13-patient cohort. 33 In our current series, we found a 19.4% rate for all patients and 39.5% for those patients with an intraoperative CSF leak. One would expect higher rates of pneumocephalus after ESBS since the surgeon cannot fill the cavity with saline at the end of the procedure, as is often done after a craniotomy, to prevent pneumocephalus.…”

Section: Postoperative Pneumocephalussupporting

confidence: 47%

“…Specific endoscopic approaches and certain pathology have been associated with a higher risk of postoperative CSF leaks. 19,33,48 Adjuvant therapies, such as radiation treatment, can decrease graft patency and impede healing. Likewise idiopathic intracranial hypertension associated with a high BMI and young age can also increase the risk of a leak.…”

Section: Risk Of Csf Leaks Associated With Esbsmentioning

confidence: 99%

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Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

Banu

Szentirmai

Mascarenhas

et al. 2014

JNS

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Object Postoperative pneumocephalus is a common occurrence after endoscopic endonasal skull base surgery (ESBS). The risk of cerebrospinal fluid (CSF) leaks can be high and the presence of postoperative pneumocephalus associated with serosanguineous nasal drainage may raise suspicion for a CSF leak. The authors hypothesized that specific patterns of pneumocephalus on postoperative imaging could be predictive of CSF leaks. Identification of these patterns could guide the postoperative management of patients undergoing ESBS. Methods The authors queried a prospectively acquired database of 526 consecutive ESBS cases at a single center between December 1, 2003, and May 31, 2012, and identified 258 patients with an intraoperative CSF leak documented using intrathecal fluorescein. Postoperative CT and MRI scans obtained within 1–10 days were examined and pneumocephalus was graded based on location and amount. A discrete 0–4 scale was used to classify pneumocephalus patterns based on size and morphology. Pneumocephalus was correlated with the surgical approach, histopathological diagnosis, and presence of a postoperative CSF leak. Results The mean follow-up duration was 56.7 months. Of the 258 patients, 102 (39.5%) demonstrated pneumocephalus on postoperative imaging. The most frequent location of pneumocephalus was frontal (73 [71.5%] of 102), intraventricular (34 [33.3%]), and convexity (22 [21.6%]). Patients with craniopharyngioma (27 [87%] of 31) and meningioma (23 [68%] of 34) had the highest incidence of postoperative pneumocephalus compared with patients with pituitary adenomas (29 [20.6%] of 141) (p < 0.0001). The incidence of pneumocephalus was higher with transcribriform and transethmoidal approaches (8 of [73%] 11) than with a transsellar approach (9 of [7%] 131). There were 15 (5.8%) of 258 cases of postoperative CSF leak, of which 10 (66.7%) had pneumocephalus, compared with 92 (38%) of 243 patients without a postoperative CSF leak (OR 3.3, p = 0.027). Pneumocephalus located in the convexity, interhemispheric fissure, sellar region, parasellar region, and perimesencephalic region was significantly correlated with a postoperative CSF leak (OR 4.9, p = 0.006) and was therefore termed “suspicious” pneumocephalus. In contrast, frontal or intraventricular pneumocephalus was not correlated with postoperative CSF leak (not significant) and was defined as “benign” pneumocephalus. The amount of convexity pneumocephalus (p = 0.002), interhemispheric pneumocephalus (p = 0.005), and parasellar pneumocephalus (p = 0.007) (determined using a scale score of 0–4) was also significantly related to postoperative CSF leaks. Using a series of permutation-based multivariate analyses, the authors established that a model containing the learning curve, the transclival/transcavernous approach, and the presence of “suspicious” pneumocephalus provides the best overall prediction for postoperative CSF leaks. Conclusions Postoperative pneumocephalus is much more common following extended approaches than following transsellar surgery. Merely the presence of pneumocephalus, particularly in the frontal or intraventricular locations, is not necessarily associated with a postoperative CSF leak. A “suspicious” pattern of air, namely pneumocephalus in the convexity, interhemispheric fissure, sella, parasellar, or perimesencephalic locations, is significantly associated with a postoperative CSF leak. The presence and the score of “suspicious” pneumocephalus on postoperative imaging, in conjunction with the learning curve and the type of endoscopic approach, provide the best predictive model for postoperative CSF leaks.

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Section: Postoperative Pneumocephalussupporting

confidence: 47%

Section: Risk Of Csf Leaks Associated With Esbsmentioning

confidence: 99%

Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

Banu

Szentirmai

Mascarenhas

et al. 2014

JNS

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“…With increasing indications for transsphenoidaletransethmoidal approaches to deal with skull base and sinonasal lesions extending toward the optic nerve and with the development of endoscopic intranasal surgery techniques, an improvement in our knowledge of the anatomy of that region is needed (Zimmer and Theodosopoulos, 2009;Bhatki et al, 2010;Cavallo et al, 2005;Muscatello et al, 2010;Virgin et al, 2010). The interrelations of the optic nerve and internal carotid artery and their relationships with bony structures and with the configurations of the sphenoid and ethmoid sinuses are important factors limiting the transsphenoidaletransethmoidal approach in events affecting the optic canal Fujii et al,1979;Kitano et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Anatomical aspects in the transsphenoidal–transethmoidal approach to the optic canal: An anatomic–cadaveric study

Yılmazlar

Saraydaroğlu

Korfalı

2012

Journal of Cranio-Maxillofacial Surgery

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“…Although this method is associated with a higher success rate and a low incidence of complications, the major difficulty for clinicians is the ability to locate accurately the GPF and its association with the GPC (Wong and Sved, 1991). Apart from anaesthesia during dental procedures (Saralaya and Nayak, 2007), the PPF infiltration through the GPF can significantly reduce bleeding during surgery to repair the nasal septum (Mercuri, 1979) and during endoscopic sinus surgery and septorhinoplasty and to help control posterior epistaxis (Williams and Ghorayeb, 1990;Das et al, 2006;Douglas and Wormald, 2006;Muscatello et al, 2010). The greater palatine artery (GPA) is easily injured during osteotomy of the medial or lateral maxillary sinus walls, pterygomaxillary dysjunction, and during down-fracturing of the maxilla (Ueki et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Anatomical variation and morphology in the position of the palatine foramina in adult human skulls from Greece

Piagkou¹,

Xanthos²,

Anagnostopoulou³

et al. 2012

Journal of Cranio-Maxillofacial Surgery

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Endoscopic endonasal craniotomy in the management of selected ethmoidal malignancies: The University of Pisa experience

Cited by 16 publications

References 22 publications

Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

Anatomical aspects in the transsphenoidal–transethmoidal approach to the optic canal: An anatomic–cadaveric study

Anatomical variation and morphology in the position of the palatine foramina in adult human skulls from Greece

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