Endoscopic Endonasal Partial Middle Turbinectomy Approach: Adaptability of the Procedure in a Cadaveric Study and in Surgery for Different Sphenoid Sinus and Skull Base Lesions

El-Banhawy, Omar A.; El-Dien, Abd El-Hafiz Shehab; Zolfakar, Ahmed; Halaka, A. N.; Ayad, Heshmat

doi:10.1055/s-2005-922014

Cited by 11 publications

(18 citation statements)

References 18 publications

(52 reference statements)

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“…Carrabba et al (2) reported that the incidence of CSF leakage was 24% after EEA. Therefore, the reconstruction of skull base defect is of paramount importance to prevent CSF leakage after endoscopic endonasal surgery (9,11). A pedicled mucosal flap is one of the major advancements in endoscopic endonasal skull base reconstruction, which is regarded by most authors as the best method to repair a defect of the skull base (11,14,15,21,23).…”

Section: Discussionmentioning

confidence: 99%

Endonasal endoscopic skull base multilayer reconstruction surgery with nasal pedicled mucosal flap to manage high flow csf leakage

Wang¹,

Hu²,

Zhang³

et al. 2012

Turkish Neurosurgery

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AIm: Multilayer reconstruction of skull base using nasal pedicled mucosal flap has been widely accepted as a standard method for repairing high flow cerebrospinal fluid [CSF] leakage. In this study, we analyzed our outcome and summarized several valuable operation experiences from this technique. mAterIAl and methOds: This study included 20 consecutive patients who underwent endoscopic endonasal multilayer reconstruction using a nasal pedicled mucosal flap to repair high flow CSF leakage and were available for follow-up. results:In this series, all cases encountered intraoperative high-flow CSF leakage, including 11 (55%) patients with opening of third ventricles (TV) and 9 (45%) patients with wide opening of cistern (CS). After endoscopic endonasal multilayer reconstruction with nasal pedicled mucosal flap, 3 patients (15.0%) encountered CSF leakage in the early postoperative period but were successfully repaired; 2 patients (10.0%) encountered late postoperative CSF leakage. In the TV group, the ratio of CSF leakage was 18.2% (2/11); while the incidence of CSF leakage was 11.1% (1/9) in the CS group. One patient developed meningitis due to CSF leakage four month after surgery, then gave up treatment and died.COnClusIOn: Multilayer reconstruction with nasal pedicled flap seems to be useful and reliable for the treatment of ventral skull base defects using endoscopic endonasal approach.KeywOrds: Endoscopic, Pedicled mucosal flap, Multilayer reconstruction, High-flow CSF leakage ÖZ AmAÇ: Nazal pediküllü mukozal flep kullanarak kafatası tabanının çok tabakalı rekonstrüksiyonu, yüksek akışlı beyin omurilik sıvısı sızıntısını tamir etmek için standart bir yöntem olarak yaygın olarak kabul edilmiştir. Bu çalışmada bu teknikle sonuçlarımızı analiz ettik ve ameliyatlarımızdan elde ettiğimiz çeşitli değerli deneyimlerimizi özetledik. yÖntem ve GereÇler: Bu çalışmaya yüksek akışlı BOS sızıntısını tamir etmek için nazal pediküllü mukozal flep kullanılarak endoskopik endonazal çok tabakalı rekonstrüksiyon yapılan ve daha sonra takibi yapılabilen arka arkaya 20 hasta dahil edildi.BulGulAr: Bu seride tüm vakalarda yüksek akışlı BOS sızıntısı vardı ve bunlar arasında üçüncü ventrikül açıklığı olan 11 (%55) hasta ve geniş sistern açıklığı olan 9 (%45) hasta vardı. Nazal pediküllü mukozal fleple endoskopik endonazal çok tabakalı rekonstrüksiyon sonrasında, 3 hastada (%15,0) erken postoperatif dönemde BOS sızıntısı oldu ama başarıyla tamir edildi; 2 hastada (%10,0) geç postoperatif BOS sızıntısı oldu. Üçüncü ventrikül açıklığı grubunda BOS sızıntısı insidansı %18,2 (2/11) iken geniş sistern açıklığı grubunda BOS sızıntısı insidansı %11,1 (1/9) bulundu. Bir hastada ameliyattan 4 ay sonra BOS sızıntısı nedeniyle menenjit gelişti ve hasta tedaviyi uygulamayıp öldü. sOnuÇ: Nazal pediküllü fleple çok tabakalı rekonstrüksiyon, endoskopik endonazal yaklaşım kullanılarak ventral kafatası tabanı defektlerinin tedavisinde faydalı ve güvenilir görünmektedir.

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Section: Discussionmentioning

confidence: 99%

Endonasal endoscopic skull base multilayer reconstruction surgery with nasal pedicled mucosal flap to manage high flow csf leakage

Wang¹,

Hu²,

Zhang³

et al. 2012

Turkish Neurosurgery

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“…7 Therefore, the reconstruction of skull base defect is of paramount importance to prevent CSF leakage after endoscopic endonasal surgery. 8,9 In patients with large dural defects of anterior and ventral skull base, there is a significant risk of post-operative cerebrospinal fluid (CSF) leak after reconstruction. Reconstruction with vascularised tissue is desirable to facilitate rapid healing, especially in irradiated patients.…”

Section: Discussionmentioning

confidence: 99%

Hadad-Bassagasteguy flap in reconstruction of skull base defects after endonasal skull base surgery

Singh

Shah

2017

Int J Otorhinolaryngol Head Neck Surg

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INTRODUCTIONIn the patients with large dural defects of anterior and ventral skull base, there is a significant risk of postoperative cerebrospinal fluid (CSF) leak. Reconstruction with the vascularised tissue is desirable to facilitate rapid healing, especially in irradiated patients. HadadBassagasteguy flap (HBF), a vascular pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium based on the posterior septal artery (branch of sphenopalatine artery), was first developed in university of Rosario, Argentina, for reconstruction of ventral skull base dural defects.1 It is increasingly becoming a "workhorse" for the reconstruction in extended endonasal skull base surgery. Endoscopic endonasal repair of traumatic CSF leaks with the nasoseptal flap (NSF) has a success rate of approximately 95% -comparable to that of traditional approaches. Methods:We prospectively analyzed the demographic data and the outcome results particularly Post-operative CSF leak in 53 patients who underwent HBF in our hospital from February 2013 to June 2014. The early harvested flap was used to reconstruct anterior skull base defects among patients with high-flow on-table CSF leak. Post-operatively the patients were analyzed for CSF leak and bleeding. Results: Most of the study subjects were between 21-50 years of age (73.6%). The mean age of the study subjects was 41.8±13.8 years. Male/female ratio of the study sample was 1.2 with 29 males and 24 females. Of the total 53 patients 46 (86.8%) has macro defects while 7 (13.2%) had micro defects. Non-secretary lesions were present in 60.4% (32/53) patients while secretary were present in 39.6% (21/53) patients. Cerebrospinal fluid leak was present in all the patients undergoing surgery and majority of them were put on lumbar drain, while bleeding was present in 49.1% patients. Of the total 53 patients only 2 had post-operative cerebrospinal fluid leak (2/53; 3.8%). Conclusions: Use of HB posterior nasal septal flap for reconstruction of anterior skull base among patients with highflow intra-operative CSF leak has a remarkable impact in preventing post-operative CSF leak. Its applicability to wide patient-profiles with respect to age, size of defect, diagnosis is making it a versatile choice of reconstruction after endonasal anterior skull base surgeries.

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“…In most cases, surgical management is best optimized using a multidisciplinary team consisting of neurosurgeons and otolaryngologists. [1][2][3][4][5] Endoscopic endonasal reconstruction of skull base defects for sealing of CSF rhinorrhea or following tumor resection is of paramount importance in avoiding serious and life-threatening complications (e.g., meningitis, encephalitis, or a cerebral abscess). [2][3][4][5] In the current study, we used the endoscopic endonasal partial middle turbinectomy approach 5 in most of the surgeries; besides the wider surgical field created by this approach, the harvested piece of turbinate obtained was used in repairing the skull base defect.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Endonasal Endoscopic Skull Base Reconstruction with Nasal Turbinate Graft

El-Banhawy

Halaka

Altuwaijri³

et al. 2008

Skull Base

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Objective: To study the long-term outcome of endonasal endoscopic skull base reconstruction with nasal turbinate tissue free graft. Patients and Methods: This study included 55 consecutive patients who underwent endonasal endoscopic skull base reconstruction with nasal turbinate graft and were available for follow-up. They were 30 patients with pituitary adenomas, 20 with cerebrospinal fluid (CSF) rhinorrhea of different etiologies, three with meningoencephalocele, and two with skull base meningiomas. Autologous nasal turbinate tissue materials were used in reconstructing the skull base defect. Clinical follow-up with endoscopic nasal examination was done routinely 1, 3, 6, and 12 months after surgery. Computed tomography and magnetic resonance imaging were performed when indicated. The follow-up period ranged from 6 months to 8 years. Results: There were no major operative or postoperative complications. Nasal turbinate graft was effective in sealing of intraoperative CSF leak, obliteration of dead space, and anatomic reconstruction of the skull base. There was no evidence of graft migration or inflammatory changes. Starting from 3 months after surgery to the rest of the follow-up period, endonasal endoscopic view of the site of duraplasty showed that: with small skull base defect (less than 5 mm), there was neither dural pulsation nor prolapse; with moderate-sized defect (5 to 10 mm), there was dural pulsation without prolapse; with larger defect (> 10 mm), there was dural pulsation and prolapse. These finding were constant regardless of the etiology of the lesion and the reconstruction material used. Conclusions: This long-term study demonstrated the efficacy of nasal turbinate graft in sealing of CSF leak without any delayed complications. Other rigid materials may be considered in reconstruction of large skull base defect (more than 10 mm) to prevent dural prolapse and herniation. For any future endonasal procedure for those patients, who had previous endonasal

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Endoscopic Endonasal Partial Middle Turbinectomy Approach: Adaptability of the Procedure in a Cadaveric Study and in Surgery for Different Sphenoid Sinus and Skull Base Lesions

Cited by 11 publications

References 18 publications

Endonasal endoscopic skull base multilayer reconstruction surgery with nasal pedicled mucosal flap to manage high flow csf leakage

Endonasal endoscopic skull base multilayer reconstruction surgery with nasal pedicled mucosal flap to manage high flow csf leakage

Hadad-Bassagasteguy flap in reconstruction of skull base defects after endonasal skull base surgery

Long-Term Outcome of Endonasal Endoscopic Skull Base Reconstruction with Nasal Turbinate Graft

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