Incidence of cerebrospinal fluid leak following petrosectomy and analysis of avoidance techniques

Walcott, Brian P.; Nahed, Brian V.; Sarpong, Yaw; Kahle, Kristopher T.; Sekhar, Laligam N.; Ferreira, Manuel

doi:10.1016/j.jocn.2011.08.001

Cited by 8 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Risk factors for a CSF leak after skull base surgery, including the ATPA, are summarized in Table 2. 5,14,15,19,20,24,30,31,33,35 Regardless of whether exposed air cells were replaced by fat or muscle tissues in these reports, the CSF leak did not completely resolve. Although the incidence ratio of postoperative CSF leakage in our hospital was not high compared with reported results by others, some patients demonstrated a refractory course and required reoperation.…”

Section: Discussionmentioning

confidence: 76%

“…10,36 However, in large series of patients who underwent skull base surgery, including the ATPA, up to 15% suffered from a postoper-ative CSF leak. 5,14,15,19,20,24,30,31,33,35 Although other modified methods (e.g., multilayer sealing techniques using fat, fascia, and inlay techniques) have been developed, CSF leaks have not been completely resolved. 7,11,16,18,21,25,34 In recent years, skull base surgery via the endonasal endoscopic approach has demonstrated outstanding progress.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Analysis of various tracts of mastoid air cells related to CSF leak after the anterior transpetrosal approach

Tamura

Tomio

Mohammad

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE The anterior transpetrosal approach (ATPA) was established in 1984 and has been particularly effective for petroclival tumors. Although some complications associated with this approach, such as venous hemorrhage in the temporal lobe and nervous disturbances, have been resolved over the years, the incidence rate of CSF leaks has not greatly improved. In this study, some varieties of air cell tracts that are strongly related to CSF leaks are demonstrated. In addition, other pre- and postoperative risk factors for CSF leakage after ATPA are discussed. METHODS Preoperative and postoperative target imaging of the temporal bone was performed in a total of 117 patients who underwent ATPA, and various surgery-related parameters were analyzed. RESULTS The existence of air cells at the petrous apex, as well as fluid collection in the mastoid antrum detected by a postoperative CT scan, were possible risk factors for CSF leakage. Tracts that directly connected to the antrum from the squamous part of the temporal bone and petrous apex, rather than through numerous air cells, were significantly related to CSF leak and were defined as "direct tract." All patients with a refractory CSF leak possessed "unusual tracts" that connected to the attic, tympanic cavity, or eustachian tube, rather than through the mastoid antrum. CONCLUSIONS Preoperative assessment of petrous pneumatization types is necessary to prevent CSF leaks. Direct and unusual tracts are particularly strong risk factors for CSF leaks.

show abstract

Section: Discussionmentioning

confidence: 76%

mentioning

confidence: 99%

Analysis of various tracts of mastoid air cells related to CSF leak after the anterior transpetrosal approach

Tamura

Tomio

Mohammad

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Frontal sinus obliteration can be performed using Gelfoam, bone chips, adipose tissue (autograft), temporalis fascia, pericranium, bioglass, polytetrafluoroethylene/carbon fiber, calcium sulfate, methylmethacrylate, oxidized cellulose, hydroxyapatite, or lyophilized cartilage. 2,6,9,17,23,24,29 The cranialization aspect of the procedure specifically relates to the elimination of the entire posterior wall, and the brain contents are allowed to fill the sinus space. Typically, a vascularized pedicled pericranial flap is procured and sutured to the inferior anterior skull base, forming a watertight seal between the brain and remnant of the frontal sinus.…”

Section: Management Strategiesmentioning

confidence: 99%

Cerebrospinal fluid fistula prevention and treatment following frontal sinus fractures: a review of initial management and outcomes

Castro

Walcott

Redjal

et al. 2012

FOC

Self Cite

View full text Add to dashboard Cite

Frontal sinus fractures are heterogeneous, and management of these fractures is often modified based on injury pattern and institutional experience. The optimal initial treatment of frontal sinus fractures is controversial. Treatment strategies are aimed at correcting cosmetic deformity, as well as at preventing delayed complications, including CSF fistulas, mucocele formation, and infection. Existing treatment options include observation, reconstruction, obliteration, cranialization, or a combination thereof. Modalities for treatment encompass both open surgical approaches and endoscopic techniques. In the absence of Class I data, the authors review the existing literature related to treatment strategies of frontal sinus fractures, particularly as they relate to CSF fistulas, to provide recommendations based on the best available evidence.

show abstract

“…However, achieving a watertight dural closure after tumor resection by using suture only is difficult due to spatial constraints. Postoperative cerebrospinal fluid (CSF) leakage due to incomplete dural closure is one of the greatest risk factors for postoperative morbidity, including meningitis and tension pneumocephalus 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Simplified Dural Reconstruction Procedure Using Biocompatible Polyglycolic Acid Felt with Autologous Abdominal Fat Grafts after a Transpetrosal Approach

et al. 2019

View full text Add to dashboard Cite

Objective: Dural reconstruction after transpetrosal approaches is complicated because complete primary closure of presidmoid dura mater is difficult to achieve. To address this problem, we use biocompatible polyglycolic acid (PGA) felt (Durawave) to reconstruct dural defects. To evaluate the use of PGA felt in dural reconstruction, we compared these results with those after conventional duralplasty using autologous fascia grafts. Methods: We retrospectively surveyed all cases that involved a transpetrosal approach since 2013. In the conventional procedure, autologous fascia was fixed over the dural defect by using stay sutures; any remaining dead space was obliterated by placing abdominal fat grafts. Since April 2017, we have used PGA felt instead of fascia. Results: Of the 37 cases identified, 27 were reconstructed according to the conventional procedure; the remaining 10 cases were reconstructed by using PGA felt. Among the 27 conventional cases, 8 experienced cerebrospinal fluid (CSF)-related complications, comprising 3 cases of rhinorrhea and 5 cases of subcutaneous fluid collection; 2 cases (7%) required repair surgeries. Of the 10 surgeries involving PGA felt, 1 patient (10%) developed subcutaneous fluid collection and required repair surgery, whereas the remaining 9 cases had no evidence of CSF leakage. In addition, the median dural reconstruction time when using PGA felt was 9 min, which is significantly shorter than when autologous fascia was used (44 min). Conclusions: Using PGA felt for presigmoid dura simplifies dural reconstruction because it Yamaguchi 2 obviates the need to suture in a deep field. PGA felt has potential to prevent CSF-related complications after transpetrosal approaches.

show abstract

Incidence of cerebrospinal fluid leak following petrosectomy and analysis of avoidance techniques

Cited by 8 publications

References 20 publications

Analysis of various tracts of mastoid air cells related to CSF leak after the anterior transpetrosal approach

Analysis of various tracts of mastoid air cells related to CSF leak after the anterior transpetrosal approach

Cerebrospinal fluid fistula prevention and treatment following frontal sinus fractures: a review of initial management and outcomes

Simplified Dural Reconstruction Procedure Using Biocompatible Polyglycolic Acid Felt with Autologous Abdominal Fat Grafts after a Transpetrosal Approach

Contact Info

Product

Resources

About