Lumber drain morbidity in endonasal endoscopic skull base surgery

“…In addition, use of a multilayered closure with nasoseptal flap and adjuvant lumbar drain placement can help mitigate the risk of postoperative CSF leak with low added patient morbidity. 5a-7a Ultimately, management of CPs depends on rigorous evaluation of preoperative imaging, surgeon experience, and consideration of the neurological and endocrinological implications of treatment.…”

Section: Commentsmentioning

confidence: 99%

Endoscopic Endonasal Transtuberculum Approach for Pediatric Tuberoinfundibular Craniopharyngioma: 2-Dimensional Operative Video

Vigo

Nunez

Prolo

et al. 2023

Operative Neurosurgery

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INDICATIONS: CORRIDOR AND LIMITS OF EXPOSURE The endoscopic endonasal transtuberculum approach grants access to suprasellar and retrochiasmatic lesions with hypothalamic involvement. Here, we present a case of a 13-year-old boy with a history of stunted growth, decreased vision, headaches, and low energy with a tuberoinfundibular craniopharyngioma. The patient consented to the procedure. ANATOMIC ESSENTIALS: NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT Evaluation of the sphenoid sinus pneumatization, internal carotid artery disposition, presence of clinoidal rings, variations of the infrachiasmatic corridor (optic chiasm location, height of dorsum sella), and location of the pituitary stalk are crucial for surgical strategy. ESSENTIALS STEPS OF THE PROCEDURE Harvesting of nasoseptal flap and access to the sphenoid sinus; drilling the sella, tuberculum, and chiasmatic sulcus up to the limbus sphenoidalis and laterally exposing the clinoidal carotid artery segment; wide dural opening to the level of distal rings inferolaterally and falciform ligaments superolaterally; identification and coagulation of superior hypophyseal branches providing tumor supply; intracapsular dissection and debulking and subpial sharp dissection at the hypothalamic tumor interface to achieve complete removal; and reconstruction with inlay collagen, fascia lata, and nasoseptal flap. PITFALLS/AVOIDANCE OF COMPLICATIONS Preservation of the superior hypophyseal arteries and stalk is essential for preventing pituitary dysfunction. Preoperative reckoning of hypothalamic invasion and identification of adequate interface aids in avoiding complications. To reduce CSF leak risk, multilayer reconstruction was performed and lumbar drain placed postoperatively. VARIANTS AND INDICATIONS FOR THEIR USE For retroclival extension, intradural pituitary transposition should be considered to expand the corridor; in patients with preoperative hypopituitarism, pituitary sacrifice is most effective to increase retroclival access.

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“…The highest level of evidence to date pertaining to perioperative LD usage and its impact on reconstructive outcomes comes from a single-institutional, prospective randomized controlled trial involving large dural defects of the suprasellar area, ACF, and PCF (72) . an infectious disease workup (73) . More recently, Birkenbeuel et al reviewed medical and technical complications related to LD placement in 64 patients who underwent endoscopic skull base surgery (74) .…”

Section: Lumbar Drainagementioning

confidence: 99%

Preoperative, technical, and postoperative considerations for skull base reconstruction: a practical review of critical concepts

Phillips

Turner

Kuan

2023

Rhin

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Despite widespread adoption and advances in endoscopic skull base surgery, with expanding indications and the ability to effectively treat larger and more complex pathologies, skull base reconstruction following tumor resection and prevention of cerebrospinal fluid leak remains a challenge for even the most seasoned of surgical teams. Mounting evidence in all areas have pushed our understanding of skull base reconstruction principles forward. In this narrative review, we summarize critical concepts and provide practical but comprehensive guiding principles on preoperative, intraoperative/technical, and postoperative management principles related to optimizing skull base reconstructive success. The goal is to provide an informative resource for skull base surgeons (both otolaryngologists and neurosurgeons) to reference regarding state-of-the-art evidence surrounding this ever-evolving topic.

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Lumber drain morbidity in endonasal endoscopic skull base surgery

Cited by 5 publications

References 44 publications

Skull Base Reconstruction following Surgical Treatment of Sinonasal Malignancies

Skull Base Reconstruction following Surgical Treatment of Sinonasal Malignancies

Endoscopic Endonasal Transtuberculum Approach for Pediatric Tuberoinfundibular Craniopharyngioma: 2-Dimensional Operative Video

Preoperative, technical, and postoperative considerations for skull base reconstruction: a practical review of critical concepts

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