Management of Cerebrospinal Fluid Leak following Retrosigmoid Posterior Cranial Fossa Surgery

Bayazıt, Yıldırım A.; Çelenk, Fatih; Düzlü, Mehmet; Göksu, Nebil

doi:10.1159/000272030

Cited by 30 publications

(41 citation statements)

References 20 publications

(14 reference statements)

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“…The incidence has been reported to range from 1-12.5% after MVD for trigeminal neuralgia 11,19. However, there was no case of CSF leakage after MVD in our series, which is similar to the findings of Bayazit et al6 where there was no CSF leakage after MVD.…”

Section: Discussionsupporting

confidence: 92%

“…Bayazit et al6 in their study found that ten out of the thirty two patients that had CSF leakage after retrosigmoid posterior cranial fossa surgery could be managed conservatively. Twelve patients needed CSF lumbar drainage.…”

Section: Discussionmentioning

confidence: 98%

“…Treatment options include either to start with conservative measures including re-suturing of the wound and to opt for CSF lumbar drainage in case the CSF leakage doesn’t stop,6,7 or to institute CSF lumbar drainage simultaneously with the conservative measures as the initial intervention 8. Surgical repair is done in case these measures fail 9.…”

Section: Introductionmentioning

confidence: 99%

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Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery

Altaf¹,

Vohra

Shams

2016

Pak J Med Sci

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Objective:Cerebrospinal fluid leakage remains a significant cause of morbidity following posterior fossa surgery, and its treatment remains a difficult problem. The aim of the study was to propose a treatment algorithm for its management.Methods:A retrospective, single-center study was conducted on 147 patients who underwent elective posterior fossa surgery for a variety of diseases. Patients with post operative CSF leakage had either been treated initially with conservative measures including re-suturing of the wound, with CSF lumbar drainage to be employed in case the CSF leakage didn’t stop, or the initial intervention was the institution of CSF lumbar drainage simultaneously with conservative measures. VP (ventriculo-peritoneal) shunt was done in patients with gross hydrocephalus on postoperative CT brain.Results:There were 25 (17%) cases of CSF leakage, including 24 incisional CSF leaks and one case of CSF otorrhea. In eight patients with incisional CSF leakage treated initially with conservative measures including re-suturing of the wound, CSF leakage stopped in only two cases. CSF lumbar drainage instituted later on in six cases with persistent leakage stopped the CSF leakage. In fourteen patients managed initially with re-suturing of the wound and concomitant CSF lumbar drainage, CSF leakage settled in all the cases. Two patients with gross hydrocephalus on post operative CT were managed successfully with VP shunt. Re-suturing of the wound with concomitant CSF lumbar drainage was found to be significantly associated (p=0.003) with the stoppage of CSF leakage, and the settlement of meningitis (p= 0.014).Conclusion:Incisional CSF leaks after posterior fossa surgery should be managed with re-suturing of the wound and concomitant CSF lumbar drainage, instead of an initial trial of conservative therapy alone.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery

Altaf¹,

Vohra

Shams

2016

Pak J Med Sci

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“…However, in our patients, CFS leak was the most common problem that was encountered in 2 of 5 patients (40%). In retrosigmoid approach the treatment algorithm of CSF leaks has been established well [9,10] . It includes one or more of the following: conservative treatment with compressive dressing, placement of a lumbar drainage, surgical reexploration and ventriculoatrial or ventriculoperitoneal shunts.…”

Section: Discussionmentioning

confidence: 99%

Complications of Pediatric Auditory Brain Stem Implantation via Retrosigmoid Approach

Bayazıt¹,

Abaday²,

Doğulu

et al. 2011

ORL

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Objective: We aimed to present the complications of auditory brain stem implantations (ABI) in pediatric patients which were performed via retrosigmoid approach. Methods: Between March 2007 and February 2010, five prelingually deaf children underwent ABI (Medel device) operation via retrosigmoid approach. All children had severe cochlear malformations. The ages ranged from 20 months to 5 years. The perioperative complications encountered in 2 patients were evaluated retrospectively. Results: No intraoperative complication was observed in the patients. Cerebrospinal fluid (CSF) leakage was the most common postoperative complication that was seen in 2 patients. The CSF leak triggered a cascade of comorbidities, and elongated the hospitalization. Conclusion: Pediatric ABI surgery can lead to morbidity. The CSF leak is the most common complication encountered in retrosigmoid approach. The other complications usually result from long-term hospital stay during treatment period of the CSF leak. Therefore, every attempt must be made to prevent occurrence of CSF leaks in pediatric ABI operations.

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“…When they occur, treatment is needed to avoid meningitis and rarely death. In adults, CSF leakage after RSS has an average incidence of 10.6% (8) with a range from 0.29 (9) to 68.7% (10). In vestibular schwannoma surgery, the incidence is higher, from 2 to 14%, compared with vestibular nerve section and microvascular decompression procedures which present an average incidence of 6.15% (11).…”

Section: Objectivementioning

confidence: 99%

Resorbable Mesh Cranioplasty Repair of Bilateral Cerebrospinal Fluid Leaks Following Pediatric Simultaneous Bilateral Auditory Brainstem Implant Surgery

Colletti

Mandalà

Colletti³

et al. 2017

Otology &Amp; Neurotology

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Objective: To present a child with cochlear nerve deficiency (CND) who received simultaneous bilateral simultaneous auditory brainstem implants (BS-ABI) and subsequently presented with bilateral cerebrospinal fluid (CSF) leaks unresponsive to standard treatments. To propose a novel rigid retrosigmoid cranioplasty for treating and preventing CSF leaks in children at high risk for this complication. Patient: A 3.5-year-old child with CND, vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities, coloboma, heart defect, atresia choanae, retarded growth and development, genital abnormality, and ear abnormality, Arnold Chiari malformation, previous treated tracheo-esophageal fistula underwent BS-ABI. Postoperatively, the child had recurrent bilateral retroauricular fluid collections. A standard revision procedure revealed breaches in the dural closure, migration of the auditory brainstem implantation (ABI) receiver stimulator on both sides and was unsuccessful in stopping the leak. Interventions: Bilateral repair with free fat grafting filling the craniectomy space and two absorbable meshes of poly-L-D-lactic (PLDL) acid stabilized with PLDL pins on the surrounding cranium, one to stabilize the fat graft and one to fix the ABI receiver stimulators inside the subperiosteal pockets. Main Outcome Measure: CSF leak recurrence, postoperative computed tomographic (CT) scans, intra-and postoperative simultaneous electrically evoked auditory brainstem responses (EABRs). Subjective and objective assessment of ABI function. Results: No postoperative CSF leaks at 60 days follow-up. EABRs and consistent behavioral responses obtained at initial mapping on both sides. Conclusions: The use of BS-ABI likely contributed to bilateral CSF leaks requiring revision surgeries in this child. Simultaneous bilateral craniotomies can put patients at risk for CSF leak. A novel cranioplasty technique employed finally proved successful in stopping the CSF leak in this case.

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Management of Cerebrospinal Fluid Leak following Retrosigmoid Posterior Cranial Fossa Surgery

Cited by 30 publications

References 20 publications

Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery

Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery

Complications of Pediatric Auditory Brain Stem Implantation via Retrosigmoid Approach

Resorbable Mesh Cranioplasty Repair of Bilateral Cerebrospinal Fluid Leaks Following Pediatric Simultaneous Bilateral Auditory Brainstem Implant Surgery

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