Plasma Ablation−Assisted Endoscopic Endonasal Transpterygoid Approach to Sphenoid Lateral Recess Cerebrospinal Fluid Leaks: Technique and Outcome

Rathod, Ramya; Virk, Ramandeep Singh; Nayak, Gyanaranjan

doi:10.1016/j.wneu.2021.01.122

Cited by 3 publications

(11 citation statements)

References 32 publications

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“…These rates are superior compared to the success rates of 86% in craniotomy and extracranial methods for the surgical repair of CSF leaks [ 37 ]. A review of recent studies published over the past 5 years showed a high success rate with zero or very minimal immediate postoperative complications ( Table 6 ) [ 8 , 30 , 31 , 32 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. The variable success rates of endoscopic repair most likely reflect the surgeons’ technical experience, the timing of management, and the nature of the leak (high-pressure versus low-pressure).…”

Section: Discussionmentioning

confidence: 99%

Management of Traumatic and Non-Traumatic Cerebrospinal Fluid Rhinorrhea—Experience from Three Southeast Asian Countries

Zahedi

Subramaniam

Kasemsiri

et al. 2022

IJERPH

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Background: Cerebrospinal fluid (CSF) rhinorrhea requires proper management to avoid disastrous consequences. The objectives of this study were to ascertain the patient characteristics, etiologies, sites of defect, skull base configurations, methods of investigation, and management outcomes of CSF rhinorrhea. Methods: A retrospective study was performed over 4 years involving three surgeons from Malaysia, Singapore, and Thailand. Hospital records were reviewed to determine the patients’ characteristics, the causes and sites of leaks, methods of investigation, skull base configurations, choices of treatment, and outcomes. Results: A total of 15 cases (7 traumatic and 8 non-traumatic) were included. Imaging was performed in all cases. The most common site of leakage was the cribriform plate (9/15 cases). The mean ± SD of the Keros heights were 4.43 ± 1.66 (right) and 4.21 ± 1.76 mm (left). Type II Keros was the most common (60%). The mean ± SD angles of the cribriform plate slope were 51.91 ± 13.43 degrees (right) and 63.54 ± 12.64 degrees (left). A class II Gera configuration was the most common (80%). All except two patients were treated with endonasal endoscopic surgical repair, with a success rate of 92.3%. A multilayered repair technique was used in all patients except one. The mean ± SD postoperative hospital stay was 9.07 ± 6.17 days. Conclusions: Non-traumatic CSF rhinorrhea outnumbered traumatic CSF rhinorrhea, with the most common site of leak at the cribriform plate. Imaging plays an important role in investigation, and Gera classification appears to be better than Keros classification for evaluating risk. Both conservative and surgical repairs are practiced with successful outcomes. Endonasal endoscopic CSF leak repair is the mainstay treatment.

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Section: Discussionmentioning

confidence: 99%

Management of Traumatic and Non-Traumatic Cerebrospinal Fluid Rhinorrhea—Experience from Three Southeast Asian Countries

Zahedi

Subramaniam

Kasemsiri

et al. 2022

IJERPH

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“…The MT resection was reported in eight studies. Partial MT resection was reported in the following studies: Abdelazim et al, 33 Castelnuovo et al, 37 Kirtane et al, 47 and Rathod et al, 35,43 and also reported the partial resection of the MT and medialization. MT resection without explicit detail on the completeness of the resectionwas reported by Bozkurt et al, 13, 35 Sreenath et al, 13 and Ulu et al 46 who report the resection of the MT or preparation of the MT as pedicled flap for skull base reconstruction in some cases.…”

Section: Transpterygoid Approachmentioning

confidence: 93%

“…The following studies had a transpterygoid approach of endoscopic endonasal repair for CSF leaks for 6 patients in Abdelazim et al, 33 3 in Babu et al, 34 32 in Bozkurt et al, 35 12 in Campbell et al, 36 in Castelnuovo et al, 37 9 in He and Zhen, 38 20 in Huang et al, 39 3 in Jolly et al, 40 13 in Maxfield et al, 41 2 in Muscatello et al, in Rathod et al, 43 33 in Sreenath et al, 13 3 in Tabaee et al, 3 in Tomazic and Stammberger, 45 and 9 in Ulu et al 46 This was the most common approach and has been trusted for its ability to access the LRS.…”

Section: Transpterygoid Approachmentioning

confidence: 99%

“…Two studies reported the use of a binostril approach including the studies by Bozkurt et al, 35 who preferred a two-surgeon and four-instrument approach, and Ulu et al 46 However, one study by Rathod et al 43 reported the use of a uninostril approach. The rest of the studies did not report on the use of either uninostril or binostril approach.…”

Section: Transpterygoid Approachmentioning

confidence: 99%

“…Tabaee et al 44 report that the cartilaginous and vomer parts of the nasal septum were resected to improve access to the sphenoid cavity. On the other hand, Rathod et al 43 explain that the use of the plasma ablation tool allowed them to avoid the need for a septectomy and hence a binostril approach as the instrument had multiple functions such as irrigation, suction, ablation, and coagulation hence evading the need to switch between multiple instruments.…”

Section: Transpterygoid Approachmentioning

confidence: 99%

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Systematic Review: Success Rate of Endoscopic Endonasal versus Combined Endonasal and Transorbital Neuroendoscopic Approach for Nontraumatic Cerebrospinal Fluid Leak Repairs in the Lateral Recess of Sphenoid Sinus

Ahmed,

Siddiqui,

Iftikhar

et al. 2024

J Neurol Surg B Skull Base

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Background Cerebrospinal fluid (CSF) leaks from the lateral recess of the sphenoid sinus (LRS) occur due to a skull base defect and are important to treat due to the associated morbidity, e.g., life-threatening meningitis. Nontraumatic CSF leaks have a predilection toward obesity which is a rising phenomenon. LRS is notoriously difficult to access because of its lateral location and its associated neurovascular complications. An alternative surgical corridor has been explored which is the transorbital neuroendoscopic (TONES) approach. Objective To compare the success rate of the endoscopic endonasal with the TONES approaches. Rationale This is the first systematic review on the endoscopic endonasal and combined transorbital approaches to treat CSF leaks from the LRS. Method A PRISMA-concordant systematic review. PubMed, MEDLINE, EMBASE, Web of Science, and SCOPUS were searched. The studies underwent abstract and full-text screening by two reviewers. The data collected included patient demographic, surgical approach, reconstruction method, layers and materials, follow-up period, ROBINS-I bias, complications, and success rate. Results In total, 26 of 4,385 studies were included for further synthesis. Of these studies, a total of 336 patients were identified from a cohort of 910 patients. The endoscopic endonasal approach showed a repair success rate of 95.24% and the combined TONES and endonasal approach showed a success rate of 100%. Conclusion Both the endoscopic endonasal and transorbital approach provide a good success rate. However, due to the small TONES sample, large, randomized control trials are needed.

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Prospective Study on Coblation Vs. Cautery in Endoscopic Trans Sphenoidal Surgery for Pituitary Macroadenoma: Impact on Nasal Function

Singh,

Chhabra,

Manogaran

et al. 2024

Indian J Otolaryngol Head Neck Surg

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Plasma Ablation−Assisted Endoscopic Endonasal Transpterygoid Approach to Sphenoid Lateral Recess Cerebrospinal Fluid Leaks: Technique and Outcome

Cited by 3 publications

References 32 publications

Management of Traumatic and Non-Traumatic Cerebrospinal Fluid Rhinorrhea—Experience from Three Southeast Asian Countries

Management of Traumatic and Non-Traumatic Cerebrospinal Fluid Rhinorrhea—Experience from Three Southeast Asian Countries

Systematic Review: Success Rate of Endoscopic Endonasal versus Combined Endonasal and Transorbital Neuroendoscopic Approach for Nontraumatic Cerebrospinal Fluid Leak Repairs in the Lateral Recess of Sphenoid Sinus

Prospective Study on Coblation Vs. Cautery in Endoscopic Trans Sphenoidal Surgery for Pituitary Macroadenoma: Impact on Nasal Function

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