Cerebrospinal fluid (CSF) rhinorrhea involves a breakdown of all barriers that separate the subarachnoid space from the upper aerodigestive tract, namely, the mucosa of the nasal cavity or paranasal sinus, skull base (i.e., bone), dura mater, and arachnoid membrane. Management of Unexpected Cerebrospinal Fluid Fistulae during Endoscopic Sinus Surgery.  |  ACOG Technology Assessment in Obstetrics and Gynecology No. Two Cases of Delayed Cerebrospinal Rhinorrhea after Transsphenoidal Surgery.

Obstet Gynecol. Its incidence did not correlate to tumor size. Intrathecal Fluorescein in Endoscopic Skull Base Surgery.

Several circumstances predispose the patient to have a CSF fistula during endoscopic sinus surgery. Transnasal repair of CSF leaks has gained popularity during the past decade. At the age of 58, the patient underwent a robotic-assisted total hysterectomy and oophorectomy due to persistent menorrhagia.

Reconstruction of the water-tight layer was accomplished by using a combination of autologous bone from the posterior nasal septum, a vascularized nasal septal flap, and a 1-square-inch piece of Duragen artificial dural implant (Integra LifeSciences, Plainsboro, NJ). 2019 May 15;59(5):184-190. doi: 10.2176/nmc.tn.2018-0270. The pathology of the lesion was consistent with a nonfunctional pituitary macroadenoma. The meta‐analysis database was compared with and added to a database comprising our own patients. 2019 Jun 28;4:100055. doi: 10.1016/j.wnsx.2019.100055. 2006 Oct;66(4):371-6; discussion 376. doi: 10.1016/j.surneu.2006.06.043. Cerebrospinal Fluid Leaks and Encephaloceles. A second spinal tap is performed 24 to 48 hours after removal of the lumbar spinal drain, to measure the spinal fluid pressure, thus evaluating the possibility of hydrocephalus and the need for a ventricular periosteal shunt. Endoscopic management of spontaneous CSF rhinorrhea with septal graft and middle turbinate rotational flap technique: a review of 31 cases. Late-Onset Intractable Cerebrospinal Fluid Leakage After Stereotactic Radiotherapy After Resection of Giant Nonfunctioning Pituitary Adenoma. In this patient population, reduction in Trendelenberg angle, minimization of pneumoperitoneum, or exploration of alternative surgical approaches may be of benefit to the patient. Analysis of Various Factors and Techniques to Improve Outcome of Surgical Management of 243 Cases of CSF Rhinorrhea.

Management of Trauma to the Nose and Paranasal Sinuses. The duration of undiagnosed CSF rhinorrhea ranged from 15 years to 4 days 5, 11, 13 with the exception of cases in which the CSF leak was identified at the time of occurrence and repaired intraoperatively (e.g., endoscopic sinus surgery or tumor ablative surgery). The success rate was monitored and correlated with the other variables. Harvey, RJ, Parmar, P, Sacks, R, Zanation, AM. 3 Conversely, hydrocephalus was most commonly diagnosed in patients with traumatic and spontaneous CSF leaks.

Determinants of success in endoscopic cerebrospinal fluid leak repair. As an alternative, a vascularized tissue flap may be designed transnasally, using middle turbinate mucoperiosteum or septal mucoperichondrium.

Here, we report a case of a patient who developed a CSF leak 28 years after transsphenoidal surgery, precipitated by a robotic-assisted hysterectomy during which increased intra-abdominal pressure and steep Trendelenberg positioning were both factors. Create a link to share a read only version of this article with your colleagues and friends. Epub 2014 Nov 22. Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options.

Of 132 patients with CSF rhinorrhea, a transnasal endoscopic approach was used in 98 to repair cranial base defects in the ethmoid and sphenoid sinuses. Inlay grafting is suited to repair defects of the posterior wall of the frontal sinus, the ethmoid roof, and, sometimes, the sphenoid sinus. 2005 Nov;147(11):1163-6; discussion 1166. As an alternative, the sphenoid sinus defect may be repaired using self‐setting hydroxyapatite bone cement. Objective: Cerebrospinal fluid (CSF) rhinorrhea is a potentially life-threatening complication following transsphenoidal surgery (TSS). Reconstruction of a skull base defect after endoscopic endonasal resection of a pituitary adenoma: Sphenoid mucosal flaps. 2012 Jun;116(6):1311-7. doi: 10.3171/2012.2.JNS111837. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Given the remote nature of the patient’s transsphenoidal surgery and relative paucity of data regarding such a complication, the condition went unrecognized for several months. The Bath-Plug Closure of Anterior Skull Base Cerebrospinal Fluid Leaks. The duration of undiagnosed CSF rhinorrhea ranged from 15 years to 4 days 5, 11, 13 with the exception of cases in which the CSF leak was identified at the time of occurrence and repaired intraoperatively (e.g., endoscopic sinus surgery or tumor ablative surgery). Such surgeries may cause damage to the bony enclosure of the brain that leads to communication with the nose.

Fujita Y, Taniguchi M, Tsuzuki T, Nakai T, Uozumi Y, Kimura H, Kohmura E. Neurol Med Chir (Tokyo). The Application of a Free Nasal Floor Mucoperiosteal Graft in Endoscopic Sinus Surgery.

Endoscopic and Keyhole Cranial Base Surgery. The Magnetic Resonance Imaging Appearance of Endoscopic Endonasal Skull Base Defect Reconstruction Using Free Mucosal Graft. Methods: To elucidate the risk factors that may affect the incidence of postoperative CSF rhinorrhea… The development of the vascularized nasoseptal flap as a closure technique has increased the surgeon’s capacity to correct even larger openings in the dura of the sella as well as widely exposed anterior skull base defects. A Case of Transnasal Endoscopic Repair for Traumatic Cerebrospinal Fluid Rhinorrhea after Multiple Cranial Surgeries難治性髄液鼻漏に対する鼻内内視鏡下髄液鼻漏閉鎖術例. When a CSF leak was encountered during TSS in these high-risk cases, thorough sellar reconstruction and long-term follow-up is necessary. 2011 Aug;44(4):937-52, viii. Cerebrospinal fluid leaks during endoscopic sinus surgery in thirty‐two patients.

Epub 2018 Feb 1. Craniomaxillofacial Trauma & Reconstruction. Mucoperichondrial and/or mucoperiosteal free grafts were used in a variety of combinations by Lanza et al.

Cranial base repair with combined vascularized nasal septal flap and autologous tissue graft following expanded endonasal endoscopic neurosurgery. Ciric, I, Ragin, A, Baumgartner, C, Pierce, D. Kaptain, GJ, Kanter, AS, Hamilton, DK, Laws, ER. COVID-19 is an emerging, rapidly evolving situation.

Ear Nose Throat J . Dusick JR, Mattozo CA, Esposito F, Kelly DF. 2019 May 15;59(5):184-190. doi: 10.2176/nmc.tn.2018-0270. The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article. Manuscript content on this site is licensed under Creative Commons Licenses, Traditional CSF Rhinorrhea Etiology and Management, Intracranial Pressure During Minimally Invasive Abdominal-Pelvic Surgery, Late Onset of CSF Rhinorrhea in a Postoperative Transsphenoidal Surgery Patient Following Robotic-Assisted Abdominal Hysterectomy, http://www.creativecommons.org/licenses/by/3.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, Primary Spontaneous Cerebrospinal Fluid Leaks Located at the Clivus.

The onlay technique is recommended if there is a risk that nerves or vessels may be damaged when dissecting the dura from the surrounding bone, when inserting the graft, or if an inlay technique is not technically possible. Gelfoam or Gelfilm are frequently used to separate the graft from the packing material, to prevent avulsion of the graft or flap during its removal. The Preoperative Sinus CT: Avoiding a “CLOSE” Call with Surgical Complications. Transsphenoidal pituitary surgery: comparison of two sellar reconstruction techniques and their effect on postoperative cerebrospinal fluid leakage.

Empirical sellar reconstruction in the absence of an intraoperative CSF leak may be of benefit following resection of large tumors, especially if the arachnoid is thinned out and herniates into the sella. Parikh A, Adapa A, Sullivan SE, McKean EL.  | 

Ogiwara T, Nagm A, Hasegawa T, Hanaoka Y, Ichinose S, Goto T, Hongo K. Neurosurg Rev. The transmitted pulsations of the brain also cause microfracturing of the cement. doi: 10.1016/j.otc.2011.06.015. 3, 5, 6, 13, 14, Of great interest for otolaryngologists is the occurrence of an iatrogenic CSF leak caused by endoscopic sinus surgery. El-Sayed, IH, Roediger, FC, Goldberg, AN, Parsa, AT, McDermott, MW. All published studies encompassing the period from 1990 to 1999 and addressing the surgical repair of CSF fistulae using a transnasal, transendoscopic approach were identified using a MEDLINE search and cross‐referencing. Jiménez Zapata HD, Rodríguez Berrocal V, Vior Fernández C, Sánchez FM, García Fernández A. J Neurol Surg B Skull Base.