Limits...
Purely endoscopic pterional extradural approach: A novel technique for repair of cerebrospinal fluid rhinorrhea.

Sinha AK, Goyal S - J Neurosci Rural Pract (2016 Apr-Jun)

Bottom Line: There was no requirement of blood transfusion in any case.All patients had a cessation of CSF leak in the postoperative period, and there was no recurrence.There was no evidence of frontal lobe retraction injury in any of these patients, and no fresh neurological deficit was observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sir Ganga Ram Hospital, New Delhi, India.

ABSTRACT

Study design: Retrospective descriptive study of an innovative surgical technique.

Objective: To assess the feasibility and success of repair of transfrontal sinus cerebrospinal fluid (CSF) rhinorrhea through pterional transcranial extradural approach using endoscope.

Summary of background data: Repair of CSF rhinorrhea has seen advancement with the evolution of endoscopic transnasal techniques. However, leaks from defect in the posterior wall of frontal sinus still remain a challenge for the skull base surgeons and requires conventional craniotomy more often. We describe a novel technique to repair these leaks by purely endoscopic pterional extradural (PEPE) approach thereby avoiding complications associated with conventional craniotomy and endoscopic transnasal approaches.

Materials and methods: Thirty-five patients with traumatic CSF rhinorrhea from the posterior wall of frontal sinus underwent repair with the present technique. They were followed up for 6-18 months and were evaluated for feasibility of procedure, recurrence of leak, and occurrence of the fresh neurological deficit.

Results: Thirty-five patients underwent CSF rhinorrhea repair using the above technique. The procedure was accomplished in all patients without any intraoperative complications. There was no requirement of blood transfusion in any case. All patients had a cessation of CSF leak in the postoperative period, and there was no recurrence. There was no evidence of frontal lobe retraction injury in any of these patients, and no fresh neurological deficit was observed.

Conclusion: This PEPE approach to repair CSF leak through the posterior wall of the frontal sinus is a novel technique in which we can avoid disadvantages associated with both conventional craniotomy as well as transnasal endoscopic approaches.

No MeSH data available.


Related in: MedlinePlus

Intrao perative photograph after covering the defect with temporalis fascia graft
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4821949&req=5

Figure 2: Intrao perative photograph after covering the defect with temporalis fascia graft

Mentions: Initially, the endoscope advancement gives a featureless picture without much anatomical landmarks, however, toward the medial side, we start visualizing the bony defect in the sinus more clearly. On further stripping of the dura, the full extent is visualized and defined. The herniating neural tissues are then reduced. Any epidural bleed if encountered is stopped by using floseal hemostatic matrix (Baxter, Deerfield, IL, USA). The defect is then defined using 30° and 45° endoscope to avoid further retraction [Figure 1]. After the defect is fully defined the temporalis fascia is harvested (fascia lata may also be used) and is secured over the defect using fibrin sealant [Figure 2]. After achieving hemostasis, the brain is allowed to fall back by elevating the head by 30°. The bone flap is then secured back with titanium miniplates, and the wound is closed in layers.


Purely endoscopic pterional extradural approach: A novel technique for repair of cerebrospinal fluid rhinorrhea.

Sinha AK, Goyal S - J Neurosci Rural Pract (2016 Apr-Jun)

Intrao perative photograph after covering the defect with temporalis fascia graft
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4821949&req=5

Figure 2: Intrao perative photograph after covering the defect with temporalis fascia graft
Mentions: Initially, the endoscope advancement gives a featureless picture without much anatomical landmarks, however, toward the medial side, we start visualizing the bony defect in the sinus more clearly. On further stripping of the dura, the full extent is visualized and defined. The herniating neural tissues are then reduced. Any epidural bleed if encountered is stopped by using floseal hemostatic matrix (Baxter, Deerfield, IL, USA). The defect is then defined using 30° and 45° endoscope to avoid further retraction [Figure 1]. After the defect is fully defined the temporalis fascia is harvested (fascia lata may also be used) and is secured over the defect using fibrin sealant [Figure 2]. After achieving hemostasis, the brain is allowed to fall back by elevating the head by 30°. The bone flap is then secured back with titanium miniplates, and the wound is closed in layers.

Bottom Line: There was no requirement of blood transfusion in any case.All patients had a cessation of CSF leak in the postoperative period, and there was no recurrence.There was no evidence of frontal lobe retraction injury in any of these patients, and no fresh neurological deficit was observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sir Ganga Ram Hospital, New Delhi, India.

ABSTRACT

Study design: Retrospective descriptive study of an innovative surgical technique.

Objective: To assess the feasibility and success of repair of transfrontal sinus cerebrospinal fluid (CSF) rhinorrhea through pterional transcranial extradural approach using endoscope.

Summary of background data: Repair of CSF rhinorrhea has seen advancement with the evolution of endoscopic transnasal techniques. However, leaks from defect in the posterior wall of frontal sinus still remain a challenge for the skull base surgeons and requires conventional craniotomy more often. We describe a novel technique to repair these leaks by purely endoscopic pterional extradural (PEPE) approach thereby avoiding complications associated with conventional craniotomy and endoscopic transnasal approaches.

Materials and methods: Thirty-five patients with traumatic CSF rhinorrhea from the posterior wall of frontal sinus underwent repair with the present technique. They were followed up for 6-18 months and were evaluated for feasibility of procedure, recurrence of leak, and occurrence of the fresh neurological deficit.

Results: Thirty-five patients underwent CSF rhinorrhea repair using the above technique. The procedure was accomplished in all patients without any intraoperative complications. There was no requirement of blood transfusion in any case. All patients had a cessation of CSF leak in the postoperative period, and there was no recurrence. There was no evidence of frontal lobe retraction injury in any of these patients, and no fresh neurological deficit was observed.

Conclusion: This PEPE approach to repair CSF leak through the posterior wall of the frontal sinus is a novel technique in which we can avoid disadvantages associated with both conventional craniotomy as well as transnasal endoscopic approaches.

No MeSH data available.


Related in: MedlinePlus