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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

(a and b) Computed tomography scan bone window of a patient with posttraumatic cerebrospinal fluid rhinorrhea showing fracture of the frontal sinus, (c) magnetic resonance imaging of the same patient showing herniation of brain tissue through the defect in posterior wall of frontal sinus with gliosis in the adjacent frontal lobe
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Figure 3: (a and b) Computed tomography scan bone window of a patient with posttraumatic cerebrospinal fluid rhinorrhea showing fracture of the frontal sinus, (c) magnetic resonance imaging of the same patient showing herniation of brain tissue through the defect in posterior wall of frontal sinus with gliosis in the adjacent frontal lobe

Mentions: Thirty-five patients with posttraumatic CSF rhinorrhea were repaired with the present technique. There were 23 males and 12 females with age ranging from 8 years to 53 years (mean age was 25.4 years). The bilateral defect was present in 5 patients while 30 patients had unilateral defect [Figure 3] in the posterior wall of the frontal sinus. These patients had history of clear watery nasal discharge with the presence of glucose in the discharge fluid and were radiologically confirmed by computed tomography (CT) cisternography or brow down magnetic resonance imaging showing herniation of brain tissue. All these patients had a failure of earlier conservative management. The duration of persistent CSF leak varied for a period of 4 weeks to 25 weeks with mean of 14.5 weeks and median of 18 weeks. Clinical follow-up was for a period of 6–18 months with a mean follow-up of 12.3 months.


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)

(a and b) Computed tomography scan bone window of a patient with posttraumatic cerebrospinal fluid rhinorrhea showing fracture of the frontal sinus, (c) magnetic resonance imaging of the same patient showing herniation of brain tissue through the defect in posterior wall of frontal sinus with gliosis in the adjacent frontal lobe
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: (a and b) Computed tomography scan bone window of a patient with posttraumatic cerebrospinal fluid rhinorrhea showing fracture of the frontal sinus, (c) magnetic resonance imaging of the same patient showing herniation of brain tissue through the defect in posterior wall of frontal sinus with gliosis in the adjacent frontal lobe
Mentions: Thirty-five patients with posttraumatic CSF rhinorrhea were repaired with the present technique. There were 23 males and 12 females with age ranging from 8 years to 53 years (mean age was 25.4 years). The bilateral defect was present in 5 patients while 30 patients had unilateral defect [Figure 3] in the posterior wall of the frontal sinus. These patients had history of clear watery nasal discharge with the presence of glucose in the discharge fluid and were radiologically confirmed by computed tomography (CT) cisternography or brow down magnetic resonance imaging showing herniation of brain tissue. All these patients had a failure of earlier conservative management. The duration of persistent CSF leak varied for a period of 4 weeks to 25 weeks with mean of 14.5 weeks and median of 18 weeks. Clinical follow-up was for a period of 6–18 months with a mean follow-up of 12.3 months.

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