medigraphic.com
Anales de Otorrinolaringología Mexicana

2022, Number 3

<< Back Next >>

Otorrinolaringología 2022; 67 (3)

Anterior skull base plasty in patients with cerebrospinal fluid fistula

Cardona-Sosa MP, Oliver-Barcena CL, Alfaro-Reynoso JA, Romero-Martínez DG

Language: Spanish
References: 23
Page: 193-200
PDF size: 268.82 Kb.


ABSTRACT

Objective: To describe our experience and results in the endoscopic surgical management of patients with anterior skull base cerebrospinal fluid fistula.
Materials and Methods: A descriptive retrospective study using clinical records was carried out from 2017 to 2020 at the Hospital Regional Licenciado Adolfo López Mateos in Mexico City. Patients who underwent endoscopic surgery of the anterior skull base due to a cerebrospinal fluid fistula were included.
Results: Eight patients were included. The most frequent etiology was iatrogenic trauma. The site of the defect was sphenoid in 4 patients with a median size of 10 mm. The overlay technique was used in 5 patients obtaining a plasty success in seven patients who with a maximum follow-up of twelve months did not present recurrence.
Conclusions: Endoscopic repair is safe and reliable for the closure of skull base defects even with defects
Material and Method: 20 mm. We recommend the combined use of multilayer techniques that include a dural substitute, pedicled nasoseptal flap, perpendicular ethmoid lamina, fascia lata, biological sealant/fibrin in addition with absolute rest in the mediate postoperative period for successful repair.


REFERENCES

  1. Ram YR, Pariha V, Janakiram N, Pande S, Bajaj J, Namdev H.Endoscopic management of cerebrospinal fluid rhinorrhea.Asian J Neurosurg 2016; 11 (3): 183-93. doi: 10.4103/1793-5482.145101.

  2. Abuabara A. Cerebrospinal fluid rhinorrhoea: Diagnosisand management. Med Oral Patol Oral Cir Bucal 2007;12: E397-400.

  3. Schlosser RJ, Woodworth BA, Wilensky EM, Grady MS, BolgerWE. Spontaneous cerebrospinal fluid leaks: A variant ofbenign intracranial hypertension. Ann Otol Rhinol Laryngol2006; 115: 495-500. doi: 10.1177/000348940611500703.

  4. Stankiewicz JA, Lal D, Connor M, Welch K. Complications inendoscopic sinus surgery for chronic rhinosinusitis: a 25-year experience. Laryngoscope 2011; 121 (12): 2684-701.doi: 10.1002/lary.21446.

  5. Flint P, Haughey B, Lund V, Niparko J, Robbins K, ThomasJ, et al. Cummings Otolaryngology–Head & Neck Surgery.

  6. 6th ed. Philadelphia; 2015: 803-14.6. Meco C, Oberascher G, Arrer E, Moser G, Albegger K.Beta-trace protein test: new guidelines for the reliablediagnosis of cerebrospinal fluid fistula. Otolaryngol HeadNeck Surg 2003; 129 (5): 508-17. https://doi.org/10.1016%2FS0194-59980301448-7.

  7. Pérez Cateriano V, Pasco Ulloa JC, Caballero Zirena AC,Álvarez Terrero A. Loss of cerebrospinal fluid associatedwith treatment using positive pressure in the airway. RevCub Med Int Emerg 2011; 10 (3): 2222-4.

  8. Lloyd KM, DelGaudio JM, Hudgins PA. Imaging of skull basecerebrospinal fluid leaks in adults. Radiol 2008; 248 (3):725-36. doi: 10.1148/radiol.2483070362.

  9. Lobo BC, Baumanis MM, Nelson RF. Surgical repair ofspontaneous cerebrospinal fluid (CSF) leaks: A systematicreview. Laryngoscope Investig Otolaryngol 2017; 2 (5):215-224. doi: 10.1002/lio2.75.

  10. Alobid I, Enseñat J, Rioja E, Enriquez K, Viscovich L, deNotaris M, et al. Management of cerebrospinal fluid leaksaccording to size. Our experience. Acta OtorrinolaringolEsp 2014; 65 (3): 162-9. doi: 10.1016/j.otorri.2013.12.003.

  11. Yadav YR, Parihar V, Janakiram N, Pande S, Bajaj J, NamdevH. Endoscopic management of cerebrospinal fluidrhinorrhea. Asian J Neurosurg 2016; 11 (3): 183-93. doi:10.4103/1793-5482.145101.

  12. Jung DS, Jeon BC, Park YS, Oh HH. Endoscopic endonasalrepair of cerebrospinal fluid rhinorrea by the combinedoverlay and underlay techniques. J Korean NeurotraumatolSoc 2006; 2 (1): 26-30. https://doi.org/10.13004/jknts.2006.2.1.26.

  13. Schlosser RJ, Bolger WE. Nasal cerebrospinal fluid leaks: criticalreview and surgical considerations. Laryngoscope 2004;114 (2): 255-65. doi: 10.1097/00005537-200402000-00015.

  14. Eide JG, Walz P, Alden TD, Rastatter JC. Pediatric skull basesurgery: Encephaloceles and cerebrospinal fluid leaks.Operative Techniques Otolaryngol Head Neck Surg 2019;30 (1): 30-36. https://doi.org/10.1016/j.otot.2019.01.012.

  15. Shetty PG, Shroff MM, Sahani DV, Kirtane MV. Evaluation ofhigh-resolution CT and MR cisternography in the diagnosisof cerebrospinal fluid fistula. AJNR Am J Neuroradiol 1998;19 (4): 633-9.

  16. Cheng P, Tang S, Qing J, Wang Y, Yao S, Ouyang T, et. al.Application of the mimic valsalva maneuver with the helpof a saccule in cerebrospinal fluid rhinorrhea reconstructionsurgery. ORL J Otorhinolaryngol Relat Spec 2015; 77(6): 366-71. doi: 10.1159/000439173.

  17. Horcajadas-Almansa A, Román-Cutillas A, Jorques-InfanteA, Ruiz-Gómez J, Busquier H. Hipertensión intracranealidiopática y fístula espontánea de líquido cefalorraquídeo.Utilidad de la monitorización de la presión intracraneal.Neurocirugia 2016; 28 (2): 93-96. DOI: 10.1016/j.neucir.2016.06.004.

  18. Locatelli D, Rampa F, Acchiardi I, Bignami M, De BernardiF, Castelnuovo P. Endoscopic endonasal approaches forrepair of cerebrospinal fluid leaks: nine-year experience.Neurosurgery 2006; 58 (4 Suppl 2): ONS-246-56. doi:10.1227/01.NEU.0000193924.65297.3F.

  19. Iavarone A, Luparello P, Lazio MS, Comini LV, Martelli F, DeLuca O, et. al. The surgical treatment of cerebrospinal fistula:Qualitative and quantitative analysis of indications and results.Head Neck 2020; 42 (2): 344-356. doi: 10.1002/hed.25981.

  20. Martín Martín C, Martínez Capoccioni G, Serramito GarcíaR, Espinosa Restrepo F. Surgical challenge: endoscopicrepair of cerebrospinal fluid leak. BMC Res Notes 2012; 5(1): 459. doi: 10.1186/1756-0500-5-459.

  21. Lorenz RR, Dean RL, Hurley DB, Chuang J, Citardi MJ.Endoscopic reconstruction of anterior and middle cranialfossa defects using acellular dermal allograft. Laryngoscope2003; 113 (3): 496-501. doi: 10.1097/00005537-200303000-00019.

  22. Pinzón Navarro M, Guerra Fuentes R, Castillo Baquero T,Villamor Rojas P. Endoscopic endonasal approach for themanagement of cerebrospinal fluid fistula. Case Series.Acta Otorrinolaringol Cir Cabeza Cuello 2018; 46 (2): 39-45.

  23. Banks CA, Palmer JN, Chiu AG, O'Malley BW Jr, WoodworthBA, Kennedy DW. Endoscopic closure of CSF rhinorrhea:193 cases over 21 years. Otolaryngol Head Neck Surg2009;140 (6): 826-33. doi: 10.1016/j.otohns.2008.12.060.




2020     |     www.medigraphic.com