Garza-Castañeda RR, Pineda-Cázares F, Durán-Ortiz M; López-García I, Bravo-ArteagaSY, Torres-Vasconcelos R

Language: Spanish
References: 23
Page: 247-255
PDF size: 273.08 Kb.

ABSTRACT

Objective: To inquire the diagnostic and management procedures among the members of the Mexican College of Otology, NeuroOtology and Skull Base Surgery (CMONCBC) by means of an anonymous survey.
Materials and Methods: A prospective, observational, descriptive, cross-sectional survey study, with 11 questions, prepared for this purpose by a panel of experts from the Regional Hospital General Ignacio Zaragoza, Mexico City, to describe the diagnostic protocol and treatment of surgeons from the Mexican College of Otology, NeuroOtology and Skull Base Surgery (CMONCBC). Survey was applied in May-June, 2021.
Results: An 11-items questionnaire was applied to the 54 members of the CMONCBC with 34 responses received; mean age of those who answered was of 41 a 49 years (± 1.07). For diagnosis the majority used the determination of glucose (19/34) and CT scan (23/34). Conservative treatment was used by the majority (27/34), as well as the use of 3 layers of grafting material in the reconstructions of skull base defects (22/34). Most of the surgeons did not indicate prophylactic vaccination (22/34).
Conclusions: There is agreement among experts in the use of diagnostic tools for the cerebrospinal fluid leaks, although there is need to establish evidence-based Mexican guidelines of treatment and random controlled trials for skull base reconstruction strategies.

REFERENCES

1. Cummings CW, Flint PW, Citardi MJ, Fakhri S. Cerebrospinalfluid rhinorrhea. In: Cummings otolaryngology: Head andNeck Surgery. Philadelphia: Elsevier; 2021: 745-58.

2. Lyons MK, Meyer FB. Cerebrospinal fluid physiology andthe management of increased intracranial pressure. MayoClin Proc 1990; 65 (5): 684-707. doi: 10.1016/s0025-6196(12)65131-3.

3. Dandy WE. Spontaneous cerebrospinal rhinorrhoea;case operated by rhinologic methods. Ann Surg 1926;12: 949-982.

4. Hirsch O. Successful closure of cerebrospinal fluid rhinorrheaby endonasal surgery. AMA Arch Otolaryngol 1952;

5. 56: 1-12. doi: 10.1001/archotol.1952.00710020018001.5. Komotar R, Starke R, Anand V, Schwartz T, Raper D. Endoscopicendonasal versus open repair of anterior skull baseCSF leak, meningocele, and encephalocele: A systematicreview of outcomes. J Neurol Surg A Cent Eur Neurosurg2012; 74 (04): 239-50. doi: 10.1055/s-0032-1325636.

6. Fliss DM, Zucker G, Cohen A, Amir A, et al. Early outcomeand complications of the extended subcranial approach tothe anterior skull base. Laryngoscope 1999; 109 (1): 153-160. doi: 10.1097/00005537-199901000-00029.

7. Lobo BC, Baumanis MM, Nelson RF. Surgical repair ofspontaneous cerebrospinal fluid (CSF) leaks: A systematicreview. Laryngoscope Investig Otolaryngol 2017; 2 (5):215-24. doi: 10.1002/lio2.75.

8. Woodworth BA, Prince A, Chiu AG, Cohen NA, SchlosserRJ, Bolger WE, et al. Spontaneous CSF leaks: A paradigmfor definitive repair and management of intracranialhypertension. Otolaryngol Head Neck Surg 2008; 138 (6):715-20. doi: 10.1016/j.otohns.2008.02.010.

9. Banu M, Kim J, Shin B, Woodworth G, Anand V, SchwartzT. Low-dose intrathecal fluorescein and etiology-basedgraft choice in endoscopic endonasal closure of CSF leaks.Clin Neurol Neurosurg 2014; 116: 28-34. doi: 10.1016/j.clineuro.2013.11.006.

10. Le C, Strong E, Luu Q. Management of anterior skull basecerebrospinal fluid leaks. J Neurol Surg B Skull Base 2016;77 (05): 404-411. doi: 10.1055/s-0036-1584229.

11. Bailey BJ, Johnson JT, Rosen CA, Batra PS. 45. In: Bailey'shead and Neck Surgery - Otolaryngology. Philadelphia: WoltersKluwer, Lippincott Williams et Wilkins; 2014: 662-74.

12. Englhard A, Volgger V, Leunig A, Meßmer C, Ledderose G.Spontaneous nasal cerebrospinal fluid leaks: management of24 patients over 11 years. Eur Arch Otorhinolaryngol 2018;275 (10): 2487-2494. doi: 10.1007/s00405-018-5089-y.

13. Roxbury CR, Lobo BC, Kshettry VR, D’Anza B, Woodard TD,Recinos PF, et al. Perioperative management in endoscopicendonasal skull-base surgery: A survey of the north Americanskull base society. Int Forum Allergy Rhinol 2017; 8(5): 631-40. doi: 10.1002/alr.22066.

14. Oakley G, Alt J, Schlosser R, Harvey R, Orlandi R. Diagnosisof cerebrospinal fluid rhinorrhea: an evidence-basedreview with recommendations. Int Forum Allergy Rhinol2015; 6 (1): 8-16. doi: 10.1002/alr.21637.

15. Zapalac JS, Marple BF, Schwade ND. Skull base cerebrospinalfluid fistulas: a comprehensive diagnostic algorithm.Otolaryngol Head Neck Surg 2002; 126: 669-676. doi:10.1067/mhn.2002.125755.

16. Schlosser R, Bolger W. Nasal cerebrospinal fluid leaks:Critical review and surgical considerations. Laryngoscope2004; 114 (2): 255-265. doi: 10.1097/00005537-200402000-00015.

17. Khan R, Sajjad M, Khan AA, Ahmad B, Ahmad S, MushtaqM, Sultan S, Iftikhar O. Comparison of lumbar drain insertionand conservative management in the treatment oftraumatic CSF rhinorrhoea. J Ayub Med Coll Abbottabad2019; 31 (3): 441-4.

18. Conger A, Zhao F, Wang X, Eisenberg A, Griffiths C, EspositoF, et al. Evolution of the graded repair of cerebrospinalfluid leaks and skull base defects in endonasal endoscopictumor surgery: Trends in repair failure and meningitis ratesin 509 patients. J Neurosurg 2018; 130 (3): 861-875. doi:10.3171/2017.11.JNS172141.

19. Eloy JA, Kuperan AB, Choudhry OJ, Harirchian S, Liu JK.Efficacy of the pedicled nasoseptal flap without cerebrospinalfluid (CSF) diversion for repair of skull base defects:incidence of postoperative CSF leaks. Int Forum AllergyRhinol 2012; 00: X-XX. doi: 10.1002/alr.21040.

20. Kim-Orden N, Shen J, Or M, Hur K, Zada G, Wrobel B.Endoscopic endonasal repair of spontaneous cerebrospinalfluid leaks using multilayer composite graft andvascularized pedicled nasoseptal flap technique. AllergyRhinol (Providence) 2019; 10: 2152656719888622. doi:10.1177/2152656719888622.

21. Zwagerman N, Shin S, Wang E, Fernandez-Miranda J, SnydermanC, Gardner P. A prospective, randomized control trialfor lumbar drain placement after endoscopic endonasalskull base surgery. J Neurol Surg B Skull Base 2016; 77 (S 02).

22. Ter-Horst L, Brouwer MC, van der Ende A, van de Beek D.Community-acquired bacterial meningitis in adults withcerebrospinal fluid leakage. Clin Infect Dis 2019; 70 (11):2256-61. doi: 10.1093/cid/ciz649.

23. Oitment C, Aref M, Almenawar S, Reddy K. Spinal duralrepair: A Canadian questionnaire. Global Spine J 2017; 8(4): 359-64. doi: 10.1177/2192568217724132.