Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients

Journal of Neurosurgery
Andrew CongerDaniel F Kelly

Abstract

The authors previously described a graded approach to skull base repair following endonasal microscopic or endoscope-assisted tumor surgery. In this paper they review their experience with skull base reconstruction in the endoscopic era. A retrospective review of a single-institution endonasal endoscopic patient database (April 2010–April 2017) was undertaken. Intraoperative CSF leaks were graded based on size (grade 0 [no leak], 1, 2, or 3), and repair technique was documented across grades. The series was divided into 2 epochs based on implementation of a strict perioperative antibiotic protocol and more liberal use of permanent and/or temporary buttresses; repair failure rates and postoperative meningitis rates were assessed for the 2 epochs and compared. In total, 551 operations were performed in 509 patients for parasellar pathology, including pituitary adenoma (66%), Rathke’s cleft cyst (7%), meningioma (6%), craniopharyngioma (4%), and other (17%). Extended approaches were used in 41% of cases. There were 9 postoperative CSF leaks (1.6%) and 6 cases of meningitis (1.1%). Postoperative leak rates for all 551 operations by grade 0, 1, 2, and 3 were 0%, 1.9%, 3.1%, and 4.8%, respectively. Fat grafts were used in 33%, 84%, 9...Continue Reading

References

Jul 1, 2008·American Journal of Rhinology·Piero NicolaiPaolo Castelnuovo
Sep 9, 2008·Neurosurgery·Amin B KassamPaul Gardner
Jan 27, 2009·Neurologia Medico-chirurgica·Shigetoshi YanoJun-ichi Kuratsu
Oct 8, 2009·American Journal of Rhinology & Allergy·Adam M ZanationAmin B Kassam
Dec 21, 2010·Journal of Neurosurgery·Amin B KassamMichael B Horowitz
Nov 29, 2011·World Neurosurgery·Victor Garcia-NavarroTheodore H Schwartz
Dec 18, 2012·Journal of Neurosurgery. Pediatrics·Srinivas ChivukulaElizabeth C Tyler-Kabara
Dec 26, 2012·Auris, Nasus, Larynx·Mustafa BerkerMetin Onerci
Aug 3, 2013·Pituitary·Alessandro PaluzziPaul A Gardner
Aug 6, 2013·Journal of Neurosurgery·Maria KoutourousiouCarl H Snyderman
May 3, 2014·Journal of Neurosurgery·Luigi Maria CavalloErnesto Pasquini
Dec 3, 2014·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Michael E IvanManish K Aghi
Dec 24, 2014·World Neurosurgery·Enrico de DivitiisMichael L J Apuzzo
Jul 5, 2015·Neurosurgery Clinics of North America·Bjorn LoboDaniel F Kelly
Aug 19, 2015·Journal of Korean Neurosurgical Society·Jae-Hyun ParkYong-Kil Hong
Oct 31, 2015·Journal of Neurosurgery·Edward R LawsAtul Gawande
Nov 18, 2015·Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society·Daniel F KellyHoward R Krauss
Jun 18, 2016·World Neurosurgery·Michael ZhangTheodore H Schwartz
Sep 30, 2016·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Omar H AhmedRichard A Lebowitz
Dec 3, 2016·Neurosurgical Focus·Varun R KshettryJames J Evans
Jan 27, 2017·American Journal of Rhinology & Allergy·Brian D'AnzaRaj Sindwani

❮ Previous
Next ❯

Citations

Mar 12, 2020·Frontiers in Bioengineering and Biotechnology·Rodrigo Ramos-ZúñigaIvan Segura-Durán
Aug 28, 2020·Frontiers in Oncology·Cathal John HannanMohsen Javadpour
Sep 12, 2020·Reviews in Endocrine & Metabolic Disorders·Andrea GiustinaShlomo Melmed
Jun 20, 2020·Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India·Vaibhav A ChandankhedeM S Gill
Nov 3, 2020·Journal of Neurological Surgery. Part B, Skull Base·Seung J LeeAdam N Mamelak
Jun 12, 2021·Curēus·Linnea C FechtnerMark S Burke
Jul 20, 2021·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Youngbeom SeoChul-Kee Park
Jul 27, 2021·Journal of Neurological Surgery. Part B, Skull Base·Mark B ChaskesJames J Evans
Sep 4, 2021·The Journal of Clinical Endocrinology and Metabolism·Regin Jay MallariDaniel F Kelly
Oct 2, 2021·Ear, Nose, & Throat Journal·Jung-Ting Lin, Heng-Jui Hsu

❮ Previous
Next ❯

Related Concepts

Related Feeds

CSF & Lymphatic System

This feed focuses on Cerebral Spinal Fluid (CSF) and the lymphatic system. Discover the latest papers using imaging techniques to track CSF outflow into the lymphatic system in animal models.