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Abstract

Background

Endoscopic repair of skull base (SB) defects is successful in over 90% of cases. Certain factors may contribute to failure of SB repair techniques or need for secondary repair.

Methods

Five-year retrospective review of endoscopic SB defect repairs performed by a single surgeon.

Results

Eighty-nine patients undergoing 110 procedures to repair 97 SB defects were evaluated. Etiology of defects included surgical/iatrogenic (64%), spontaneous (17%), traumatic (12%), congenital (6%), and idiopathic (1%). Defects occurred in the sella (41%), sphenoid sinus (18%), ethmoid roof (17%), olfactory cleft (16%), frontal sinus/recess (6%), and middle cranial fossa (2%). Sixty-three patients (71%) underwent primary SB defect repair and 26 patients underwent secondary repair (29%). In revision cases, mean number of prior repair attempts was 1.5 (range, 1-4). Factors potentially contributing to need for secondary SB defect repair included inability to localize SB defect (p =0 008), development of new SB defect, prior sinus or SB surgery (p < 0.001), prior craniotomy (p < 0.001), prior radiation therapy (p = 0.002), and intracranial infection (p = 0.023). SB defects were successfully closed in 83 patients overall (93%), with success achieved in 97% of primary patients and 85% of secondary patients. Of failures, 3 patients required craniotomy for defect closure, 2 patients underwent permanent cerebrospinal fluid (CSF) diversion, and 1 patient has persistent CSF rhinorrhea.

Conclusion

Although endoscopic repair of SB defect remains largely successful, certain factors should alert the surgeon to the potential for failure of repair or need for secondary SB defect repair.

Keywords

Cerebrospinal fluid CSF leak endoscopic sinus surgery intrathecal fluorescein lumbar drain neoplasm skull base wound healing

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References

Wigand

M.E.

Transnasal ethmoidectomy under endoscopic control.

Rhinology 19: 7–15, 1981.

Locatelli

Rampa

Acchiardi

Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: Nine year experience.

Oper Neurosurg 58: 246–257, 2006.

Kirtane

M.V.

Gauitham

and Upadhyaya

S.R.

Endoscopic CSF rhinorrhea closure: Our experience in 267 cases.

Otolaryngol Head Neck Surg 132: 208–212, 2005.

Mirza

Tahaper

McClelland

and Jones

N.S.

Sinonasal cerebrospinal fluid leaks: Management of 97 patients over 10 years.

Laryngoscope 115: 1774–1777, 2005.

Hegazy

H.M.

Carrau

R.L.

Snyderman

C.H.

Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: A meta-analysis.

Laryngoscope 110: 1166–1172, 2000.

Lee

T.J.

Huang

C.C.

Chauang

C.C.

and Huang

S.F.

Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: ten-year experience.

Laryngoscope 114: 1475–1481, 2004.

Chin

G.Y.

and Rice

D.H.

Transnasal endoscopic closure of cerebrospinal fluid leaks.

Laryngoscope 113: 136–138, 2003.

Lopatin

A.S.

Kapitanov

D.N.

and Potapov

A.A.

Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks.

Arch Otolaryngol Head Neck Surg 129: 859–863, 2003.

McMains

K.C.

Gross

C.W.

and Kountakis

S.E.

Endoscopic management of cerebrospinal fluid rhinorrhea.

Laryngoscope 114: 1833–1837, 2004.

10.

Mattox

D.E.

and Kennedy

D.W.

Endoscopic management of cerebrospinal fluid leaks and cephaloceles.

Laryngoscope 100: 857–862, 1990.

11.

Marshall

A.H.

Jones

N.S.

and Robertson

I.J.A.

An algorithm for the management of CSF rhinorrhoea illustrated by 36 cases.

Rhinology 37: 182–185, 1999.

12.

Lanza

D.C.

O'Brien

D.A.

and Kennedy

D.W.

Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles.

Laryngoscope 106: 1119–1125, 1996.

13.

Casiano

R.R.

and Jassir

Endoscopic cerebrospinal fluid rhinorrhea repair: Is lumbar drain necessary?

Otolaryngol Head Neck Surg 121: 745–750, 1999.

14.

Zweig

J.L.

Carrau

R.L.

Celin

S.E.

Endoscopic repair of cerebrospinal fluid leaks to the sinonasal tract: Predictors of success.

Otolaryngol Head Neck Surg 123: 195–201, 2000.

15.

Schlosser

R.J.

Wilensky

E.M.

Grady

M.S.

Cerebrospinal fluid pressure monitoring after repair of cerebrospinal fluid leaks.

Otolaryngol Head Neck Surg 130: 443–448, 2004.

16.

Schlosser

R.J.

Wilensky

E.M.

Grady

M.S.

and Bolger

W.E.

Elevated intracranial pressure in spontaneous CSF leaks.

Am J Rhinol 17: 191–195, 2003.

17.

Schlosser

R.J.

and Bolger

W.E.

Management of multiple spontaneous nasal meningoencephaloceles.

Laryngoscope 112: 980–985, 2002.

18.

Schlosser

R.J.

and Bolger

W.E.

Significance of empty sella in cerebrospinal fluid leaks.

Otolaryngol Head Neck Surg 128: 32–38, 2003.

19.

Schlosser

R.J.

and Bolger

W.E.

Spontaneous nasal cerebrospinal fluid leaks and empty sella syndrome: A clinical association.

Am J Rhinol 17: 91–96, 2003.

20.

Schlosser

R.J.

Wilensky

E.M.

Grady

M.S.

and Bolger

W.E.

Spontaneous cerebrospinal fluid leaks: A variant of benign intracranial hypertension.

Ann Otol Rhinol Laryngol 115: 495–500, 2006.

21.

Lindstrom

D.R.

Toohill

R.J.

Loerhl

T.A.

and Smith

T.L.

Managment of cerebrospinal fluid rhinorrhea: The Medical College of Wisconsin experience.

Laryngoscope 114: 969–974, 2004.

22.

Silver

R.I.

Moonis

Schlosser

R.J.

Radiographic signs of elevated intracranial pressure in idiopathic cerebrospinal fluid leaks: A possible presentation of idiopathic intracranial hypertension.

Am J Rhinol 21: 257–261, 2007.

23.

Leong

J.L.

Citardi

M.J.

and Batra

P.S.

Reconstruction of skull base defects after minimally invasive endoscopic resection of anterior skull base neoplasms.

Am J Rhinol 20: 476–482, 2006.

24.

Lund

V.J.

Howard

D.J.

and Wei

W.I.

Endoscopic resection of malignant tumors of the nose and sinuses.

Am J Rhinol 21: 89–94, 2007.

25.

Pinheiro-Neto

C.D.

Prevedello

D.M.

Carrau

R.L.

Improving the design of the pedicled nasoseptal flap for skull base reconstruction: A radioanatomic study.

Laryngoscope 117: 1560–1569, 2007.

26.

Stone

J.A.

Castillo

Neelon

and Mukherji

S.K.

Evaluation of CSF leaks: High resolution CT compared with contrast-enhanced CT and radionuclide cisternography.

AJNR Am J Neuroradiol 20: 706–712, 1999.

27.

Sillers

M.J.

Morgan

and El Gammal

Magnetic resonance cisternography and thin coronal computerized tomography in the evaluation of cerebrospinal fluid rhinorrhea.

Am J Rhinol 11: 387–392, 1997.

28.

Hubbard

J.L.

McDonald

T.J.

Pearson

B.W.

and Laws

E.R.J.

Spontaneous cerebrospinal fluid rhinorrhea: Evolving concepts in diagnosis and surgical management based on the Mayo Clinic experience from 1970 through 1981.

Neurosurgery 16: 314–321, 1985.

29.

Eljammel

M.S.

Pidgeon

C.N.

and Toland

MRI cisternography and localization of CSF fistulae.

Br J Neurosurg 8: 433–437, 1994.

Factors Contributing to Failure in Endoscopic Skull Base Defect Repair

Abstract

Background

Methods

Results

Conclusion

Keywords

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References