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Wales R, Chakravarty D, Gilmour E, Kontorinis G. The Use of Synthetic, Nonabsorbable Graft for Middle Fossa Repair in Patients With Spontaneous Cerebrospinal Fluid Leak: A Pilot, Prospective Study. Otol Neurotol 2024:00129492-990000000-00593. [PMID: 39072673 DOI: 10.1097/mao.0000000000004257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To evaluate the efficacy of a nonabsorbable, synthetic graft for the reconstruction of spontaneous middle fossa (sMF) cerebrospinal fluid (CSF) leaks. PATIENTS Six adult patients (age ≥16 yr) who had sMF CSF leaks surgically repaired within an 18-month period at a single university hospital using synthetic, nonbiological, nonabsorbable graft (Neuro-Patch) and a retrospective control group of five patients undergoing multilayer MF repair with autologous grafts. INTERVENTIONS MF repair through a combined transmastoid/MF approach using Neuro-Patch or multilayer autologous grafts. MAIN OUTCOME MEASURES The incidence of postoperative leak within 6 months postoperatively was the main outcome measure; we also recorded the need for lumbar drain, additional hearing loss, length of inpatient stay, body mass index, previous meningitis, preoperative increased intracranial pressure, and age. RESULTS In the Neuro-Patch group, there was no postoperative CSF leak without the need for lumbar drain. We observed no additional hearing loss; patients were monitored for 2 days without any readmissions. Increased intracranial pressure (four of six), previous episodes of meningitis (two of six) or obesity (five of six) did not affect patient outcomes. Demographic and prognostic factors were the same for the control group. However, one patient needed lumbar drain postoperatively because of residual leak; lumbar drain was used in one more case (two of five cases), whereas three of five patients had to stay for longer than 2 days (5 d). CONCLUSIONS Our pilot study suggests the use of Neuro-Patch via combined transmastoid/MF approach as an effective technique with minimum, if any morbidity; it could be of particular benefit for patients with larger MF dura defects. A larger number of patients are required to strengthen the evidence.
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Affiliation(s)
| | - Daragh Chakravarty
- Department of Otolaryngology-Skull Base Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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2
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Gagliano D, Tariciotti L, D'ammando A, Fiore G, Remore LG, Demasi M, Schisano L, Accorona R, Bertani GA, Locatelli M. Fully Endoscopic Trans-Sphenoidal (TNS) Gross Total Resection of a Rare Granular Cell Tumor of Neurohypophysis: Surgical Video and Case Strategy Discussion. Neurol India 2024; 72:497-499. [PMID: 39041963 DOI: 10.4103/neurol-india.neurol-india-d-24-00172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/05/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Dario Gagliano
- Department of Pathophysiology and Transplantation, Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Leonardo Tariciotti
- Department of Pathophysiology and Transplantation, Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Antonio D'ammando
- Department of Pathophysiology and Transplantation, Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Fiore
- Department of Pathophysiology and Transplantation, Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luigi G Remore
- Department of Pathophysiology and Transplantation, Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marco Demasi
- Department of Pathophysiology and Transplantation, Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luigi Schisano
- Department of Pathophysiology and Transplantation, Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Remo Accorona
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulio A Bertani
- Department of Pathophysiology and Transplantation, Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Locatelli
- Department of Pathophysiology and Transplantation, Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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3
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Ramot Y, Kronfeld N, Steiner M, Manassa NN, Bahar A, Nyska A. Neural tissue tolerance to synthetic dural mater graft implantation in a rabbit durotomy model. J Toxicol Pathol 2024; 37:83-91. [PMID: 38584968 PMCID: PMC10995433 DOI: 10.1293/tox.2023-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/09/2024] [Indexed: 04/09/2024] Open
Abstract
In neurosurgical interventions, effective closure of the dura mater is essential to prevent cerebrospinal fluid leakage and minimize post-operative complications. Biodegradable synthetic materials have the potential to be used as dura mater grafts owing to their regenerative properties and low immunogenicity. This study evaluated the safety of ArtiFascia, a synthetic dura mater graft composed of poly(l-lactic-co-caprolactone acid) and poly(d-lactic-co-caprolactone acid), in a rabbit durotomy model. Previously, ArtiFascia demonstrated positive local tolerance and biodegradability in a 12-month preclinical trial. Here, specialized stains were used to evaluate potential brain damage associated with ArtiFascia use. Histochemical and immunohistochemical assessments included Luxol Fast Blue, cresyl Violet, Masson's Trichrome, neuronal nuclei,, Glial Fibrillary Acidic Protein, and ionized calcium-binding adaptor molecule 1 stains. The stained slides were graded based on the brain-specific reactions. The results showed no damage to the underlying brain tissue for either the ArtiFascia or control implants. Neither inflammation nor neuronal loss was evident, corroborating the safety of the ArtiFascia. This approach, combined with previous histopathological analyses, strengthens the safety profile of ArtiFascia and sets a benchmark for biodegradable material assessment in dura graft applications. This study aligns with the Food and Drug Administration guidelines and offers a comprehensive evaluation of the potential neural tissue effects of synthetic dura mater grafts.
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Affiliation(s)
- Yuval Ramot
- Department of Dermatology, Hadassah Medical Center, PO Box
12000, Jerusalem, 9112001, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, PO
Box 12272, Jerusalem, 9112001, Israel
| | - Noam Kronfeld
- Department of Dermatology, Hadassah Medical Center, PO Box
12000, Jerusalem, 9112001, Israel
- Envigo CRS (Israel), Einstein St., Building 13B, Weizmann
Science Park, Ness Ziona, 7414001, Israel
| | - Michal Steiner
- Pre-Clinical Consultant, Carmel St. 11/22, Rehovot, 7630511,
Israel
| | - Nora Nseir Manassa
- Nurami Medical Nanofiber Technology, Ha-Namal St 36, Haifa,
303203, Israel
| | - Amir Bahar
- Nurami Medical Nanofiber Technology, Ha-Namal St 36, Haifa,
303203, Israel
| | - Abraham Nyska
- Consultant in Toxicologic Pathology, Tel Aviv and Tel Aviv
University, Yehuda HaMaccabi 31, Tel Aviv 6200515, Israel
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4
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Godse NR, Sreenath SB, Sbeih F, Woodard TD, Kshettry VR, Recinos PF, Sindwani R. Fascia Lata: Another Workhorse for Complex Skull Base Reconstruction. Am J Rhinol Allergy 2023:19458924231170955. [PMID: 37081750 DOI: 10.1177/19458924231170955] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Multiple methods exist for skull base reconstruction of defects created by expanded endonasal approaches. While the nasoseptal flap (NSF) has been well established as the workhorse of mucosal reconstruction in complex skull base defects in multi-layered closures, a variety of options exist for the inner layer of multilayer reconstruction, including fascia lata (FL). OBJECTIVE To present our experience and outcomes in utilizing FL in multiple ways to reconstruct a wide variety of complex skull base defects. METHODS Retrospective review was performed from May 2017 to February 2022 to identify 50 consecutive patients who underwent endoscopic skull base reconstruction using FL. RESULTS FL was employed for reconstruction in 50 patients included in the study: 37 undergoing primary expanded endonasal skull base surgery and 13 revision cases. A wide range of complex pathology was treated, with meningioma and craniopharyngioma being the two most common. FL was utilized as a "button" graft (34/50, 68.0%), free graft inlay/onlay (13/50, 26.0%), and as a button graft combined with onlay (3/50, 6.0%). Expanded surgery defects addressed included tuberculum sella/sphenoid planum (36/50, 72.0%), clivus (6/50, 12.0%), and cribriform/planum (8/50, 16.0%). Successful reconstruction with fascia lata was accomplished in 46/50 cases (92%), with only 4 cases (8%) requiring revision for post-op CSF leak. Donor-site complications were rare with only 1 case (2.0%) of post-op seroma. CONCLUSION FL, usually with NSF, offers a versatile option for the reconstruction of challenging defects with excellent outcomes and minimal morbidity. FL is emerging as a workhorse for reconstruction of the inner layer of complex skull base defects.
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Affiliation(s)
- Neal R Godse
- Section of Rhinology and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Firas Sbeih
- Section of Rhinology and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Troy D Woodard
- Section of Rhinology and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Minimally Invasive Cranial Base and Pituitary Surgery Section, Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Varun R Kshettry
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Minimally Invasive Cranial Base and Pituitary Surgery Section, Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Pablo F Recinos
- Section of Rhinology and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Minimally Invasive Cranial Base and Pituitary Surgery Section, Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Raj Sindwani
- Section of Rhinology and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Minimally Invasive Cranial Base and Pituitary Surgery Section, Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
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Xu C, Dong RP, Cheng XL, Zhao JW. Late presentation of dural tears: Two case reports and review of literature. World J Clin Cases 2023; 11:2464-2473. [PMID: 37123324 PMCID: PMC10130997 DOI: 10.12998/wjcc.v11.i11.2464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/23/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND The late presentation of dural tears (LPDT) has a low incidence rate and hidden symptoms and is easily ignored in clinical practice. If the disease is not treated in time, a series of complications may occur, including low intracranial pressure headache, infection, pseudodural cyst formation, and sinus formation. Here, we describe two cases of LPDT.
CASE SUMMARY Two patients had sudden fever 1 wk after lumbar surgery. Physical examination showed obvious tenderness in the operation area. The patients were confirmed as having LPDT by lumbar magnetic resonance imaging and surgical exploration. One case was caused by continuous negative pressure suction and malnutrition, and the other was caused by decreased dural ductility and low postoperative nutritional status. The first symptom of both patients was fever, with occasional headache. Both patients underwent secondary surgery to treat the LPDT. Dural defects were observed and dural sealants were used to seal the dural defects, then drainage tubes were retained for drainage. After the operation, the patients were treated with antibiotics and the patients’ surgical incisions healed well, without fever or incision tenderness. Both recovered and were discharged 1 wk after the operation.
CONCLUSION LPDT is a rare complication of spinal surgery or neurosurgery that has hidden symptoms and can easily be overlooked. Since it may cause a series of complications, LPDT needs to be actively addressed in clinical practice.
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Affiliation(s)
- Chang Xu
- Department of Orthopedics, Jilin Provincial Armed Police Corps Hospital, Changchun 130000, Jilin Province, China
| | - Rong-Peng Dong
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun 130012, Jilin Province, China
| | - Xue-Liang Cheng
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun 130012, Jilin Province, China
| | - Jian-Wu Zhao
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun 130012, Jilin Province, China
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Alicandri-Ciufelli M, Serafini E, Pavesi G, Marchioni D, Mantovani M, Dallari D, Iaccarino C. Cadaver Homologous Banked Fascia Lata in Skull Base Reconstruction: Preliminary Multidisciplinary Experiences. Indian J Otolaryngol Head Neck Surg 2023; 75:941-946. [PMID: 37206800 PMCID: PMC10188890 DOI: 10.1007/s12070-023-03517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023] Open
Abstract
Skull base reconstruction has been a widely debated issue. Both autologous and heterologous materials have been proposed, however the formers are usually preferred due to their optimal healing outcomes and integration. Nevertheless they are still associated with donor-site functional and aesthetic morbidity. The aim of this study is to report a preliminary experience of different sites defects skull base repair with Cadaver homologous banked fascia lata graft. Patients who underwent reconstruction of skull base defects with Cadaver homologous banked fascia lata between January 2020 until July 2021 were included in the study. Three patients were finally identified for the study. Patient 1 underwent combined craniotomic-endoscopic surgical access for extended anterior skull base neoplasm with subsequent repair with homologous cadaver fascia lata. Patient 2 underwent endoscopic transphenoidal surgery for sellar-parasellar neoplasm. After tumor debulking the surgical cavity was obliterated with homologous cadaver fascia lata. Patient 3 finally had politrauma with otic capsule-violating fracture with profused CSF leak. An endoscopic obliteration of external and middle ear was performed using homologous cadaver fascia lata with blind sac closure of external auditory canal. No graft displacement or reabsorption was observed in these patients at the last follow-up. Cadaver homologous banked fascia lata has proved safety, efficacy and ductility in reconstruction of different skull base defects. Level of Evidence: Level IV-retrospective cohort study.
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Affiliation(s)
- Matteo Alicandri-Ciufelli
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Edoardo Serafini
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giacomo Pavesi
- Department of Neurosurgery, University Hospital of Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Matteo Mantovani
- Department of Neurosurgery, University Hospital of Modena, Modena, Italy
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy
| | - Corrado Iaccarino
- Department of Neurosurgery, University Hospital of Modena, Modena, Italy
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7
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Kim BK, Kong DS, Nam DH, Hong SD. Comparison of Graft Materials in Multilayer Reconstruction with Nasoseptal Flap for High-Flow CSF Leak during Endoscopic Skull Base Surgery. J Clin Med 2022; 11:jcm11226711. [PMID: 36431187 PMCID: PMC9697000 DOI: 10.3390/jcm11226711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Cerebrospinal fluid (CSF) leak is a crucial complication after endoscopic skull base surgery. Therefore, multilayer reconstruction with grafts is as essential as a reconstruction with pedicled flaps. Although widely used, the multilayer technique with autologous fascia lata has drawbacks, such as additional wound and donor site complications. We compared acellular dermal graft and banked homologous fascia lata graft (alternative grafts) with autologous fascia lata graft for high-flow CSF leak repair. We retrospectively enrolled 193 subjects who underwent endoscopic skull base reconstruction with multilayer fascial grafts and nasoseptal flap for high-flow CSF leaks from November 2014 to February 2020 at a single institution. Acellular dermal matrix (ADM), banked homologous fascia lata, and autologous fascia lata were used in 48 (24.9%), 102 (52.8%), and 43 (22.3%) patients, respectively. Postoperative CSF leaks occurred in 23 (11.9%) patients and meningitis in 8 (4.1%). There was no significant difference in postoperative CSF leak (p = 0.36) and meningitis (p = 0.17) across the graft groups. Additionally, we could not find out contributing risk factors for postoperative CSF leak and meningitis. ADM and banked homologous fascia lata are non-inferior to autologous fascia lata for endoscopic skull base reconstruction in water-tight reconstruction or safety without additional donor site morbidities.
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Affiliation(s)
- Byung Kil Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu 41404, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence:
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Spitaels J, Moore J, Zaidman N, Arroteia IF, Appelboom G, Barrit S, Carlot S, De Maertelaer V, Hassid S, De Witte O. Fibrin-coated collagen fleece versus absorbable dural sealant for sellar closure after transsphenoidal pituitary surgery: a comparative study. Sci Rep 2022; 12:7998. [PMID: 35568737 PMCID: PMC9107464 DOI: 10.1038/s41598-022-12059-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
Various surgical methods to prevent postoperative cerebrospinal fluid (CSF) leaks during transsphenoidal surgery have been reported. However, comparative studies are scarce. We aimed to compare the efficacy of a fibrin-coated collagen fleece (TachoSil) versus a dural sealant (DuraSeal) to prevent postoperative CSF leakage. We perform a retrospective study comparing two methods of sellar closure during endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenoma resection: TachoSil patching versus DuraSeal packing. Data concerning diagnosis, reconstruction technique, and surgical outcomes were analyzed. The primary endpoint was postoperative CSF leak rate. We reviewed 198 consecutive patients who underwent 219 EETS for pituitary adenoma from February 2007 and July 2018. Intraoperative CSF leak occurred in 47 cases (21.5%). A total of 33 postoperative CSF leaks were observed (15.1%). A reduction of postoperative CSF leaks in the TachoSil application group compared to the conventional technique using Duraseal was observed (7.7% and 18.2%, respectively; p = 0.062; Pearson exact test) although non-statistically significant. Two patients required lumbar drainage, and no revision repair was necessary to treat postoperative CSF rhinorrhea in Tachosil group. Fibrin-coated collagen fleece patching may be a valuable method to prevent postoperative cerebrospinal fluid (CSF) leaks during EETS for pituitary adenoma resection.
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Affiliation(s)
- Julien Spitaels
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Bruxelles, Belgium.
| | - Justin Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nathalie Zaidman
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | - Geoffrey Appelboom
- Department of Neurosurgery, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Sami Barrit
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Bruxelles, Belgium
| | - Sébastien Carlot
- Department of Otorhinolaryngology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Viviane De Maertelaer
- Institute of Interdisciplinary Research (IRIBHM), Université Libre de Bruxelles, Brussels, Belgium
| | - Sergio Hassid
- Department of Otorhinolaryngology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier De Witte
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Bruxelles, Belgium
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Silan F, Consiglio F, Dell'Antonia F, Montagner G, Trojan D, Berna G. Cryopreserved fascia lata allograft use in surgical facial reanimation: a retrospective study of seven cases. Maxillofac Plast Reconstr Surg 2020; 42:2. [PMID: 32099836 PMCID: PMC7007484 DOI: 10.1186/s40902-020-0246-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Facial palsy treatment comprises static and dynamic techniques. Among dynamic techniques, local temporalis transposition represents a reliable solution to achieve facial reanimation. The present study describes a modification of the temporalis tendon transfer using a cryopreserved fascia allograft. Case presentation Between March 2015 and September 2018, seven patients with facial palsy underwent facial reanimation with temporalis tendon transfer and fascia lata allograft. Patients with long-term palsy were considered, and both physical and social functions were evaluated. The mean follow-up time was 21.5 months. No immediate complications were observed. Patients reported improvement in facial symmetry both in static and dynamic. Improvement was noticed also in articulation, eating, drinking, and saliva control. The Facial Disability Index revealed an improvement both in physical function subscale and in the social/well-being function subscale. Conclusions This modified orthodromic technique allows to reduce the operative time and the risk of complications connected to the use of autologous tissues. The use of the cryopreserved fascia allografts from cadaveric donors seems to provide promising and long-standing results in the treatment of facial palsy.
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Affiliation(s)
- Francesco Silan
- 1Plastic and Reconstructive Surgery Department, Ca' Foncello Hospital, 31100 Treviso, Italy
| | - Fabio Consiglio
- 1Plastic and Reconstructive Surgery Department, Ca' Foncello Hospital, 31100 Treviso, Italy
| | - Francesco Dell'Antonia
- 1Plastic and Reconstructive Surgery Department, Ca' Foncello Hospital, 31100 Treviso, Italy
| | - Giulia Montagner
- Fondazione Banca dei Tessuti di Treviso Onlus, Via dell'Ospedale 3, 31100 Treviso, Italy
| | - Diletta Trojan
- Fondazione Banca dei Tessuti di Treviso Onlus, Via dell'Ospedale 3, 31100 Treviso, Italy
| | - Giorgio Berna
- 1Plastic and Reconstructive Surgery Department, Ca' Foncello Hospital, 31100 Treviso, Italy
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10
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Tahami SA, Afshar-Fereydonian N, Kazemi F, Taheri M. Comparing the results of duraplasty using amniotic membrane versus pericranium as dural graft; concerning CSF leakage and pseudomeningocele. Br J Neurosurg 2019; 34:51-54. [PMID: 31656091 DOI: 10.1080/02688697.2019.1680797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Seyed Ahmad Tahami
- Department of Neurosurgery, Iran University of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
| | | | - Farid Kazemi
- Department of Neurosurgery, Iran University of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
| | - Morteza Taheri
- Department of Neurosurgery, Iran University of Medical Sciences, 7Tir Hospital, Tehran, Iran
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11
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Chen PG, Clampitt MR, Chorath KT, Lin RP, Weitzel EK, McMains KC, Bunegin L. Augmentation of Dural Defect Repairs Strength With an Acrylic Plate in a Porcine Ex Vivo Model. Am J Rhinol Allergy 2019; 33:757-762. [DOI: 10.1177/1945892419866310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Large skull base defects can be challenging to repair. This study uses a controlled ex vivo model to examine the failure pressures of various dural repairs of large skull base defects using mucosa with fibrin glue under 3 conditions: No Additional Support of the repair, support with a Foley catheter (Direct Support), and with Foley catheter contact over a rigid acrylic plate (Diffuse Support). Methods Failure pressures of dural repairs with and without support were determined in a porcine model using an ex vivo closed testing apparatus. In addition, 20 mm × 15 mm dural defects were created. Skull base repairs were performed using porcine dura as an underlay graft followed by a septal mucosa overlay. Saline was infused at 30 mL/h, applying even force to the underside of the graft until repair failure occurred for each condition (none, direct, and diffuse support). Five trials were performed per repair type for a total of 15 repairs. Results The mean failure pressures were as follows: No Additional Support, 6.494 ± 2.553 mm Hg; Direct Support, 5.103 ± 3.913 mm Hg; and Diffuse Support, 15.649 ± 2.638 mm Hg. A post hoc Bonferroni-Holm test demonstrated significant difference between No Additional Support and Diffuse Support ( P = .001), as well as Direct Support and Diffuse Support ( P = .002). Conclusion Support of dural repairs in this model withstood higher pressures when the Foley catheter’s support is distributed evenly using a flat acrylic plate. Use of this plate is the only repair tested in this model that tolerated normal adult supine intracranial pressures.
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Affiliation(s)
- Philip G. Chen
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Michael R. Clampitt
- Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kevin T. Chorath
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Ryan P. Lin
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
- Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base, San Antonio, Texas
- Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Erik K. Weitzel
- Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base, San Antonio, Texas
| | - Kevin C. McMains
- Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base, San Antonio, Texas
| | - Leonid Bunegin
- Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, Texas
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Reconstruction of Dural Defects in Endoscopic Transnasal Approaches for Intradural Lesions Using Multilayered Fascia with a Pressure-Control Spinal Drainage System. World Neurosurg 2018; 114:e1316-e1324. [PMID: 29631081 DOI: 10.1016/j.wneu.2018.03.209] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Nasoseptal flap reconstruction is a widely accepted method for reducing cerebrospinal fluid (CSF) leakage after endoscopic transnasal surgeries (ETSs). However, this method is associated with nasal complications and is difficult to apply repeatedly in recurrent cases. Therefore, alternative methods are needed. METHODS Layers of autologous fascia lata were placed on the inside and outside of the dural defect to sufficiently cover it, and the grafts were compressed with an inflated balloon. A lumbar drainage system with a pressure-control valve was used for 72 hours postoperatively. We retrospectively analyzed data on patients with skull base lesions showing intracranial extensions that required wide opening of the ventral dura in ETS. Fifty cases (47 skull base tumors and 3 others) were included, 28 of which were recurrent cases. RESULTS In 21 cases (42%), the nasal septum was not intact because of the previous ETS. Seventeen patients (34%) had a history of radiotherapy and 9 (18%) had undergone multisession radiotherapies. None of the 50 patients required additional surgery for postoperative CSF rhinorrhea, and 2 had intermittent CSF leakage that resolved with prolonged lumbar drainage placement for a week. Previous multisession radiotherapy was the only significant risk factor for the need of prolonged drainage (P = 0.029). CONCLUSIONS The multilayer closure method with a pressure-control spinal drainage system is a simple, safe, and effective method for preventing postoperative CSF leakage, which can be readily applied to dural defects in any parts of the skull base regions and in patients with various conditions.
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