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Hasegawa H, Kiyofuji S, Umekawa M, Shinya Y, Okamoto K, Shono N, Kondo K, Shin M, Saito N. Profiles of central nervous system surgical site infections in endoscopic transnasal surgery exposing the intradural space. J Hosp Infect 2024; 146:166-173. [PMID: 37516279 DOI: 10.1016/j.jhin.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Despite its efficacy and minimal invasiveness, the clean-contaminated nature of endoscopic transnasal surgery (ETS) may be susceptible to central nervous system surgical site infections (CNS-SSIs), especially when involving intradural exposure. However, the profiles of ETS-associated CNS-SSIs are not fully elucidated. METHODS The institutional ETS cases performed between May 2017 and March 2023 were retrospectively analysed. The incidences of CNS-SSIs were calculated, and their risk factors examined. RESULTS The incidence of CNS-SSIs was 2.3% (7/305) in the entire cohort and 5.0% (7/140) in ETSs with intradural exposure. All the CNS-SSIs were meningitis and developed following ETS with intradural exposure. The incidences were 0%, 5.6% and 5.8% in ETSs with Esposito grade 1, 2 and 3 intraoperative cerebrospinal fluid leakage, respectively. Among the pre- and intra-operative factors, body mass index (unit odds ratio (OR), 0.62; 95% confidence interval (CI), 0.44-0.89; P<0.01), serum albumin (unit OR, 0.03; 95% CI, 0.0007-0.92; P=0.02), and American Society of Anesthesiologists physical status score (unit OR, 20.7; 95% CI, 1.65-259; P<0.01) were significantly associated with CNS-SSIs. Moreover, postoperative cerebrospinal fluid leakage was also significantly associated with CNS-SSIs (OR, 18.4; 95% CI, 3.55-95.0; P<0.01). CONCLUSIONS The incidence of ETS-associated CNS-SSIs is acceptably low. Intradural exposure was a prerequisite for CNS-SSIs. Malnutrition and poor comorbidity status should be recognized as important risks for CNS-SSIs in ETS.
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Affiliation(s)
- H Hasegawa
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan.
| | - S Kiyofuji
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - M Umekawa
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - Y Shinya
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - K Okamoto
- Department of Infectious Diseases, University of Tokyo, Tokyo, Japan
| | - N Shono
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - K Kondo
- Department of Otorhinolaryngology, University of Tokyo, Tokyo, Japan
| | - M Shin
- Department of Neurosurgery, Teikyo University, Tokyo, Japan
| | - N Saito
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
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Sumislawski P, Piotrowska M, Regelsberger J, Flitsch J, Rotermund R. Sphenoid Sinus Mucosal Flap after Transsphenoidal Surgery-A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:282. [PMID: 38399569 PMCID: PMC10890001 DOI: 10.3390/medicina60020282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Skull base reconstruction is a crucial step during transsphenoidal surgery. Sphenoid mucosa is a mucosal membrane located in the sphenoid sinus. Preservation and lateral shifting of sphenoid mucosa as sphenoid mucosal flap (SMF) during the transsphenoidal exposure of the sella may be important for later closure. This is the first systematic review to evaluate the utility of sphenoid mucosal flap for sellar reconstruction after transsphenoidal surgery. Materials and Methods: A systematic literature search was performed in January 2023: Cochrane, EMBASE, PubMed, Scopus, and Web of Science. The following keywords and their combinations were used: "sphenoid mucosa", "sphenoid sinus mucosa", "sphenoid mucosal flap", "sphenoid sinus mucosal flap". From a total number of 749 records, 10 articles involving 1671 patients were included in our systematic review. Results: Sphenoid sinus mucosa used to be applied for sellar reconstruction as either a vascularized pedicled flap or as a free flap. Three different types of mucosal flaps, an intersinus septal flap, a superiorly based flap and an inferiorly based flap, were described in the literature. Total SMF covering compared to partial or no SMF covering in sellar floor reconstruction resulted in fewer postoperative CSF leaks (p = 0.008) and a shorter duration of the postoperative lumbar drain (p = 0.003), if applied. Total or partial SMF resulted in fewer local complications (p = 0.012), such as fat graft necrosis, bone graft necrosis, sinusitis or fungal infection, in contrast to no SMF implementation. Conclusions: SMF seems to be an effective technique for skull base reconstruction after transsphenoidal surgery, as it can reduce the usage of avascular grafts such as fat along with the incidence of local complications, such as fat graft necrosis, bone graft necrosis, sinusitis and fungal infection, or it may improve the sinonasal quality of life by maintaining favorable wound healing through vascular flap and promote the normalization of the sphenoid sinus posterior wall. Further clinical studies evaluating sphenoid mucosal flap preservation and application in combination with other techniques, particularly for higher-grade CSF leaks, are required.
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Affiliation(s)
- Piotr Sumislawski
- Department of Neurosurgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany;
| | - Martyna Piotrowska
- Faculty of Medicine and Dentistry, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Jan Regelsberger
- Department of Neurosurgery, Diako Krankenhaus Flensburg, 24939 Flensburg, Germany;
| | - Jörg Flitsch
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany;
| | - Roman Rotermund
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany;
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Park JS, Kim DH, Kim SW, Kim SW, Ahn S, Basurrah MA, Jeun SS. Sinonasal Outcomes of the Combined Transseptal/Transnasal Approach with Unilateral Nasoseptal Rescue Flap in Endoscopic Endonasal Transsphenoidal Surgery: A Propensity Score Matching Analysis. J Neurol Surg B Skull Base 2024; 85:21-27. [PMID: 38327514 PMCID: PMC10849868 DOI: 10.1055/a-1946-0240] [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: 07/08/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022] Open
Abstract
Objectives The authors applied surgical techniques acquired during the use of endoscopic combined transseptal/transnasal approach to reduce approach-related morbidity and improve sinonasal outcomes. Study Design This is a retrospective cohort study of a prospectively collected database. Setting The study setting involves a tertiary referral center. Participants A total of 86 patients who underwent endoscopic endonasal transsphenoidal surgery for newly diagnosed pituitary adenomas from April 2018 to March 2021 were included. Patients treated via the combined transseptal/transnasal approach served as the study group ( n = 18); those treated via the bilateral transnasal approach comprised the control group ( n = 68). From the control group, propensity score matching (PSM) analysis was further performed to account for potential confounders and selection bias. Main Outcome Measures Paired analysis was performed for pre- and 6-month-postoperative time points in study group, control group, and PSM control group. Olfactory function was evaluated by Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), and sinonasal outcomes were assessed by Sino-Nasal Outcome Test-22 (SNOT-22). Results In the study group, CCCRC ( p = 0.517) and CCSIT ( p = 0.497) did not show any significant difference before and after surgery. There was some improvement in the symptom score of SNOT-22, but it was not statistically significant ( p = 0.115). In the control group adjusted with PSM, a significant decrease in olfaction ( p = 0.047) was observed using CCCRC. The CCSIT score was also decreased but not significant ( p = 0.163). Also, there was no difference in the improvement of SNOT-22 ( p = 0.781). Conclusion Our new surgical method preserves olfactory function without compromising surgical outcomes.
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Affiliation(s)
- Jae-Sung Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Stephen Ahn
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Sin-Soo Jeun
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Huang Y, Zheng T, Liu Y, Fang R. Comparison of microscopic transsphenoidal surgery and neuroendoscopic transsphenoidal surgery in pituitary adenoma resection and the risk factors of postoperative cerebrospinal fluid leakage. Am J Transl Res 2023; 15:4746-4754. [PMID: 37560241 PMCID: PMC10408534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/08/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To compare microscopic transsphenoidal surgery (MTS) and neuroendoscopic transsphenoidal surgery (NTS) in pituitary adenoma (PA) resection and analyze the risk factors of postoperative cerebrospinal fluid leakage (CFL). METHODS The clinical data of 127 patients with PA treated in Xi'an International Medical Center Hospital from January 2019 to January 2021 were analyzed retrospectively. Among them, 54 patients treated by MTS for PA resection were assigned to the control group, while the rest of the 73 patients treated by NTS for PA resection were assigned to the study group. The total tumor resection rate, decrease of hormone levels after operation, alleviation of primary symptoms and complications were compared between the two groups. Logistics regression analysis was conducted to analyze the risk factors of CFL. RESULTS The control group experienced a shorter operation time than the study group (P<0.001). The resection rates of the control and study groups were comparable, but the study group showed a lower incidence of postoperative complications than the control group (P = 0.004). In addition, the study group showed better alleviation of primary symptoms than the control group (P = 0.013). After surgery, the two groups presented decreased levels of prolactin and growth hormone (P<0.001), and also showed decreased average adrenocorticotropic hormone (P<0.001). Moreover, the two groups were not significantly different in the levels of prolactin, growth hormone and adrenocorticotropic hormone after surgery (P>0.05). According to multivariate logistics regression analysis, body mass index (BMI) (P = 0.003, OR = 8.791, 95% CI: 2.050-37.693), intraoperative CFL (P = 0.002, OR = 21.614, 95% CI: 0.305-153.162) and therapeutic regimen (P = 0.011, OR = 7.060, 95% CI: 1.554-32.076) were independent risk factors for postoperative CFL. CONCLUSION Compared with MTS, endoscopic transsphenoidal surgery requires a notably longer time, but it can strongly improve the total resection rate of patients and reduce the incidence of postoperative complications. Endoscopic surgery is a protective factor of postoperative CFL.
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Affiliation(s)
- Yuanzhi Huang
- Department of Neurosurgery, Xi’an International Medical Center HospitalXi’an 710100, Shaanxi, China
| | - Tao Zheng
- Department of Neurosurgery, Xi’an International Medical Center HospitalXi’an 710100, Shaanxi, China
| | - Yang Liu
- Department of Neurosurgery, Xi’an International Medical Center HospitalXi’an 710100, Shaanxi, China
| | - Rongjin Fang
- Department of Neurosurgery, Ankang Hospital of Traditional Chinese MedicineAnkang 725000, Shaanxi, China
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Hasegawa H, Shin M, Shinya Y, Kashiwabara K, Kikuta S, Kondo K, Saito N. Long-term Outcomes of Non-vascularized Multilayer Fascial Closure Technique for Dural Repair in Endoscopic Transnasal Surgery: Efficacy, Durability, and Limitations. World Neurosurg 2023; 175:e97-e107. [PMID: 36914030 DOI: 10.1016/j.wneu.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE Non-vascularized multilayer fascial closure technique (NMFCT) can be used instead of nasoseptal flap reconstruction for dural repair in endoscopic transnasal surgery (ETS); however, due to the lack of blood supply, its long-term durability and possible limitations need to be clarified. METHODS This was a retrospective study on patients who underwent ETS with intraoperative cerebrospinal fluid (CSF) leakage. We assessed the postoperative and delayed CSF leakage rates and the associated risk factors. RESULTS Among 200 ETSs with intraoperative CSF leakage, 148 (74.0%) ETSs were performed for skull base pathologies other than pituitary neuroendocrine tumor. The mean follow-up period was 34.4 months. Esposito grade 3 leakage was confirmed in 148 (74.0%) cases. NMFCT was used either with (67 [33.5%]) or without (133 [66.5%]) lumbar drainage. There were 10 cases (5.0%) of postoperative CSF leakage that necessitated reoperation. In 4 other cases (2.0%), CSF leakage was suspected but lumbar drainage alone successfully restored the condition. Multivariate logistic regression analyses revealed that posterior skull base location (P < 0.01, odds ratio 11.5, 95% CI 1.99-2.17 × 102) and craniopharyngioma pathology (P = 0.03, odds ratio 9.4, 95% CI 1.25-1.92 × 102) were significantly associated with postoperative CSF leakage. No delayed leakage occurred during the observation period except for 2 patients who underwent multiple radiotherapies. CONCLUSIONS NMFCT is a reasonable alternative with long-term durability, though vascularized flap may be a better choice for cases in which vascularity of the surrounding tissues is significantly impaired due to interventions including multiple radiotherapies.
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Affiliation(s)
- Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan.
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan; Department of Neurosurgery, Teikyo University, Itabashi, Tokyo, Japan
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Kosuke Kashiwabara
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, University of Tokyo, Bunkyo, Tokyo, Japan
| | - Shu Kikuta
- Department of Otorhinolaryngology, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otorhinolaryngology, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan
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Figueredo LF, Martínez AL, Suarez-Meade P, Marenco-Hillembrand L, Salazar AF, Pabon D, Guzmán J, Murguiondo-Perez R, Hallak H, Godo A, Sandoval-Garcia C, Ordoñez-Rubiano EG, Donaldson A, Chaichana KL, Peris-Celda M, Bendok BR, Samson SL, Quinones-Hinojosa A, Almeida JP. Current Role of Endoscopic Endonasal Approach for Craniopharyngiomas: A 10-Year Systematic Review and Meta-Analysis Comparison with the Open Transcranial Approach. Brain Sci 2023; 13:842. [PMID: 37371322 DOI: 10.3390/brainsci13060842] [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] [Received: 04/11/2023] [Revised: 04/29/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
In recent years, the endoscopic endonasal approach (EEA) for craniopharyngiomas has proven to be a safe option for extensive tumor resection, with minimal or no manipulation of the optic nerves and excellent visualization of the superior hypophyseal branches when compared to the Transcranial Approach (TCA). However, there is an ongoing debate regarding the criteria for selecting different approaches. To explore the current results of EEA and discuss its role in the management of craniopharyngiomas, we performed MEDLINE, Embase, and LILACS searches from 2012 to 2022. Baseline characteristics, the extent of resection, and clinical outcomes were evaluated. Statistical analysis was performed through an X2 and Fisher exact test, and a comparison between quantitative variables through a Kruskal-Wallis and verified with post hoc Bonferroni. The tumor volume was similar in both groups (EEA 11.92 cm3, -TCA 13.23 cm3). The mean follow-up in months was 39.9 for EEA and 43.94 for TCA, p = 0.76). The EEA group presented a higher visual improvement rate (41.96% vs. 25% for TCA, p < 0.0001, OR 7.7). Permanent DI was less frequent with EEA (29.20% vs. 67.40% for TCA, p < 0.0001, OR 0.2). CSF Leaks occurred more frequently with EEA (9.94% vs. 0.70% for TCA, p < 0.0001, OR 15.8). Recurrence rates were lower in the EEA group (EEA 15.50% vs. for TCA 21.20%, p = 0.04, OR 0.7). Our results demonstrate that, in selected cases, EEA for resection of craniopharyngiomas is associated with better results regarding visual preservation and extent of tumor resection. Postoperative CSF leak rates associated with EEA have improved compared to the historical series. The decision-making process should consider each person's characteristics; however, it is noticeable that recent data regarding EEA justify its widespread application as a first-line approach in centers of excellence for skull base surgery.
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Affiliation(s)
- Luisa F Figueredo
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Andrea L Martínez
- Faculty of Medicine, Universidad de Los Andes, Bogotá 111711, Colombia
| | - Paola Suarez-Meade
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | | | - Daniela Pabon
- Faculty of Medicine, Universidad de Los Andes, Bogotá 111711, Colombia
| | - Juan Guzmán
- Faculty of Medicine, Universidad de Los Andes, Bogotá 111711, Colombia
| | | | - Hana Hallak
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN 55901, USA
| | - Alex Godo
- Faculty of Medicine, Universitat Pompeu Fabra & Universitat Autònoma de Barcelona, 08002 Barcelona, Spain
| | | | - Edgar G Ordoñez-Rubiano
- Department of Neurological Surgery, Fundación Universitaria de las Ciencias de la Salud, Hospital de San José-Sociedad de Cirugía de Bogotá, Bogotá 111711, Colombia
| | - Angela Donaldson
- Department of Otolaryngology (ENT), Head and Neck Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Kaisorn L Chaichana
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - María Peris-Celda
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN 55901, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Susan L Samson
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Internal Medicine, Division of Endocrinology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Joao Paulo Almeida
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
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Plou P, Serioli S, Leonel LCPC, Alexander AY, Agosti E, Vilany L, Graepel S, Choby G, Pinheiro-Neto CD, Peris-Celda M. Surgical Anatomy and Approaches of the Anterior Cranial Fossa from a Transcranial and Endonasal Perspective. Cancers (Basel) 2023; 15:cancers15092587. [PMID: 37174053 PMCID: PMC10177555 DOI: 10.3390/cancers15092587] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
The anterior cranial fossa (ACF) is a complex anatomical region that can be affected by a broad spectrum of pathology. For the surgical treatment of these lesions, many approaches have been described, each of them with different scope and potential surgical complications, often associated with significant morbidity. Traditionally, tumors involving the ACF have been operated by transcranial approaches; however, in the last two decades, endoscopic endonasal approaches (EEAs) have been gaining popularity. In this work, the authors review and describe the anatomical aspects of the ACF and the technical nuances of transcranial and endoscopic approaches for tumors located in this region. Four approaches were performed in embalmed cadaveric specimens and the key steps were documented. Four illustrative cases of ACF tumors were selected to demonstrate the clinical application of anatomical and technical knowledge, which are essential in the preoperative decision-making process.
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Affiliation(s)
- Pedro Plou
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Simona Serioli
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy
| | - Luciano C P C Leonel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
| | - A Yohan Alexander
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
| | - Edoardo Agosti
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy
| | - Larissa Vilany
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
| | - Stephen Graepel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Garret Choby
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Carlos D Pinheiro-Neto
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Maria Peris-Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA
- Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
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8
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Hasegawa H, Shinya Y, Ono M, Kikuta S, Kondo K, Saito N. Kashimé: A Novel Knotless Surgical Suture to Simplify Dural Stitches in Endoscopic Transnasal Surgery. Oper Neurosurg (Hagerstown) 2023; 24:417-424. [PMID: 36701657 DOI: 10.1227/ons.0000000000000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Dural suturing is an effective adjunct to skull base dural repair in endoscopic transnasal surgery, although it is technically cumbersome. Here, we presented a novel surgical suture "Kashimé" (Kono Seisakusho) that can be tightened without tying. OBJECTIVE To examine the efficacy of Kashimé for skull base dural repair in endoscopic transnasal surgery. METHODS Kashimé was used in 8 patients with skull base dural defects during nonpedicled flap-based multilayered skull base reconstruction to close or approximate the gaps between the dural edges or secure a free fascial graft. The time required for each dural stitch (passing a needle through the dura, pulling out the thread, and tightening it) and the incidence of postoperative cerebrospinal fluid leakage were the study end points. RESULTS Based on our preliminary experiences with 12 stitches used, no postoperative cerebrospinal fluid leakage was observed. The learning curve was steep, and the mean (±SD) time was 127 (±44) seconds for a single stitching procedure, except for the first case. Regarding the metal artifact, although a beam hardening artifact was not observed on computed tomography, a 4- to 9-mm diameter image defect was observed on magnetic resonance imaging. CONCLUSION Kashimé can help surgeons to complete a single dural stitch in endoscopic transnasal surgery for approximately 2 minutes. It may be an optimal tool for skull base reconstruction, but the efficacy and safety need to be investigated.
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Affiliation(s)
- Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Shu Kikuta
- Department of Otorhinolaryngology, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otorhinolaryngology, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan
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9
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Zhang G, Wang P, Wang J, Zou D, Yao H, Liu J, Tang C, Jiang H, Tan X, Wu N. Endoscopic endonasal surgery for non-invasive pituitary neuroendocrinology tumors with incomplete pseudocapsule. Front Neurol 2023; 14:1109388. [PMID: 37051052 PMCID: PMC10083277 DOI: 10.3389/fneur.2023.1109388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/02/2023] [Indexed: 03/28/2023] Open
Abstract
BackgroundPituitary neuroendocrinology tumors (PitNETs) with pseudocapsule can be effectively removed by the pseudocapsule-based extracapsular resection technique. In the areas without pseudocapsule, the tumor cells can spread into the adjacent tissues at the cellular level, which brings a great challenge to achieving total tumor resection.MethodsOur surgical strategy for PitNETs with an incomplete pseudocapsule is to combine the pseudocapsule-based extracapsular resection technique with the intensive excision technique for the removal of the tumor. Specifically, the pseudocapsule-based extracapsular resection technique is applied in the areas with pseudocapsule, while in the areas without pseudocapsule, the intensive excision technique bounded by adjacent normal structures is adopted. Moreover, a pathological examination was performed to determine the situations of pseudocapsule and tumor cell remnant.ResultsAll growth hormone-secreting PitNETs achieved biochemical remission after surgery. There was no deterioration of pituitary functions postoperatively, and the preoperative hypopituitarism had improved in all patients postoperatively. In total, two cases suffered a transient diabetes insipidus, and intraoperative cerebrospinal fluid leakage was observed in two cases but no postoperative cerebrospinal fluid leakage in all cases. There was no recurrence during the follow-up. The fragmental pseudocapsule and small tumor remnants were found in the majority of suspicious tissues by histological staining.ConclusionThe effectiveness and safety of the surgical strategy were preliminarily explored for removing PitNETs without incomplete pseudocapsules. In overview, the pseudocapsule-based extracapsular resection technique is applied in areas with pseudocapsule, while the intensive excision bounded by adjacent normal structures is adopted in other areas.
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Affiliation(s)
- Gang Zhang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
- Chongqing Medical University, Chongqing, China
| | - Pan Wang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
- Chongqing Medical University, Chongqing, China
| | - Junwei Wang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
| | - Dewei Zou
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
| | - Hui Yao
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Jie Liu
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
- Chongqing Medical University, Chongqing, China
| | - Chao Tang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
- Chongqing Medical University, Chongqing, China
| | - Haotian Jiang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
- Chongqing Medical University, Chongqing, China
| | - Xiaorong Tan
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
- Chongqing Medical University, Chongqing, China
| | - Nan Wu
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
- *Correspondence: Nan Wu,
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Factors Influencing Cerebrospinal Fluid Leaking following Pituitary Adenoma Transsphenoidal Surgery: A Meta-Analysis and Comprehensive Review. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5213744. [PMID: 36017392 PMCID: PMC9398767 DOI: 10.1155/2022/5213744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
Background Surgical resection is the main method to treat pituitary adenoma. Cerebrospinal fluid leakage (CSF Leak) is the main complication after transsphenoidal surgery. The impact of postoperative CSF Leak can be predicted in advance, and preventive measures can be taken in time. Clinically, a variety of factors may affect the occurrence of postoperative CSF Leak. In this study, meta-analysis was used to investigate the risk factors of postoperative CSF Leak as a clinical reference. Methods The databases PubMed, Medline, Embrase, Cochrane library, CNKI, and CBM were searched for all studies on the risk factors of postoperative CSF Leak. Studies were screened and finally included. The quality of the included studies was assessed by the Newcastle-Ottawa scale. We used Revman 5.4 software to conduct the pooled effect size of every potential statistically significant factor. Results 13 articles with a total of 5967 patients with pituitary adenoma and 405 cases of postoperative CSF Leak were finally included, accounting for 6.79%. All of the 13 articles had a quality score > 5, indicating good quality. Meta-analysis showed that patient age (OR = 0.71, 95% CI (0.41, 1.20), P = 0.20) was not a factor influencing postoperative CSF Leak, while BMI (MD = 2.26, 95% CI (1.31, 3.20), P < 0.00001), tumor size (MD = 1.35, 95% CI (0.22, 2.49), P = 0.02), whether a second operation was performed (OR = 2.20, 95% CI (1.45, 3.33), P = 0.0002), and intraoperative CSF Leak (OR = 8.88, 95% CI (3.64, 21.69), P < 0.00001) were risk factors for postoperative CSF Leak in patients. Discussion. BMI, tumor size, reoperation, and intraoperative CSF Leak are the risk factors of postoperative CSF Leak. However, not all the factors were covered in this study, it is still worth continuing to deeply investigate in this topic.
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