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Moreno-Luna R, Sánchez FM, Kaen A, Cabrerizo JRG, Castro NM, García JG, Aubá JMV, Ruiz-Valdepeñas EC, Cánovas IM, Del Cuvillo Bernal A, Piñero AG, Solano JMM, de Liesa RF, Sánchez-Gómez S, Alobid I. Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document. Acta Otorrinolaringol Esp (Engl Ed) 2022; 73:323-335. [PMID: 36031110 DOI: 10.1016/j.otoeng.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. OBJECTIVES The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. MATERIAL AND METHODS Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. RESULTS We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. CONCLUSIONS We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.
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Affiliation(s)
- Ramón Moreno-Luna
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ariel Kaen
- Unidad de Base de Cráneo, Servicio de Neurocirugía, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Nieves Mata Castro
- Servicio de Otorrinolaringología, Hospital Universitario de Torrejón, Madrid, Spain
| | - Jaime González García
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - José Miguel Villacampa Aubá
- Servicio de Otorrinolaringología, Fundación Jiménez Díaz, Madrid, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Irene Monjas Cánovas
- Servicio de Otorrinolaringología, Hospital General Universitario de Alicante, Alicante, Spain
| | - Alfonso Del Cuvillo Bernal
- Unidad de Rinología, Hospital Universitario de Jerez, Cádiz, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Juan Manuel Maza Solano
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Rafael Fernández de Liesa
- Servicio de de Otorrinolaringología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Serafín Sánchez-Gómez
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, Spain; Comisión de Formación de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Isam Alobid
- Unidad de Base de Cráneo, Departamento de Otorrinolaringología, Hospital Clínic, Barcelona, Spain; Comisión de Rinología, Alergia y Base de Cráneo Anterior, Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC).
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Calvo-Henríquez C, Maldonado-Alvarado B, Chiesa-Estomba C, Mayo-Yáñez M, Martínez-Capoccioni G, Lechien JR, Ruano-Ravina A, López-Cortijo C, Martin-Martin C. Creation and validation of a radiological checklist for functional endoscopic sinonasal surgery. A YO-IFOS initiative. Acta Otorrinolaringol Esp (Engl Ed) 2021; 72:305-311. [PMID: 34535221 DOI: 10.1016/j.otoeng.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/02/2020] [Indexed: 10/20/2022]
Abstract
BACKGROUND Functional endoscopic sinus surgery might lead to dangerous complications. Studying and analysing preoperative CT scans provides surgeons with a precise knowledge of their patient's anatomy, thus reducing the risk of potential complications. Checklists highlighting key anatomical areas have been published and proven useful. However, none of these are widely accepted or systematically used in daily practice. OBJECTIVE In this paper, the rhinology group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS) aim to create and validate a new checklist designed to be fast and user friendly for daily practice. METHODS Two CT sinonasal scans were selected as test cases. Forty otolaryngologists were selected from five tertiary referral hospitals. It was a cross-sectional study; each participant was their own control. All participants completed a questionnaire after the analysis of both CT scans to prevent learning bias. The evaluation included ten items critical in endoscopic sinus surgery according to previous publications. RESULTS There were 80 evaluations. There was a significant increase in the number of correctly identified critical structures with the use of the checklist (p=.009). There was a statistically significant difference in low- experience evaluators, while it was not statistically significant for experienced surgeons. The most unanswered structures were suprabullar recess, dangerous v2 nerve, anterior ethmoid artery, dangerous vidian nerve and Onodi cell. The most wrongly identified structures were Keros type, septal deviation and cribiform middle turbinate. CONCLUSION The YO-IFOS radiological checklist has proven a useful tool for correctly studying sinonasal anatomical variations. There is a clear learning component in the use of the checklist although it does not in any way exempt specialists from thorough study of sinonasal anatomy. Given the risk-benefit ratio, we strongly suggest the routine use of the checklist to systematically assess CT-scans prior to endoscopic sinonasal surgery.
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Affiliation(s)
- Christian Calvo-Henríquez
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain.
| | - Byron Maldonado-Alvarado
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain
| | - Carlos Chiesa-Estomba
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Service of Otolaryngology, Donostia University Hospital, Spain
| | - Miguel Mayo-Yáñez
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Service of Otolaryngology, Hospital Complex of La Coruña, Spain
| | - Gabriel Martínez-Capoccioni
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain
| | - Jerome R Lechien
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, University of Paris Saclay, France
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Spain
| | - Cristóbal López-Cortijo
- Department of Otolaryngology-Head and Neck Surgery, Hospital Puerta de Hierro de Madrid, Spain
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3
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Moreno-Luna R, Mariño Sánchez F, Kaen A, Gras Cabrerizo JR, Mata Castro N, González García J, Villacampa Aubá JM, Cárdenas Ruiz-Valdepeñas E, Monjas Cánovas I, Del Cuvillo Bernal A, García Piñero A, Maza Solano JM, Fernández de Liesa R, Sánchez-Gómez S, Alobid I. Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document. Acta Otorrinolaringol Esp (Engl Ed) 2021; 73:S0001-6519(21)00041-8. [PMID: 34330369 DOI: 10.1016/j.otorri.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. OBJECTIVES The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. MATERIAL AND METHODS Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. RESULTS We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. CONCLUSIONS We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.
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Affiliation(s)
- Ramón Moreno-Luna
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - Ariel Kaen
- Unidad de Base de Cráneo, Servicio de Neurocirugía, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Nieves Mata Castro
- Servicio de Otorrinolaringología, Hospital Universitario de Torrejón, Madrid, España
| | - Jaime González García
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España
| | - José Miguel Villacampa Aubá
- Servicio de Otorrinolaringología, Fundación Jiménez Díaz, Madrid, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Irene Monjas Cánovas
- Servicio de Otorrinolaringología, Hospital General Universitario de Alicante, Alicante, España
| | - Alfonso Del Cuvillo Bernal
- Unidad de Rinología, Hospital Universitario de Jerez, Cádiz, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | | | - Juan Manuel Maza Solano
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Rafael Fernández de Liesa
- Servicio de de Otorrinolaringología, Hospital Universitario Miguel Servet, Zaragoza, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Serafín Sánchez-Gómez
- Unidad de Rinología y Base de Cráneo, Hospital Universitario Virgen Macarena, Sevilla, España; Comisión de Formación de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC)
| | - Isam Alobid
- Unidad de Base de Cráneo, Departamento de Otorrinolaringología, Hospital Clínic, Barcelona, España; Comisión de Rinología, Alergia y Base de Cráneo Anterior. Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL y CCC).
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Calvo-Henríquez C, Maldonado-Alvarado B, Chiesa-Estomba C, Mayo-Yáñez M, Martínez-Capoccioni G, Lechien JR, Ruano-Ravina A, López-Cortijo C, Martin-Martin C. Creation and validation of a radiological checklist for functional endoscopic sinonasal surgery. A YO-IFOS initiative. Acta Otorrinolaringol Esp 2021. [PMID: 33714450 DOI: 10.1016/j.otorri.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Functional endoscopic sinus surgery might lead to dangerous complications. Studying and analysing preoperative CT scans provides surgeons with a precise knowledge of their patient's anatomy, thus reducing the risk of potential complications. Checklists highlighting key anatomical areas have been published and proven useful. However, none of these are widely accepted or systematically used in daily practice. OBJECTIVE In this paper, the rhinology group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS) aim to create and validate a new checklist designed to be fast and user friendly for daily practice. METHODS Two CT sinonasal scans were selected as test cases. Forty otolaryngologists were selected from five tertiary referral hospitals. It was a cross-sectional study; each participant was their own control. All participants completed a questionnaire after the analysis of both CT scans to prevent learning bias. The evaluation included ten items critical in endoscopic sinus surgery according to previous publications. RESULTS There were 80 evaluations. There was a significant increase in the number of correctly identified critical structures with the use of the checklist (p=.009). There was a statistically significant difference in low- experience evaluators, while it was not statistically significant for experienced surgeons. The most unanswered structures were suprabullar recess, dangerous v2 nerve, anterior ethmoid artery, dangerous vidian nerve and Onodi cell. The most wrongly identified structures were Keros type, septal deviation and cribiform middle turbinate. CONCLUSION The YO-IFOS radiological checklist has proven a useful tool for correctly studying sinonasal anatomical variations. There is a clear learning component in the use of the checklist although it does not in any way exempt specialists from thorough study of sinonasal anatomy. Given the risk-benefit ratio, we strongly suggest the routine use of the checklist to systematically assess CT-scans prior to endoscopic sinonasal surgery.
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Affiliation(s)
- Christian Calvo-Henríquez
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain.
| | - Byron Maldonado-Alvarado
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain
| | - Carlos Chiesa-Estomba
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Service of Otolaryngology, Donostia University Hospital, Spain
| | - Miguel Mayo-Yáñez
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Service of Otolaryngology, Hospital Complex of La Coruña, Spain
| | - Gabriel Martínez-Capoccioni
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain
| | - Jerome R Lechien
- Rhinology Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Study Group, Spain; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, University of Paris Saclay, France
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Spain
| | - Cristóbal López-Cortijo
- Department of Otolaryngology-Head and Neck Surgery, Hospital Puerta de Hierro de Madrid, Spain
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Sánchez Ortega JF, Pinilla Arias D, Vázquez Míguez A, Calatayud Pérez JB. Intracranial hypotension secondary to spontaneous spinal cerebrospinal fluid fistula: Three case reports. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30107-X. [PMID: 33082102 DOI: 10.1016/j.neucir.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/16/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
Spontaneous intracranial hypotension syndrome (SIH) is a rare condition. The main symptom is orthostatic headache, although other symptoms such as vegetative symptoms, meningism, or focal neurological deficits may appear. The most common cause is a cerebrospinal fluid leak, usually traumatic. Spontaneous cerebrospinal fluid leaks are rare and associated with the presence of meningeal cysts / diverticula or in the setting of connective tissue diseases. The diagnosis is based on imaging tests, both to detect intracranial complications and bilateral subdural hematomas and to locate the leak point at the intracranial or spinal level. The treatment of SIH is usually conservative: bed rest, caffeine and analgesics. Epidural blood patch is a good option when symptoms persist. Surgery is indicated in refractory cases or when there is an evident and accessible anatomic defect. This article describes three clinical cases with intracranial hypotension syndrome secondary to a spontaneous spinal cerebrospinal fluid leak.
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Manso Melgosa AB, García Gutiérrez H, Fernández Porras M, Castrillo Manero AB, Pérez Marijuán B. [External lumbar drainage with volumetric continuing infusion pump in patients with cerebrospinal fluid leak. A case series]. Enferm Clin 2017; 27:40-3. [PMID: 28029524 DOI: 10.1016/j.enfcli.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the incidence and complications arising in a number of cases of patients with cerebrospinal fluid leak treated by external lumbar drainage with infusion pump (IP) volumetric continuous from 2001 to 2014. Quantify cerebrospinal fluid leak closed by lumbar drainage with IP. METHODS Retrospective descriptive case series study. POPULATION patients undergoing transsphenoidal pituitary surgery, Chiari surgery and laminectomy, that developed postoperative cerebrospinal fluid leak treated with continuous external lumbar drainage by IP. VARIABLES age, sex, type of intervention, variables related to the practice of the pump and complications. Average and medians were calculated for quantitative variables, frequencies and percentages for qualitative. RESULTS Sample: 11 subjects. Incidence in running IP: disconnection, occlusion and acoustic alarm activation. Most frequently complication is headache; a case of pneumocephalus. DISCUSSION The small number of subjects and the heterogeneity of these do not allow for comparison or establishing associations between variables. The resolution of the cerebrospinal fluid leak with continuous IP is lower in this study than others, and may be influenced by the small number of subjects. It should be noted the frequent activation of the pump alarm for no apparent cause. IMPLICATIONS FOR PRACTICE Protocol would be developed for preparing the IP team to reduce the acoustic alarm activation, and would make a prospective multicenter study.
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Reyes L, García S, Torales J, Halperín I, Alobid I, Hanzu F, Mora M, Valero R, Enseñat J. [Endoscopic endonasal surgery for sellar region pathology. An analysis of our first 200 patients. What we have learned]. Neurocirugia (Astur) 2016; 27:229-36. [PMID: 27012678 DOI: 10.1016/j.neucir.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 01/25/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Pituitary and sellar region tumours account for 10-15% of intracranial benign tumours, with pituitary adenoma being the most common one. In this article, a review is presented on 9 years of experience in surgical treatment using an endoscopic approach of sellar region lesions. The main features of our surgical technique will be explained, as well as the results in clinical and hormonal terms. MATERIAL AND METHODS A retrospective analysis was conducted on 200 patients operated on due to sellar lesions by the same neurosurgeon (J.E.) using an endoscopic endonasal transsphenoidal approach between February 2006 and February 2015. The cases excluded were, those requiring extended approaches of the skull base, as well as craniopharyngiomas, inflammatory, metastatic, or malignant lesions. RESULTS Of the 200 patients treated (59.5% women, mean age of 51.7 years, range: 18-82 years old), there were: 7 Rathke cysts and 193 adenomas (26 micro-adenomas and 165 macro-adenomas). All of them sub-classified according to the degree of invasion of the cavernous sinus (Knosp 0, 1, and 2: 129 cases and Knosp 3 and 4: 71 cases). Total resection was achieved in 143 patients (71.5%), subtotal resection in 39 (19.5%), and partial resection in 18 (9%). In the group of higher occupancy of the cavernous sinus (Knosp 3 and 4) complete resection was achieved in 55.5% (40 of 71 patients). Hormonal remission was achieved in 34 patients with acromegaly (85%), 23 patients with prolactinomas (76%), and 30 patients with Cushing's disease (86%). CONCLUSION The results obtained in our series, due to the centralisation of pathology and experience, are comparable to those achieved in pituitary surgery reference centres. Early surgical exploration of cerebrospinal fluid leaks reduces the risk of post-surgical meningitis.
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Affiliation(s)
- Luis Reyes
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
| | - Sergio García
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Jorge Torales
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Irene Halperín
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Isam Alobid
- Servicio de Otorrinolaringología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Felicia Hanzu
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Mireia Mora
- Servicio de Endocrinología, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Ricard Valero
- Servicio de Anestesiología y Reanimación, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Joaquim Enseñat
- Servicio de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, España
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Quillo-Olvera J, Zambrano-Velarde LE, Velázquez-Santana H, Gutiérrez-Partida CF, Velázquez-García F, Alcántara-Gómez LA. [Simultaneous diagnosis of pseudomeningocele, tethered cord syndrome and cerebrospinal fluid fistula: Report of a case]. Neurocirugia (Astur) 2016; 27:194-8. [PMID: 26936617 DOI: 10.1016/j.neucir.2015.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/04/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
Abstract
The clinical case is presented on a patient with an extensive sacral dysraphism, a history of myelomeningocele surgical repair in her childhood, as well as tethered cord syndrome. The patient was also diagnosed with pseudomeningocele and a cerebrospinal fluid cutaneous fístula. A surgical approach was used, with encouraging results being obtained in the clinical outcome of the patient. A review of the literature was performed to support the surgical decision in this case.
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Affiliation(s)
- Javier Quillo-Olvera
- Instituto Soriano de Cirugía de Columna Mínimamente Invasiva, Centro Médico ABC, Campus Santa Fe, México, D.F., México.
| | - Luis E Zambrano-Velarde
- Servicio de Neurocirugía, Hospital Regional Dr. Valentín Gómez Farías, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Jalisco, México
| | - Héctor Velázquez-Santana
- Servicio de Neurocirugía, Hospital Regional Dr. Valentín Gómez Farías, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Jalisco, México
| | - Carlos F Gutiérrez-Partida
- Instituto Soriano de Cirugía de Columna Mínimamente Invasiva, Centro Médico ABC, Campus Santa Fe, México, D.F., México
| | - Francisco Velázquez-García
- Servicio de Neurocirugía, Hospital Regional Dr. Valentín Gómez Farías, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Jalisco, México
| | - Leopoldo A Alcántara-Gómez
- Servicio de Neurocirugía, Hospital Regional Dr. Valentín Gómez Farías, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Jalisco, México
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Martínez Arias À, Bernal-Sprekelsen M, Rioja E, Enseñat J, Prats-Galino A, Alobid I. Endoscopic transpterygoid approach and skull base repair after sphenoid meningoencephalocele resection. Our experience. Acta Otorrinolaringol Esp 2014; 66:1-7. [PMID: 25052487 DOI: 10.1016/j.otorri.2014.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/27/2014] [Accepted: 03/28/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Cerebrospinal fluid leaks associated to meningoencephaloceles of the sphenoid lateral recess are rare entities. A congenital bony defect at this level results in the persistence of Sternberg's canal, or a lateral craniopharyngeal canal, which is supposed to be the origin of these lesions. Our objective was to show that the endoscopic transpterygoid approach is an effective technique for their treatment. METHODS We present a series of 5 cases of meningoencephaloceles of the sphenoid lateral recess treated with endoscopic sinus surgery (4 women and one man; mean age=59, range 37-72 years). Cerebrospinal fluid rhinorrhoea was present in all of them and they all underwent a transpterygoid approach with reconstruction of the skull base. We describe the surgical technique and review the literature. RESULTS No complications were observed during surgery or the postoperative period. After a mean follow-up of 81 months, only one recurrence was seen. CONCLUSIONS The transpterygoid approach has proven to be effective for the treatment of meningoencephaloceles of the sphenoid lateral recess. Providing wide access to identify the defect, followed by meningoencephalocele ablation, is the key for successful surgery.
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Affiliation(s)
- Àngels Martínez Arias
- Servicio de Otorrinolaringología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Manuel Bernal-Sprekelsen
- Unidad de Base de Cráneo, Servicio de Otorrinolaringología, Hospital Clínic Barcelona, Barcelona, España
| | - Elena Rioja
- Servicio de Otorrinolaringología Althaia Xarxa Assistencial, Manresa, España
| | | | - Alberto Prats-Galino
- Laboratorio de Neuroanatomía quirúrgica, Hospital Clínic, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - Isam Alobid
- Unidad de Base de Cráneo, Servicio de Otorrinolaringología, Hospital Clínic Barcelona, Barcelona, España.
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10
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Rama-López J, Rodríguez-Villalba R, Sarría-Echegaray P, Tomás-Barberán M. [Combined approach for the treatment of spontaneous temporal encephaloceles: transmastoid plus temporal minicraniotomy]. Acta Otorrinolaringol Esp 2013; 65:43-6. [PMID: 23953829 DOI: 10.1016/j.otorri.2013.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 04/19/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
Abstract
Spontaneous encephaloceles are defined as brain herniations with no apparent cause. The aim of this paper is to describe the surgical technique performed in our department. We reviewed the last 3 cases treated with combined approach (transmastoid plus minicraniotomy) with 2-layer closure. In all cases the bone defects were located and successfully sealed. We had no postoperative complications. There were no relapses in our follow-up period. The transmastoid approach has the advantage over the open approach with middle fossa craniotomy in that it locates the bone defect with no brain retraction. Nevertheless, it is not useful in large-sized, multiple or anterior defects. Due to those drawbacks, we think that the combined approach with temporal minicraniotomy is the best choice for this entity.
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Affiliation(s)
- Julio Rama-López
- Servicio de Otorrinolaringología, Sección de Otoneurología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España.
| | - Rosana Rodríguez-Villalba
- Servicio de Otorrinolaringología, Sección de Otoneurología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - Pedro Sarría-Echegaray
- Servicio de Otorrinolaringología, Sección de Otoneurología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - Manuel Tomás-Barberán
- Servicio de Otorrinolaringología, Sección de Otoneurología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
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11
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Simal-Julián JA, Miranda-Lloret P, Pancucci G, Evangelista-Zamora R, Pérez-Borredá P, Sanromán-Álvarez P, Perez-de-Sanromán L, Botella-Asunción C. [Endonasal skull base endoscopy]. Neurocirugia (Astur) 2013; 24:210-5. [PMID: 23831339 DOI: 10.1016/j.neucir.2013.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/09/2013] [Accepted: 05/12/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVE The endoscopic endonasal techniques used in skull base surgery have evolved greatly in recent years. Our study objective was to perform a qualitative systematic review of the likewise systematic reviews in published English language literature, to examine the evidence and conclusions reached in these studies comparing transcranial and endoscopic approaches in skull base surgery. MATERIAL AND METHODS We searched the references on the MEDLINE and EMBASE electronic databases selecting the systematic reviews, meta-analyses and evidence based medicine reviews on skull based pathologies published from January 2000 until January 2013. We focused on endoscopic impact and on microsurgical and endoscopic technique comparisons. RESULTS Full endoscopic endonasal approaches achieved gross total removal rates of craniopharyngiomas and chordomas higher than those for transcranial approaches. In anterior skull base meningiomas, complete resections were more frequently achieved after transcranial approaches, with a trend in favour of endoscopy with respect to visual prognosis. Endoscopic endonasal approaches minimised the postoperative complications after the treatment of cerebrospinal fluid (CSF) leaks, encephaloceles, meningoceles, craniopharyngiomas and chordomas, with the exception of postoperative CSF leaks. CONCLUSIONS Randomized multicenter studies are necessary to resolve the controversy over endoscopic and microsurgical approaches in skull base surgery.
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