Cerebrospinal fluid diverters for cranial base repair in endoscopic endonasal approaches

Authors

Keywords:

cerebrospinal fluid shunts, neuroendoscopy, skull base, spinal puncture, ventriculoperitoneal shunt.

Abstract

Introduction: Endoscopic endonasal approaches offer multiple advantages for the surgical management of cranial base tumors. However, postoperative cerebrospinal fluid fistula is high. Cerebrospinal fluid diverters are used as preventive or therapeutic methods to reduce this complication.
Objectives: Describe the results of using cerebrospinal fluid diversion methods in cranial base repair.
Method: A descriptive, prospective study was carried out on 77 patients with cranial base tumors operated on by endoscopic endonasal approaches, in which cerebrospinal fluid diversion methods were used. A postoperative evaluation of their use was carried out, evaluating complications and effectiveness in relation to cerebrospinal fluid leak. For data analysis, absolute and relative frequencies were used as summary measures.
Results: There was a predominance of the use of lumbar spinal drainage over ventriculoperitoneal shunt (83.1% /16.9%). Complications experienced with lumbar spinal drains were: Post-puncture headache (6.5%), cerebrospinal fluid fistula (2.6%), central nervous system infection (1.3%). While, with the use of ventriculoperitoneal shunt, pneumocephalus was only evident in one patient (1.3%). 97.4 % of the methods were determined to be effective.
Conclusions: With the present study, the favorable results of the use of cerebrospinal fluid diversion methods in the repair of the cranial base in endoscopic endonasal approaches are evident.

Downloads

Download data is not yet available.

Author Biographies

Carlos Roberto Vargas Gálvez, Hospital Clínico Quirúrgico Hermanos "Ameijeiras"

Neurocirujano, servicio de Neurocirugía del hospital Clínico Quirúrgico Hermanos " Ameijeiras"

Omar López Arbolay, Hospital Clínico Quirúrgico Hermanos "Ameijeiras"

Neurocirujano, jefe del servicio de Neurocirugía del hospital Clínico Quirúrgico Hermanos " Ameijeiras"

Marlon Manuel Ortiz Machín, Hospital Clínico Quirúrgico Hermanos "Ameijeiras"

Neurocirujano, servicio de Neurocirugía del hospital Clínico Quirúrgico Hermanos " Ameijeiras"

References

1. Ostrom QT, Cioffi G, Waite K, Kruchko C, Barnholtz-Sloan JS. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014-2018. Neuro Oncol. 2021; 23(12 Suppl 2):iii1-iii105. DOI: 10.1093/neuonc/noab200

2. Martinez-Perez R, Requena LC, Carrau RL, Prevedello DM. Modern endoscopic skull base neurosurgery. J Neurooncol. 2021; 151(3):461-75. DOI: 10.1007/s11060-020-03610-9

3. Hara T, Akutsu H, Tanaka S, Kino H, Miyamoto H, Ii R, et al. Risk Factors for Postoperative Cerebrospinal Fluid Leak after Graded Multilayer Cranial Base Repair with Suturing via the Endoscopic Endonasal Approach. Neurol Med Chir (Tokyo). 2023; 63(2):48-57. DOI: 10.2176/jns-nmc.2022-0132

4. Proulx ST. Cerebrospinal fluid outflow: a review of the historical and contemporary evidence for arachnoid villi, perineural routes, and dural lymphatics. Cell Mol Life Sci. 2021; 78(6):2429-2457. DOI: 10.1007/s00018-020-03706-5

5. Machín MO, Arbolay OL. Concerns of cerebrospinal fluid leak in aggressive expanded endonasal endoscopic approach for craniopharyngiomas. J Neurol Stroke. 2020;(4):154-6. DOI: 10.15406/jnsk.2020.10.00430

6. Makary-Chadi A, Habib Z, and Hassan R. Cerebrospinal Fluid Rhinorrhea in Children. CSF Rhinorrhea: Pathophysiology, Diagnosis and Skull Base Reconstruction. Cham: Springer International Publishing; 2022. DOI: 10.1007/978-3-030-94781-1_31

7. Khan DZ, Ali AMS, Koh CH, Dorward NL, Grieve J, Layard Horsfall H, et al. Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review. Pituitary. 2021; 24(5):698-713. DOI: 10.1007/s11102-021-01145-4

8. Sunderland GJ, Jenkinson MD, Conroy EJ, Gamble C, Mallucci CL. Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: A Narrative Review. Life (Basel). 2021; 11(5):393. DOI: 10.3390/life11050393

9. Ortiz-Machín M, López-Arbolay O, Vargas-Gálvez C, Ottenwalder-Díaz A. Surgical Cavity in Extended Endoscopic Endonasal Approach to the Skull Base and their Relationship with Cerebrospinal luid Leak. GJMR. 2023. [acceso: 13/06/2023];23(A1):1-4. Disponible en: https://medicalresearchjournal.org/index.php/GJMR/article/view/102278

10. Arbolay O, Ortiz M, Pérez P, García J. Guzmán J. Colocación endoscópica por vía occipital de catéteres ventriculares permanentes. Nota técnica. Revista Chilena de Neurocirugía. 2016. [acceso: 13/06/2023]; 42:102-6. Disponible en: https://revistachilenadeneurocirugia.com/index.php/revchilneurocirugia/article/view/106/93

11. Buddeberg BS, Bandschapp O, Girard T. Post-dural puncture headache. Minerva Anestesiol. 2019; 85(5):543-53. DOI: 10.23736/S0375-9393.18.13331-1

12. Zahedi FD, Subramaniam S, Kasemsiri P, Periasamy C, Abdullah B. Management of Traumatic and Non-Traumatic Cerebrospinal Fluid Rhinorrhea-Experience from Three Southeast Asian Countries. Int J Environ Res Public Health. 2022; 19(21):13847. DOI: 10.3390/ijerph192113847

13. Kim-Orden N, Shen J, Or M, Hur K, Zada G, Wrobel B. Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Leaks Using Multilayer Composite Graft and Vascularized Pedicled Nasoseptal Flap Technique. Allergy Rhinol (Providence). 2019; 10:2152656719888622. DOI: 10.1177/2152656719888622

14. Fraser S, Gardner PA, Koutourousiou M, Kubik M, Fernandez-Miranda JC, Snyderman CH, et al. Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery. J Neurosurg. 2018;128(4):1066-71. DOI: 10.3171/2016.12.JNS1694

15. Huo CW, King J, Goldschlager T, Dixon B, Chen Zhao Y, Uren B, et al. The effects of cerebrospinal fluid (CSF) diversion on post-operative CSF leak following extended endoscopic anterior skull base surgery. J Clin Neurosci. 2022; 98:194-202. DOI: 10.1016/j.jocn.2022.02.006

16. Zwagerman NT, Wang EW, Shin SS, Chang YF, Fernandez-Miranda JC, Snyderman CH, et al. Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial. J Neurosurg. 2018:1-7. DOI:10.3171/2018.4.JNS172447

17. Hannan CJ, Kewlani B, Browne S, Javadpour M. Multi-layered repair of high-flow CSF fistulae following endoscopic skull base surgery without nasal packing or lumbar drains: technical refinements to optimise outcome. Acta Neurochir (Wien). 2023; 165(8):2299-2307. DOI: 10.1007/s00701-023-05581-y

18. Castelnuovo P, Valentini M, Sileo G, Battaglia P, Bignami M, Turri-Zanoni M. Management of recurrent cerebrospinal fluid leak, current practices and open challenges. A systematic literature review. Acta Otorhinolaryngol Ital. 2023; 43(Suppl 1):S14-S27. DOI: 10.14639/0392-100X-suppl.1-43-2023-02

19. Cavallo LM, Frank G, Cappabianca P, Solari D, Mazzatenta D, Villa A, Zoli M, D'Enza AI, Esposito F, Pasquini E. The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. J Neurosurg. 2014; 121(1):100-13. DOI: 10.3171/2014.3.JNS131521

20. Van Gerven L, Qian Z, Starovoyt A, Jorissen M, Meulemans J, van Loon J, et al. Endoscopic, Endonasal Transsphenoidal Surgery for Tumors of the Sellar and Suprasellar Region: A Monocentric Historical Cohort Study of 369 Patients. Front Oncol. 2021; 11:643550. DOI: 10.3389/fonc.2021.643550

21. Khan DZ, Ali AMS, Koh CH, Dorward NL, Grieve J, Layard Horsfall H, et al. Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review. Pituitary. 2021; 24(5):698-713. DOI: 10.1007/s11102-021-01145-4

22. Kutlay M, Durmaz A, Özer I, Kural C, Temiz Ç, Kaya S, et al. Extended endoscopic endonasal approach to the ventral skull base lesions. Clin Neurol Neurosurg. 2018; 167:129-140. DOI: 10.1016/j.clineuro.2018.02.032

23. Alshareef M, Alroqi A, Albaharna H, Alsayed A, Alromaih S, Alrasheed AS, et al. Nasoseptal flap and rigid reconstruction in endoscopic endonasal skull base surgeries: The longitudinal experience of a single center. Ear Nose Throat J. 2022: 1455613221099483. DOI: 10.1177/01455613221099483

24. Sahin A, Dalgic N, Kilic M, Kirgiz P, Kanik MK, Oz E, et al. The role of intraventricular antibiotic therapy in the treatment of ventriculo-peritoneal shunt infection in children. Childs Nerv Syst. 2021; 37(5):1605-12. DOI: 10.1007/s00381-021-05116-9

25. Nawabi NLA, Stopa BM, Lassarén P, Bain PA, Mekary RA, Gormley WB. External ventricular drains and risk of freehand placement: A systematic review and meta-analysis. Clin Neurol Neurosurg. 2023; 231:107852. DOI: 10.1016/j.clineuro.2023.107852

Downloads

Published

2024-04-01

How to Cite

1.
Vargas Gálvez CR, López Arbolay O, Ortiz Machín MM. Cerebrospinal fluid diverters for cranial base repair in endoscopic endonasal approaches. Rev Cubana Med Milit [Internet]. 2024 Apr. 1 [cited 2025 Jan. 10];53(2):e024016521. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/16521

Issue

Vol. 53 No. 2 (2024): April - June

Section

Research Article

License

Authors who have publications with this Journal accept the following terms:

  • The authors will retain their copyright and guarantee the Journal the right of first publication of their work, which will simultaneously be subject to the Creative Commons Attribution License. The content presented here can be shared, copied and redistributed in any medium or format; Can be adapted, remixed, transformed or created from the material, using the following terms: Attribution (giving appropriate credit to the work, providing a link to the license, and indicating if changes have been made); non-commercial (you cannot use the material for commercial purposes) and share-alike (if you remix, transform or create new material from this work, you can distribute your contribution as long as you use the same license as the original work).
  • The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (for example: depositing it in an institutional electronic archive or publishing it in a monographic volume) as long as the initial publication in this Journal is indicated.
  • Authors are allowed and recommended to disseminate their work through the Internet (e.g., in institutional electronic archives or on their website) before and during the submission process, which can produce interesting exchanges and increase citations. of the published work.

Most read articles by the same author(s)

1 2 > >>