Endoscopic Skull Base Repair Strategy for CSF Leaks Associated with Pneumocephalus

Overview

Journal J Clin Med

Specialty General Medicine

Date 2020 Dec 30

PMID 33375669

Citations 5

Authors

Anda Gata

Corneliu Toader

Veronica Elena Trombitas

Annamaria Ilyes

Silviu Albu

Affiliations

Soon will be listed here.

Abstract

Background: Cerebrospinal (CSF) fluid leaks with associated pneumocephalus (PNC) represent a condition bearing serious risks for the patient, with little data available in the literature. Reported success rates of endoscopic skull base repair are lower when PNC is associated than in the case of simple CSF leaks. The present study represents an analysis of our experience with endoscopic management of this condition.

Methods: Records of patients with pneumocephalus and associated CSF leaks, who underwent endoscopic skull base repair, were reviewed. Demographics, history, etiology of PNC, size of defect, surgical approach, reconstruction technique and complications were evaluated.

Results: Twenty patients with CSF leaks and PNC underwent endonasal repair by the senior author between 2005 and 2019. Defect size was larger than 15 mm in all cases. All patients presented either worsening of PNC under conservative treatment or tension PNC. First-attempt closure of the defect was successful in all patients (100%), with resolution of the pneumocephalus. One patient developed a synechia in the proximity of the frontal ostium, as a postoperative complication. The mean follow-up was 39 months (range: 15-94 months).

Conclusion: The present study represents a proposed argument for earlier endoscopic endonasal treatment in patients presenting CSF leaks and pneumocephalus.

Citing Articles

A Comprehensive Analysis of Tobacco Smoking History as a Risk for Outcomes after Endoscopic Transsphenoidal Resection of Pituitary Adenoma.

Min S, Zhang G, Hu A, Petito G, Tripathi S, Shukla G J Neurol Surg B Skull Base. 2024; 85(3):255-260.

PMID: 38778915 PMC: 11111311. DOI: 10.1055/a-2043-0263.

Traumatic tension pneumocephalus: a case report and perspective from Indonesia.

Omer G, Maurizi R, Velletrani G, Francavilla B, Ali S, Abdullah A Front Neurol. 2024; 15:1391270.

PMID: 38765266 PMC: 11099267. DOI: 10.3389/fneur.2024.1391270.

Dural reconstruction with or without a bone graft of paranasal and anterior skullbase malignancies: Retrospective single-center analysis of 11 cases and review of literature.

Sommer B, Konietzko I, Bonk M, Schaller T, Markl B, Kahl K Brain Spine. 2024; 4:102740.

PMID: 38510629 PMC: 10951748. DOI: 10.1016/j.bas.2023.102740.

Traumatic tension pneumocephalus: a case report and perspective from Indonesia.

Harlyjoy A, Nathaniel M, Nugroho A, Gunawan K Front Neurol. 2024; 15:1339521.

PMID: 38385032 PMC: 10879582. DOI: 10.3389/fneur.2024.1339521.

Transnasal Endoscopic Treatment of Tension Pneumocephalus Caused by Posttraumatic or Iatrogenic Ethmoidal Damage.

Omer G, Maurizi R, Francavilla B, Rekawt Hama Rashid K, Velletrani G, Salah H Case Rep Otolaryngol. 2023; 2023:2679788.

PMID: 37649693 PMC: 10465261. DOI: 10.1155/2023/2679788.

References

Markham J . The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta Neurochir (Wien). 1967; 16(1):1-78. DOI: 10.1007/BF01401900. View

Guo K, Heng L, Zhang H, Ma L, Zhang H, Jia D . Risk factors for postoperative intracranial infections in patients with pituitary adenoma after endoscopic endonasal transsphenoidal surgery: pneumocephalus deserves further study. Neurosurg Focus. 2019; 47(2):E5. DOI: 10.3171/2019.5.FOCUS19269. View

Wise S, Harvey R, Patel S, Frankel B, Schlosser R . Endoscopic repair of skull base defects presenting with pneumocephalus. J Otolaryngol Head Neck Surg. 2009; 38(4):509-16. View

Allensworth J, Rowan N, Storck K, Woodworth B, Schlosser R . Endoscopic repair of spontaneous skull base defects decreases the incidence rate of intracranial complications. Int Forum Allergy Rhinol. 2019; 9(10):1089-1096. DOI: 10.1002/alr.22399. View

Siegel J, Hampton K, Rabinstein A, McLaughlin D, Diaz-Gomez J . Oxygen Therapy with High-Flow Nasal Cannula as an Effective Treatment for Perioperative Pneumocephalus: Case Illustrations and Pathophysiological Review. Neurocrit Care. 2017; 29(3):366-373. DOI: 10.1007/s12028-017-0464-x. View

Biju R, Wu J, Hussain Z . Tension pneumocephalus after skull base surgery. A case report and review of literature. J Clin Neurosci. 2020; 75:218-220. DOI: 10.1016/j.jocn.2020.03.041. View

Pillai P, Sharma R, Mackenzie L, Reilly E, Beery 2nd P, Papadimos T . Traumatic tension pneumocephalus - Two cases and comprehensive review of literature. Int J Crit Illn Inj Sci. 2017; 7(1):58-64. PMC: 5364769. DOI: 10.4103/IJCIIS.IJCIIS_8_17. View

Bernal-Sprekelsen M, Rioja E, Ensenat J, Enriquez K, Viscovich L, Agredo-Lemos F . Management of anterior skull base defect depending on its size and location. Biomed Res Int. 2014; 2014:346873. PMC: 4033343. DOI: 10.1155/2014/346873. View

Roberts G, Foy P, Bolger C . Idiopathic spontaneous cerebrospinal fluid rhinorrhoea and pneumocephalus: case report and literature review. Br J Neurosurg. 1996; 10(5):513-7. DOI: 10.1080/02688699647195. View

10.

Ivan M, Iorgulescu J, El-Sayed I, McDermott M, Parsa A, Pletcher S . Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery. J Clin Neurosci. 2014; 22(1):48-54. DOI: 10.1016/j.jocn.2014.08.009. View

11.

DelGaudio J, Ingley A . Treatment of pneumocephalus after endoscopic sinus and microscopic skull base surgery. Am J Otolaryngol. 2009; 31(4):226-30. DOI: 10.1016/j.amjoto.2009.02.012. View

12.

Clark D, Citardi M, Fakhri S . Endoscopic management of skull base defects associated with persistent pneumocephalus following previous open repair: a preliminary report. Otolaryngol Head Neck Surg. 2010; 142(6):820-6. DOI: 10.1016/j.otohns.2009.12.041. View

13.

Conger Jr B, Illing E, Bush B, Woodworth B . Management of Lateral Frontal Sinus Pathology in the Endoscopic Era. Otolaryngol Head Neck Surg. 2014; 151(1):159-63. DOI: 10.1177/0194599814529078. View

14.

Marcus J, Laufer I, Mehrara B, Kraus D, Singh B, Bilsky M . Anterior and anterolateral resection for skull base malignancies: techniques and complication avoidance. Neurosurg Clin N Am. 2012; 24(1):11-8. DOI: 10.1016/j.nec.2012.08.008. View

15.

Kim D, Hong Y, Jeun S, Park J, Jung K, Kim S . Invagination of the Sphenoid Sinus Mucosa after Endoscopic Endonasal Transsphenoidal Approach and Its Significance. PLoS One. 2016; 11(9):e0162836. PMC: 5021325. DOI: 10.1371/journal.pone.0162836. View

16.

Zasler N . Posttraumatic tension pneumocephalus. J Head Trauma Rehabil. 1999; 14(1):81-4. DOI: 10.1097/00001199-199902000-00009. View

17.

Reasoner D, Todd M, Scamman F, Warner D . The incidence of pneumocephalus after supratentorial craniotomy. Observations on the disappearance of intracranial air. Anesthesiology. 1994; 80(5):1008-12. DOI: 10.1097/00000542-199405000-00009. View

18.

Bernal-Sprekelsen M, Carrau R . Ascending meningitis secondary to traumatic cerebrospinal fluid leaks. Am J Rhinol. 2000; 14(4):257-9. DOI: 10.2500/105065800779954473. View

19.

Albu S, Emanuelli E, Trombitas V, Florian I . Effectiveness of lumbar drains on recurrence rates in endoscopic surgery of cerebrospinal fluid leaks. Am J Rhinol Allergy. 2013; 27(6):e190-4. DOI: 10.2500/ajra.2013.27.3986. View

20.

Matsuda T, Horiguchi K, Higuchi Y, Hanazawa T, Okamoto Y, Iwadate Y . Unexpected prominent tension pneumosella five years after endoscopic endonasal transsphenoidal surgery. Laryngoscope. 2017; 128(8):1798-1801. DOI: 10.1002/lary.27060. View