Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa
Objective: To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube. Methods: Retrospective review of a cohort of translabyri...
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KeAi Communications Co., Ltd.
2021-04-01
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Series: | World Journal of Otorhinolaryngology-Head and Neck Surgery |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S2095881121000160 |
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doaj-d62759a61a4c427e93586312931ab4742021-04-28T06:08:50ZengKeAi Communications Co., Ltd.World Journal of Otorhinolaryngology-Head and Neck Surgery2095-88112021-04-01728287Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossaMatthew W. Cooper0Bryan K. Ward1Jeffery Sharon2Howard W. Francis3Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USADepartment of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USADepartment of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USADepartment of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA; Corresponding author. DUMC Box 3805, Durham, NC 27710, USA.Objective: To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube. Methods: Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique. Results: In addition to meticulous packing of potential conduits using soft tissue, hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue. Early results of a small patient cohort using this technique are encouraging and there were no wound infections. There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells, with no recurrence after appropriate implementation of the described protocol during revision surgery. Conclusion: Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.http://www.sciencedirect.com/science/article/pii/S2095881121000160Translabyrinthine approachCerebrospinal fluid leakRhinorrheaAir cell tractPetrous apexEustachian tube |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Matthew W. Cooper Bryan K. Ward Jeffery Sharon Howard W. Francis |
spellingShingle |
Matthew W. Cooper Bryan K. Ward Jeffery Sharon Howard W. Francis Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa World Journal of Otorhinolaryngology-Head and Neck Surgery Translabyrinthine approach Cerebrospinal fluid leak Rhinorrhea Air cell tract Petrous apex Eustachian tube |
author_facet |
Matthew W. Cooper Bryan K. Ward Jeffery Sharon Howard W. Francis |
author_sort |
Matthew W. Cooper |
title |
Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa |
title_short |
Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa |
title_full |
Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa |
title_fullStr |
Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa |
title_full_unstemmed |
Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa |
title_sort |
reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa |
publisher |
KeAi Communications Co., Ltd. |
series |
World Journal of Otorhinolaryngology-Head and Neck Surgery |
issn |
2095-8811 |
publishDate |
2021-04-01 |
description |
Objective: To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube. Methods: Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique. Results: In addition to meticulous packing of potential conduits using soft tissue, hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue. Early results of a small patient cohort using this technique are encouraging and there were no wound infections. There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells, with no recurrence after appropriate implementation of the described protocol during revision surgery. Conclusion: Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa. |
topic |
Translabyrinthine approach Cerebrospinal fluid leak Rhinorrhea Air cell tract Petrous apex Eustachian tube |
url |
http://www.sciencedirect.com/science/article/pii/S2095881121000160 |
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