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No1-2(3) 2020

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DOI 10.37219/2528-8253-2020-1-26
Palamar OI, Huk AP, Teslenko DS, Okonskyi DI, Aksyonov RV
Subcranial surgery of nasal CSF leak, endoscopic capabilities
Palamar Orest
Romodanov Neurosurgery Institute; Section on endoscopic and craniofacial surgery; neurosurgeon;
32 Platona Mayborody St, Kyiv, Ukraine; Tel./Fax: 044 4839573
email: p_orest@ukr.net
ORCIDiD: 0000-0003-1806-9463
ResearcherID: R-2634-2017

Huk Andriy
Romodanov Neurosurgery Institute; Section on endoscopic and craniofacial surgery; neurosurgeon
32 Platona Mayborody St, Kyiv, Ukraine; Tel./Fax: 044 4839573
email: a.huk@uscp.kiev.ua
ORCIDiD: 0000-0002-2754-7570
ResearcherID : Q-7205-2017

Okonskyi Dmytro
Romodanov Neurosurgery Institute; Section on endoscopic and craniofacial surgery; neurosurgeon
32 Platona Mayborody St, Kyiv, Ukraine; Tel./Fax: 044 4839573
email: dr.okonskiy@ukr.net
ORCID iD: 0000-0002-7315-1833
Researcher ID R-2024-2017

Aksyonov Ruslan
Romodanov Neurosurgery Institute; Section on endoscopic and craniofacial surgery; neurosurgeon;
32 Platona Mayborody St, Kyiv, Ukraine; Tel./Fax: 044 4839573
email: aksyonovrv@gmail.com
ORCID iD: 0000-0003-3744-6172
Researcher ID R-1996-2017

Teslenko Dmytro
Romodanov Neurosurgery Institute; Section on endoscopic and craniofacial surgery; neurosurgeon;
32 Platona Mayborody St, Kyiv, Ukraine; Tel./Fax: 044 4839573
email: info@pituitary.com.ua
ORCID iD: 0000-0001-5882-641X
Researcher ID R-2051-2017

Abstract

Introduction: The problem of choosing surgical approach in the treatment of CSF leak is the subject of discussion depending of the location and the size of the bone defect of the skull base.
Materials and methods: 37 patients with nasal CSF leak were treated. In 17 cases, nasal CSF leak was caused by meningo(encephalo)cele. Spontaneous nasal cerebrospinal fluid occurred in 14 cases. In 3 cases, nasal CSF leak was the result of traumatic brain injury (in one case, the cause of nasal CSF leak was post-traumatic meningoencephalocele of the frontal sinus); in the other 3 cases there was postoperative wound nasal cerebrospinal fluid.
Results and discussion: Groups of patients were formed depending on the use of vascularized or moved (free) flaps: 1). Multilayer plastics of bone defects of the anterior and middle cranial fossae using displaced (free) flaps. 2). Multilayer plastic of bone defects of the anterior and middle cranial fossa using a nasoseptal flap or middle nasal concha on the leg. In all cases (100%) nasal CSF leak was eliminated. External lumbar drainage was performed in 6 patients and only in cases where the plastic of the bone defect was performed by displaced free flaps.
Conclusions: 1). The use of endoscopic endonasal techniques is a minimally invasive method to close skull base bone defects (including large – more than 20 mm) in the area of the anterior and middle cranial fossae. 2). Subcranial approaches are expedient, effective and technically more convenient for nasal CSF leak defects of the frontal sinus and defects in the anterior cells of the etmoid bone.3). Vascularized flaps is expedient for plastic at middle (11-20 mm) and big (more than 20 mm) bone defects of skull base.

Keywords

spontaneous nasal CSF leak; meningocele; subcranial approach; endoscopic approach; nasoseptal flap.


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