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Reconstructive challenges in the extended endoscopic transclival approach

Published online by Cambridge University Press:  01 April 2015

A Kamat ,
J Y K Lee ,
G H Goldstein ,
J G Newman ,
P B Storm ,
J N Palmer  and
N D Adappa
A Kamat*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
J Y K Lee
Affiliation:
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
G H Goldstein
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
J G Newman
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
P B Storm
Affiliation:
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
J N Palmer
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
N D Adappa
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
*
Address for correspondence: Dr Ameet Kamat, Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Ravdin 5 Philadelphia, Pennsylvania 19104, USA E-mail: drkamat@gmail.com
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Abstract

Objective:

We wanted to present our experience with the extended endoscopic approach to clival pathology, focusing on cerebrospinal fluid leak and reconstruction challenges.

Methods:

We examined a consecutive series of 37 patients undergoing the extended endoscopic approach for skull base tumours, 9 patients with clival pathology. Patients were examined for the incidence of post-operative cerebrospinal fluid leak in relation to tumour pathology, location, size, reconstruction and lumbar drain.

Results:

The overall incidence of post-operative cerebrospinal fluid leak was 10.8 per cent. Seventy-five per cent of patients who had a post-operative cerebrospinal fluid leak underwent a transclival approach (p < 0.05). All patients with clival pathology who underwent an intradural dissection had a post-operative cerebrospinal fluid leak (p < 0.05).

Conclusion:

Post-operative cerebrospinal fluid leak rates after the extended endoscopic approach have improved significantly after advancements including the vascularised nasoseptal flap. Despite this, transclival approaches continue to pose much difficulty. Further investigation is necessary to develop technical improvements that can meet the unique challenges associated with this region.

Keywords

Skull BaseCranial Fossa, PosteriorCerebrospinal Fluid LeakEndoscopyNatural Orifice Endoscopic SurgeryMinimally Invasive Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 5 , May 2015 , pp. 468 - 472
Copyright
Copyright © JLO (1984) Limited 2015 

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Footnotes

Presented as a poster at the 23rd North American Skull Base Society Annual Meeting, 15–17 February 2013, Miami, Florida, USA

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