TY - JOUR
T1 - Supraorbital Keyhole Approach to the Skull Base
T2 - Evaluation of Complications Related to CSF Fistulas and Opened Frontal Sinus
AU - Thaher, Firas
AU - Hopf, Nikolai
AU - Hickmann, Anne Katrin
AU - Kurucz, Peter
AU - Bittl, Markus
AU - Henkes, Hans
AU - Feigl, Guenther C.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - AimCerebrospinal fluid (CSF) rhinorrhea due to a breach in the frontal sinus (FS) presents one of the main postoperative complications of the supraorbital keyhole approach. The goal of this study was to further analyze the actual surgical morbidity and potential risk for patients due to an opened FS after a surgery via a supraorbital craniotomy and compare the results with data published in the current literature. Methods and PatientsA total of 350 consecutive patients who underwent surgeries via the supraorbital keyhole approach for various lesions were included in this retrospective study. Information on clinical history, neurologic symptoms, surgical approach, and postoperative complications was obtained retrospectively by a review of the patients' charts, the radiologic reports, and a thorough review of pre- and postoperative cranial computed tomography (CCT) imaging. ResultsThe frequency of CSF rhinorrhea after this type of craniotomy in the literature is reported to range between 0% and 9.1%. In this study, analysis of postoperative CCT scans revealed that 88 patients (25.1%) showed a radiographic breach of the FS. Only 8 of these patients (2.3%) developed a CSF leak with rhinorrhea postoperatively. In all cases conservative treatment with lumbar drainage failed, and therefore a surgical revision for permanent closure was required. Only one patient (0.3%) with a CSF leak also developed meningitis. ConclusionInadvertent opening of the FS during the supraorbital craniotomy is a common surgery-related morbidity; however, the risk for the patient to develop a potentially dangerous meningitis was found to be minimal.
AB - AimCerebrospinal fluid (CSF) rhinorrhea due to a breach in the frontal sinus (FS) presents one of the main postoperative complications of the supraorbital keyhole approach. The goal of this study was to further analyze the actual surgical morbidity and potential risk for patients due to an opened FS after a surgery via a supraorbital craniotomy and compare the results with data published in the current literature. Methods and PatientsA total of 350 consecutive patients who underwent surgeries via the supraorbital keyhole approach for various lesions were included in this retrospective study. Information on clinical history, neurologic symptoms, surgical approach, and postoperative complications was obtained retrospectively by a review of the patients' charts, the radiologic reports, and a thorough review of pre- and postoperative cranial computed tomography (CCT) imaging. ResultsThe frequency of CSF rhinorrhea after this type of craniotomy in the literature is reported to range between 0% and 9.1%. In this study, analysis of postoperative CCT scans revealed that 88 patients (25.1%) showed a radiographic breach of the FS. Only 8 of these patients (2.3%) developed a CSF leak with rhinorrhea postoperatively. In all cases conservative treatment with lumbar drainage failed, and therefore a surgical revision for permanent closure was required. Only one patient (0.3%) with a CSF leak also developed meningitis. ConclusionInadvertent opening of the FS during the supraorbital craniotomy is a common surgery-related morbidity; however, the risk for the patient to develop a potentially dangerous meningitis was found to be minimal.
KW - cerebrospinal fluid leak
KW - meningitis
KW - supraorbital keyhole approach
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U2 - 10.1055/s-0034-1389368
DO - 10.1055/s-0034-1389368
M3 - Article
C2 - 26216739
AN - SCOPUS:84944441685
SN - 2193-6315
VL - 76
SP - 433
EP - 437
JO - Journal of Neurological Surgery, Part A: Central European Neurosurgery
JF - Journal of Neurological Surgery, Part A: Central European Neurosurgery
IS - 6
ER -