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Endoscopic transpterygoidal repair of a large cranial defect with cerebrospinal fluid leak in a patient with extensive osteoradionecrosis of the skull base: case report and technical note

Published online by Cambridge University Press:  28 September 2015

Y Brand ,
E Lim ,
V Waran  and
N Prepageran
Y Brand
Affiliation:
Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia
E Lim
Affiliation:
Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia
V Waran
Affiliation:
Department of Neurosurgery, University of Malaya, Kuala Lumpur, Malaysia
N Prepageran*
Affiliation:
Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia
*
Address for correspondence: Prof Dr Narayanan Prepageran, Department of Otorhinolaryngology, University of Malaya Medical Centre, 50630 Kuala Lumpur, Malaysia Fax: +603 7954 8619 E-mail: prepageran@yahoo.com
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Abstract

Background:

Endoscopic endonasal techniques have recently become the method of choice in dealing with cerebrospinal fluid leak involving the anterior cranial fossa. However, most surgeons prefer an intracranial approach when leaks involve the middle cranial fossa. This case report illustrates the possibilities of using endoscopic techniques for cerebrospinal fluid leaks involving the middle fossa.

Case report:

A 37-year-old male patient presented with multiple areas of cranial defect with cerebrospinal fluid leak due to osteoradionecrosis following radiation for nasopharyngeal carcinoma 4 years earlier. Clinical examination showed involvement of all cranial nerves except the IInd and XIth nerves on the left side. A prior attempt to repair the cerebrospinal fluid leak with craniotomy was not successful.

Conclusion:

This case demonstrates the successful endoscopic repair of a large cranial defect with cerebrospinal fluid leak.

Keywords

Cerebrospinal Fluid LeakMiddle Cranial FossaOsteoradionecrosisSphenoid Bone

Information

Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 12 , December 2015 , pp. 1243 - 1247
Copyright
Copyright © JLO (1984) Limited 2015 

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References

1Wigand, ME. Enlarged middle fossa approach to the cerebello-pontine angle. Technique and indications [in French]. Rev Laryngol Otol Rhinol (Bord) 1998;119:159–62Google Scholar
2de Lara, D, Ditzel Filho, LF, Prevedello, DM, Carrau, RL, Kasemsiri, P, Otto, BA et al. Endonasal endoscopic approaches to the paramedian skull base. World Neurosurg 2014;82(6 suppl):S121–9CrossRefGoogle Scholar
3Birzgalis, AR, Ramsden, RT, Farrington, WT, Small, W. Severe radionecrosis of the temporal bone. J Laryngol Otol 1993;107:183–7CrossRefGoogle ScholarPubMed
4Huang, XM, Zheng, YQ, Zhang, XM, Mai, HQ, Zeng, L, Liu, X et al. Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma. Laryngoscope 2006;116:1626–31CrossRefGoogle ScholarPubMed
5Lim, BY, Pang, KP, Low, WK, Tan, HM. CSF otorrhea complicating temporal bone osteoradionecrosis in a patient with nasopharyngeal carcinoma. Ear Nose Throat J 2005;84:39–40CrossRefGoogle Scholar
6Lee, AF, Foo, W, Chappell, R, Fowler, JF, Sze, WM, Poon, YF et al. Effect of time, dose, and fractionation on temporal lobe necrosis following radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1998;40:35–42Google ScholarPubMed
7Bernal-Sprekelsen, M, Alobid, I, Mullol, J, Trobat, F, Tomas-Barberan, M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinology 2005;43:277–81Google ScholarPubMed
8Stone, JA, Castillo, M, Neelon, B, Mukherji, SK. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol 1999;20:706–12Google ScholarPubMed
9Prevedello, DM, Ditzel Filho, LF, Solari, D, Carrau, RL, Kassam, AB. Expanded endonasal approaches to middle cranial fossa and posterior fossa tumors. Neurosurg Clin N Am 2010;21:621–35CrossRefGoogle ScholarPubMed
10Kassam, AB, Prevedello, DM, Carrau, RL, Snyderman, CH, Thomas, A, Gardner, P et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors’ initial 800 patients. J Neurosurg 2011;114:1544–68CrossRefGoogle Scholar
11Theodosopoulos, PV, Guthikonda, B, Brescia, A, Keller, JT, Zimmer, LA. Endoscopic approach to the infratemporal fossa: anatomic study. Neurosurgery 2010;66:196–202CrossRefGoogle Scholar