Suture Repair in Endoscopic Surgery for Craniovertebral Junction
Objective Endoscopic approaches to the craniovertebral junction (CVJ) have been established as viable and effective surgical treatments in the past decade. One of the major complications is leakage of the cerebrospinal fluid (CSF). This study aimed to investigate the efficacy and feasibility of sutu...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Spinal Neurosurgery Society
2019-06-01
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| Series: | Neurospine |
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| Online Access: | http://www.e-neurospine.org/upload/pdf/ns-1938174-087.pdf |
| _version_ | 1797332233253552128 |
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| author | Mei-Yin Yeh Wen-Cheng Huang Jau-Ching Wu Chao-Hung Kuo Hsuan-Kan Chang Tsung-Hsi Tu Peng-Yuan Chang Yu-Shu Yen Henrich Cheng |
| author_facet | Mei-Yin Yeh Wen-Cheng Huang Jau-Ching Wu Chao-Hung Kuo Hsuan-Kan Chang Tsung-Hsi Tu Peng-Yuan Chang Yu-Shu Yen Henrich Cheng |
| author_sort | Mei-Yin Yeh |
| collection | DOAJ |
| description | Objective Endoscopic approaches to the craniovertebral junction (CVJ) have been established as viable and effective surgical treatments in the past decade. One of the major complications is leakage of the cerebrospinal fluid (CSF). This study aimed to investigate the efficacy and feasibility of suture closure at the nasopharyngeal mucosa upon durotomy. Methods A series of consecutive patients who underwent different endoscopic approaches to the CVJ were retrospectively reviewed. The pathologies, surgical corridors, neurological and functional outcomes, radiological evaluations, and complications were analyzed. Different strategies of repair for the intraoperative CSF leakage were described and compared. Results A total of 22 patients covering 13 years were analyzed. There were 12, 2, and 8 patients who underwent transnasal, transoral, and combined approaches, respectively. There were 8 patients (36.4%) who experienced intraoperative CSF leakage, and were grouped into 2: 4 in the nonsuture (NS) group and 4 in the suture-repaired (SR) group. The NS group had 3 (75%) persistent CSF leakages postoperation that caused 1 mortality, whereas patients of the SR group had only 1 minor CSF rhinorrhea that healed spontaneously within days. Conclusion In this series of 22 patients who required anterior endoscopic resection of pathologies at the CVJ, there was 1 (4.5%) serious complication related to CSF leakage. For patients who had no durotomy, the mucosal incision at the nasopharynx usually healed rapidly and there were few procedure-related complications. For patients with intraoperative CSF leakage, suture closure was technically challenging but could significantly lower the risks of postoperative complications. |
| first_indexed | 2024-03-08T07:46:34Z |
| format | Article |
| id | doaj.art-1f2f8f704c1345aab0af907abb85f646 |
| institution | Directory Open Access Journal |
| issn | 2586-6583 2586-6591 |
| language | English |
| last_indexed | 2024-03-08T07:46:34Z |
| publishDate | 2019-06-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj.art-1f2f8f704c1345aab0af907abb85f6462024-02-02T16:00:08ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912019-06-0116225726610.14245/ns.1938174.087876Suture Repair in Endoscopic Surgery for Craniovertebral JunctionMei-Yin Yeh0Wen-Cheng Huang1Jau-Ching Wu2Chao-Hung Kuo3Hsuan-Kan Chang4Tsung-Hsi Tu5Peng-Yuan Chang6Yu-Shu Yen7Henrich Cheng8 Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, TaiwanObjective Endoscopic approaches to the craniovertebral junction (CVJ) have been established as viable and effective surgical treatments in the past decade. One of the major complications is leakage of the cerebrospinal fluid (CSF). This study aimed to investigate the efficacy and feasibility of suture closure at the nasopharyngeal mucosa upon durotomy. Methods A series of consecutive patients who underwent different endoscopic approaches to the CVJ were retrospectively reviewed. The pathologies, surgical corridors, neurological and functional outcomes, radiological evaluations, and complications were analyzed. Different strategies of repair for the intraoperative CSF leakage were described and compared. Results A total of 22 patients covering 13 years were analyzed. There were 12, 2, and 8 patients who underwent transnasal, transoral, and combined approaches, respectively. There were 8 patients (36.4%) who experienced intraoperative CSF leakage, and were grouped into 2: 4 in the nonsuture (NS) group and 4 in the suture-repaired (SR) group. The NS group had 3 (75%) persistent CSF leakages postoperation that caused 1 mortality, whereas patients of the SR group had only 1 minor CSF rhinorrhea that healed spontaneously within days. Conclusion In this series of 22 patients who required anterior endoscopic resection of pathologies at the CVJ, there was 1 (4.5%) serious complication related to CSF leakage. For patients who had no durotomy, the mucosal incision at the nasopharynx usually healed rapidly and there were few procedure-related complications. For patients with intraoperative CSF leakage, suture closure was technically challenging but could significantly lower the risks of postoperative complications.http://www.e-neurospine.org/upload/pdf/ns-1938174-087.pdfTransnasaltransoraland combined endoscopic approachesCraniovertebral junctionBasilar invaginationChordomaOdontoidectomyAtlantoaxial deformity |
| spellingShingle | Mei-Yin Yeh Wen-Cheng Huang Jau-Ching Wu Chao-Hung Kuo Hsuan-Kan Chang Tsung-Hsi Tu Peng-Yuan Chang Yu-Shu Yen Henrich Cheng Suture Repair in Endoscopic Surgery for Craniovertebral Junction Neurospine Transnasal transoral and combined endoscopic approaches Craniovertebral junction Basilar invagination Chordoma Odontoidectomy Atlantoaxial deformity |
| title | Suture Repair in Endoscopic Surgery for Craniovertebral Junction |
| title_full | Suture Repair in Endoscopic Surgery for Craniovertebral Junction |
| title_fullStr | Suture Repair in Endoscopic Surgery for Craniovertebral Junction |
| title_full_unstemmed | Suture Repair in Endoscopic Surgery for Craniovertebral Junction |
| title_short | Suture Repair in Endoscopic Surgery for Craniovertebral Junction |
| title_sort | suture repair in endoscopic surgery for craniovertebral junction |
| topic | Transnasal transoral and combined endoscopic approaches Craniovertebral junction Basilar invagination Chordoma Odontoidectomy Atlantoaxial deformity |
| url | http://www.e-neurospine.org/upload/pdf/ns-1938174-087.pdf |
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