Affiliation:
1. Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
Abstract
Abstract
OBJECTIVE:
Resection of the anterior clinoid process is important for the exposure of aneurysms on clinoidal and supraclinoidal segments of the internal carotid artery. Cerebrospinal fluid (CSF) rhinorrhea can complicate anterior clinoidectomy when the optic strut is pneumatized and its removal communicates the subarachnoid space with the sphenoid sinus. We present a technique for repairing this defect and preventing CSF rhinorrhea.
METHODS:
A suture is secured around a strip of temporalis muscle, which is then pushed through the opening in the optic strut completely into the sphenoid sinus. The ends of suture that trail the muscle are used to retract the muscle from the sphenoid sinus back into the optic strut. The suture is trimmed and the repair is covered with sealant or fibrin glue.
RESULTS:
During an 8-year period in which 127 patients with proximal internal carotid artery aneurysms that required anterior clinoidectomy were treated, pneumatized optic struts were encountered in 14 patients (11%). Four patients were treated with the “yo-yo” technique, none of whom experienced CSF rhinorrhea. Before using this technique, 10 patients were managed with standard packing techniques (wax, muscle, and gel foam) and four of these patients subsequently experienced CSF rhinorrhea (40%). In these four patients, all required reoperation with either craniotomy and packing with pericranium (one patient), Couldwell-Luc procedure (one patient), or endoscopic transnasal obliteration of the sphenoid sinus with fat (two patients).
CONCLUSION:
The “yo-yo” technique of tightly wedging a muscle plug into the optic strut proved to be simple, fast, and effective, preventing CSF rhinorrhea in all patients in whom it was applied. Although experience with this technique is limited, reversing the direction of packing and pulling muscle from the sphenoid sinus into the optic strut eliminated a complication that occurred in 40% of patients with standard packing techniques.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Clinical Neurology,Surgery
Reference18 articles.
1. Relationship of the optic nerve to the paranasal sinuses as shown by computed tomography;Bansberg;Otolaryngol Head Neck Surg,1987
2. Aneurysms of the ophthalmic (C6) segment of the internal carotid artery: Treatment options and strategies based on a clinical series;Beretta;J Neurosurg Sci,2004
3. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhoea;Bibas;Br J Neurosurg,2000
4. Endoscopic transnasal intradural repair of anterior skull base cerebrospinal fluid fistulae;Briggs;J Clin Neurosci,2004
5. Relationship of the optic nerve to the posterior paranasal sinuses: A CT anatomic study;DeLano;AJNR Am J Neuroradiol,1996
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