Peri-operative management of endoscopic endonasal cerebrospinal fluid leak repair: an international survey.

Autor: Favier V; Département d'ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Montpellier, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, Montpellier, 34000, France. valentin_favier@hotmail.com., Lavigne P; Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Canada., Ayad T; Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Canada., Herman P; ENT department - Skull Base Center, Lariboisière University Hospital, Paris, France., Vérillaud B; ENT department - Skull Base Center, Lariboisière University Hospital, Paris, France., Manet R; Service de neurochirurgie, chirurgie des adénomes hypophysaires et de la base du crane, Hôpital neurologique Pierre Wertheimer, Hospices civils de Lyon, Bron, France., Jouanneau E; Service de neurochirurgie, chirurgie des adénomes hypophysaires et de la base du crane, Hôpital neurologique Pierre Wertheimer, Hospices civils de Lyon, Bron, France., Crampette L; Département d'ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Montpellier, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, Montpellier, 34000, France., Fieux M; Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, Pierre Bénite cedex, F-69310, France.; Université de Lyon, Université Lyon 1, Lyon, F-69003, France., Carsuzaa F; Service ORL, Chirurgie Cervico-Maxillo-Faciale et Audiophonologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, 86000, France.; Laboratoire Inflammation Tissus Epithéliaux et Cytokines (LITEC), UR15560, Université de Poitiers, Poitiers, 86000, France.
Jazyk: angličtina
Zdroj: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery [Eur Arch Otorhinolaryngol] 2024 Oct; Vol. 281 (10), pp. 5347-5355. Date of Electronic Publication: 2024 Jun 24.
DOI: 10.1007/s00405-024-08770-2
Abstrakt: Purpose: Peri-operative management of nasal cerebrospinal fluid (CSF) leaks is not consensual due to limited evidence. The main aim of this study was to identify key factors in peri-operative management of endoscopic endonasal CSF leak repair among international experts.
Methods: A 60-item survey questionnaire collected opinions of members of international learned societies of ENT surgeons and neurosurgeons on nasal packing, post-operative instructions, antibiotic prophylaxis, and CSF volume depletion.
Results: The survey had 153 respondents (124 otorhinolaryngologists and 29 neurosurgeons). A resting position was recommended by 85% (130/151) of respondents for extended CSF leak of the anterior skull base, mainly in Fowler's position (72% (110/153)). Nasal packing was used by 85% (130/153) of respondents; 33.3% (51/153) used it to stabilize the reconstruction, and 22.2% (34/153) to prevent bleeding. It was usually removed after 48 h in 44.4% of cases (68/153). CSF depletion was considered by 47.1% (72/153) of respondents in case of CSF leak recurrence and by 34.6% (53/153) in cases of increased intracranial pressure. All respondents gave specific postoperative instructions to patients including driving, running, swimming, diving restrictions and flighting restrictions. In subgroup analysis, ENT surgeons more often recommended a resting position than neurosurgeons (71% vs. 37.9% ; p = 0.0008) and prescribed more antibiotics (82.3% vs. 21.4% ; p < 0.0001).
Conclusion: Although postoperative management after CSF closure remains challenging and not codified, this international survey revealed some points of consensus concerning resting position and restriction of post-operative activities. Prospective clinical studies must be undertaken to evaluate their efficiency.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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