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Suture Repair in Endoscopic Surgery for Craniovertebral Junction.
Neurospine 2019; 16(2):257-266N

Abstract

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.

Authors+Show Affiliations

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. School of Medicine, National Yang-Ming University, Taipei, Taiwan.Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. School of Medicine, National Yang-Ming University, Taipei, Taiwan.Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. School of Medicine, National Yang-Ming University, Taipei, Taiwan.Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. School of Medicine, National Yang-Ming University, Taipei, Taiwan. Department of Biomedical and Engineering, National Yang-Ming University, Taipei, Taiwan.Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. School of Medicine, National Yang-Ming University, Taipei, Taiwan.Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. School of Medicine, National Yang-Ming University, Taipei, Taiwan. Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, Taiwan.Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. School of Medicine, National Yang-Ming University, Taipei, Taiwan. Tao-Yuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan.Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. School of Medicine, National Yang-Ming University, Taipei, Taiwan.Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. School of Medicine, National Yang-Ming University, Taipei, Taiwan. Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31261465

Citation

Yeh, Mei-Yin, et al. "Suture Repair in Endoscopic Surgery for Craniovertebral Junction." Neurospine, vol. 16, no. 2, 2019, pp. 257-266.
Yeh MY, Huang WC, Wu JC, et al. Suture Repair in Endoscopic Surgery for Craniovertebral Junction. Neurospine. 2019;16(2):257-266.
Yeh, M. Y., Huang, W. C., Wu, J. C., Kuo, C. H., Chang, H. K., Tu, T. H., ... Cheng, H. (2019). Suture Repair in Endoscopic Surgery for Craniovertebral Junction. Neurospine, 16(2), pp. 257-266. doi:10.14245/ns.1938174.087.
Yeh MY, et al. Suture Repair in Endoscopic Surgery for Craniovertebral Junction. Neurospine. 2019;16(2):257-266. PubMed PMID: 31261465.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Suture Repair in Endoscopic Surgery for Craniovertebral Junction. AU - Yeh,Mei-Yin, AU - Huang,Wen-Cheng, AU - Wu,Jau-Ching, AU - Kuo,Chao-Hung, AU - Chang,Hsuan-Kan, AU - Tu,Tsung-Hsi, AU - Chang,Peng-Yuan, AU - Yen,Yu-Shu, AU - Cheng,Henrich, Y1 - 2019/06/30/ PY - 2019/05/26/received PY - 2019/06/12/accepted PY - 2019/7/2/entrez PY - 2019/7/2/pubmed PY - 2019/7/2/medline KW - Basilar invagination KW - Chordoma KW - Craniovertebral junction KW - Odontoidectomy KW - Transnasal KW - and combined endoscopic approaches KW - transoral SP - 257 EP - 266 JF - Neurospine JO - Neurospine VL - 16 IS - 2 N2 - 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. SN - 2586-6583 UR - https://www.unboundmedicine.com/medline/citation/31261465/Suture_Repair_in_Endoscopic_Surgery_for_Craniovertebral_Junction L2 - http://e-neurospine.org/journal/view.php?doi=10.14245/ns.1938174.087 DB - PRIME DP - Unbound Medicine ER -