TY - JOUR
T1 - Endoscopic Endonasal Eustachian Tube Obliteration as a Treatment for Tension Pneumocephalus After Translabyrinthine Resection of Vestibular Schwannoma
AU - Ji, Keven S.Y.
AU - Rimmer, Ryan
AU - Dogan, Aclan
AU - Cetas, Justin
AU - Ciporen, Jeremy
AU - Sanusi, Olabisi
AU - Gupta, Sachin
AU - Geltzeiler, Mathew
N1 - Publisher Copyright:
© 2022, Otology & Neurotology, Inc.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Objective Cerebrospinal fluid leak and pneumocephalus are rare but potentially devastating complications associated with translabyrinthine resection of cerebellopontine angle masses. Persistent pneumocephalus despite proximal eustachian tube (ET) obliteration is rare. We describe, to our knowledge, the first report of successful management of tension pneumocephalus by endoscopic endonasal ET obliteration using a novel V-loc (Covidien; Medtronic, Minneapolis, MN) suture technique. Patients A 63-year-old man presented with altered mental status 10 months after translabyrinthine excision of a left cerebellopontine angle vestibular schwannoma measuring 2.8 × 2.9 × 3.3 cm. Computed tomography demonstrated diffuse ventriculomegaly and new pneumocephalus along the right frontal lobe, lateral ventricles, and third ventricle, and air within the left translabyrinthine resection cavity. Intervention The patient underwent left-sided endoscopic endonasal ET obliteration using 2-0, 9-inch V-loc suture. Main Outcome Measure Postoperatively, the patient's mental status improved with a decrease in size of the lateral and third ventricles on computed tomography. Conclusion Endoscopic endonasal ET obliteration, a technique previously applied to recalcitrant cerebrospinal fluid leaks, is a safe and reasonable alternative to reentering the original surgical site for patients with pneumocephalus after lateral skull base surgery. Utilizing a V-loc suture for this technique instead of a traditional suture may improve procedural ease and speed.
AB - Objective Cerebrospinal fluid leak and pneumocephalus are rare but potentially devastating complications associated with translabyrinthine resection of cerebellopontine angle masses. Persistent pneumocephalus despite proximal eustachian tube (ET) obliteration is rare. We describe, to our knowledge, the first report of successful management of tension pneumocephalus by endoscopic endonasal ET obliteration using a novel V-loc (Covidien; Medtronic, Minneapolis, MN) suture technique. Patients A 63-year-old man presented with altered mental status 10 months after translabyrinthine excision of a left cerebellopontine angle vestibular schwannoma measuring 2.8 × 2.9 × 3.3 cm. Computed tomography demonstrated diffuse ventriculomegaly and new pneumocephalus along the right frontal lobe, lateral ventricles, and third ventricle, and air within the left translabyrinthine resection cavity. Intervention The patient underwent left-sided endoscopic endonasal ET obliteration using 2-0, 9-inch V-loc suture. Main Outcome Measure Postoperatively, the patient's mental status improved with a decrease in size of the lateral and third ventricles on computed tomography. Conclusion Endoscopic endonasal ET obliteration, a technique previously applied to recalcitrant cerebrospinal fluid leaks, is a safe and reasonable alternative to reentering the original surgical site for patients with pneumocephalus after lateral skull base surgery. Utilizing a V-loc suture for this technique instead of a traditional suture may improve procedural ease and speed.
KW - Cerebrospinal fluid leak
KW - Endonasal
KW - Endoscopic
KW - V-loc
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U2 - 10.1097/MAO.0000000000003606
DO - 10.1097/MAO.0000000000003606
M3 - Article
C2 - 35970161
AN - SCOPUS:85135998370
SN - 1531-7129
VL - 43
SP - E856-E860
JO - Otology and Neurotology
JF - Otology and Neurotology
IS - 8
ER -