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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(07): 580-586
DOI: 10.1590/0004-282X20160087
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Endoscopic endonasal management of cerebrospinal fluid rhinorrhea after anterior clinoidectomy for aneurysm surgery: changing the paradigm of complication management

Endoscopia endonasal no tratamento da fístula liquórica após clinoidectomia anterior na cirurgia de aneurisma: mudando o paradigma no manejo desta complicação
Andre Beer-Furlan
1   Centro de Base de Crânio de São Paulo, São Paulo SP, Brasil;
2   DFVneuro, São Paulo SP, Brasil;
,
Leonardo Balsalobre
1   Centro de Base de Crânio de São Paulo, São Paulo SP, Brasil;
2   DFVneuro, São Paulo SP, Brasil;
3   Hospital Professor Edmundo Vasconcelos, Centro de Otorrino e Fonoaudiologia, São Paulo SP, Brasil;
,
Eduardo de Arnaldo Silva Vellutini
1   Centro de Base de Crânio de São Paulo, São Paulo SP, Brasil;
2   DFVneuro, São Paulo SP, Brasil;
,
Aldo Cassol Stamm
1   Centro de Base de Crânio de São Paulo, São Paulo SP, Brasil;
2   DFVneuro, São Paulo SP, Brasil;
3   Hospital Professor Edmundo Vasconcelos, Centro de Otorrino e Fonoaudiologia, São Paulo SP, Brasil;
,
Felix Hendrik Pahl
1   Centro de Base de Crânio de São Paulo, São Paulo SP, Brasil;
2   DFVneuro, São Paulo SP, Brasil;
,
Andre Felix Gentil
4   Hospital Israelita Albert Einstein, São Paulo SP, Brasil.
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ABSTRACT

Resection of the anterior clinoid process results in the creation of the clinoid space, an important surgical step in the exposure and clipping of clinoidal and supraclinoidal internal carotid artery aneurysms. Cerebrospinal fluid rhinorrhea is an undesired and potentially serious complication. Conservative measures may be unsuccesful, and there is no consensus on the most appropriate surgical treatment. Two patients with persistent transclinoidal CSF rhinorrhea after aneurysm surgery were successfully treated with a combined endoscopic transnasal/transeptal binostril approach using a fat graft and ipsilateral mucosal nasal septal flap. Anatomical considerations and details of the surgical technique employed are discussed, and a management plan is proposed.

RESUMO

A ressecção da clinóide anterior resulta na criação do espaço clinoideo, um passo cirúrgico importante na exposição e clipagem de aneurismas dos segmentos clinoideo e supraclinoideo da artéria carótida interna. Fístula liquórica é uma das complicaçoes mais indesejadas e é potencialmente grave. O manejo com medidas conservadoras pode ser bem sucedido, e não há consenso sobre o tratamento cirúrgico mais adequado. Dois pacientes com rinorréia persistente secundária a fistula liquórica transclinoidal após cirurgia de aneurisma foram tratados com sucesso por uma abordagem endoscópica combinada transnasal/transseptal binostril usando um enxerto de gordura e retalho de mucosa naso-septal ipsilateral. Considerações anatçmicas e detalhes da técnica cirúrgica empregada são discutidos, e um plano de manejo destes tipo de fistula líquorica é proposto.

aneurysm - cerebrospinal fluid leak - endoscopy
aneurisma - vazamento de líquido cefalorraquidiano - endoscopia


Publication History

Received: 08 January 2016

Accepted: 09 May 2016

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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