Surgical Parameters for Minimally Invasive Trans–Eustachian Tube CSF Leak Repair

A Cadaveric Study and Literature Review

Research output: Contribution to journalArticle

Abstract

Background: Cerebrospinal fluid rhinorrhea from a lateral skull base defect refractory to spontaneous healing and/or conservative management is most commonly managed via open surgery. Approach for repair is dictated by location of the defect, which may require surgical exploration. The final common pathway is the eustachian tube (ET). Endoscopic ET obliteration via endonasal and lateral approaches is under development. Whereas ET anatomy has been studied, surgical landmarks have not been previously described or quantified. We aimed to define surgical parameters of specific utility to endoscopic ET obliteration. Methods: A literature review was performed of known ET anatomic parameters. Next, using a combination of endoscopic and open techniques in cadavers, we cannulated the intact ET and dissected its posterior component to define the major curvature position of the ET, defined as the genu, and quantified the relative distances through the ET lumen. The genu was targeted as a major obstacle encountered when cannulating the ET from the nasopharynx. Results: Among 10 ETs, we found an average distance of 23 ± 5 mm from the nasopharynx to the ET genu, distance of 24 ± 3 mm from the genu to the anterior aspect of the tympanic membrane and total ET length of 47 ± 4 mm. Conclusions: Although membranous and petrous components of the ET are important to its function, the genu may be a more useful surgical landmark. Basic surgical parameters for endoscopic ET obliteration are defined.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Eustachian Tube
Nasopharynx
Cerebrospinal Fluid Rhinorrhea
Tympanic Membrane
Skull Base
Cadaver

Keywords

  • Cadaver
  • Catheter
  • Cerebrospinal leak
  • Endoscopy
  • Eustachian tube

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{c6d4ae9796984a7db5049eb694671370,
title = "Surgical Parameters for Minimally Invasive Trans–Eustachian Tube CSF Leak Repair: A Cadaveric Study and Literature Review",
abstract = "Background: Cerebrospinal fluid rhinorrhea from a lateral skull base defect refractory to spontaneous healing and/or conservative management is most commonly managed via open surgery. Approach for repair is dictated by location of the defect, which may require surgical exploration. The final common pathway is the eustachian tube (ET). Endoscopic ET obliteration via endonasal and lateral approaches is under development. Whereas ET anatomy has been studied, surgical landmarks have not been previously described or quantified. We aimed to define surgical parameters of specific utility to endoscopic ET obliteration. Methods: A literature review was performed of known ET anatomic parameters. Next, using a combination of endoscopic and open techniques in cadavers, we cannulated the intact ET and dissected its posterior component to define the major curvature position of the ET, defined as the genu, and quantified the relative distances through the ET lumen. The genu was targeted as a major obstacle encountered when cannulating the ET from the nasopharynx. Results: Among 10 ETs, we found an average distance of 23 ± 5 mm from the nasopharynx to the ET genu, distance of 24 ± 3 mm from the genu to the anterior aspect of the tympanic membrane and total ET length of 47 ± 4 mm. Conclusions: Although membranous and petrous components of the ET are important to its function, the genu may be a more useful surgical landmark. Basic surgical parameters for endoscopic ET obliteration are defined.",
keywords = "Cadaver, Catheter, Cerebrospinal leak, Endoscopy, Eustachian tube",
author = "Brown, {Erik C.} and Brandon Lucke-Wold and Justin Cetas and Aclan Dogan and Sachin Gupta and Timothy Hullar and Timothy Smith and Jeremy Ciporen",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.wneu.2018.09.123",
language = "English (US)",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Surgical Parameters for Minimally Invasive Trans–Eustachian Tube CSF Leak Repair

T2 - A Cadaveric Study and Literature Review

AU - Brown, Erik C.

AU - Lucke-Wold, Brandon

AU - Cetas, Justin

AU - Dogan, Aclan

AU - Gupta, Sachin

AU - Hullar, Timothy

AU - Smith, Timothy

AU - Ciporen, Jeremy

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Cerebrospinal fluid rhinorrhea from a lateral skull base defect refractory to spontaneous healing and/or conservative management is most commonly managed via open surgery. Approach for repair is dictated by location of the defect, which may require surgical exploration. The final common pathway is the eustachian tube (ET). Endoscopic ET obliteration via endonasal and lateral approaches is under development. Whereas ET anatomy has been studied, surgical landmarks have not been previously described or quantified. We aimed to define surgical parameters of specific utility to endoscopic ET obliteration. Methods: A literature review was performed of known ET anatomic parameters. Next, using a combination of endoscopic and open techniques in cadavers, we cannulated the intact ET and dissected its posterior component to define the major curvature position of the ET, defined as the genu, and quantified the relative distances through the ET lumen. The genu was targeted as a major obstacle encountered when cannulating the ET from the nasopharynx. Results: Among 10 ETs, we found an average distance of 23 ± 5 mm from the nasopharynx to the ET genu, distance of 24 ± 3 mm from the genu to the anterior aspect of the tympanic membrane and total ET length of 47 ± 4 mm. Conclusions: Although membranous and petrous components of the ET are important to its function, the genu may be a more useful surgical landmark. Basic surgical parameters for endoscopic ET obliteration are defined.

AB - Background: Cerebrospinal fluid rhinorrhea from a lateral skull base defect refractory to spontaneous healing and/or conservative management is most commonly managed via open surgery. Approach for repair is dictated by location of the defect, which may require surgical exploration. The final common pathway is the eustachian tube (ET). Endoscopic ET obliteration via endonasal and lateral approaches is under development. Whereas ET anatomy has been studied, surgical landmarks have not been previously described or quantified. We aimed to define surgical parameters of specific utility to endoscopic ET obliteration. Methods: A literature review was performed of known ET anatomic parameters. Next, using a combination of endoscopic and open techniques in cadavers, we cannulated the intact ET and dissected its posterior component to define the major curvature position of the ET, defined as the genu, and quantified the relative distances through the ET lumen. The genu was targeted as a major obstacle encountered when cannulating the ET from the nasopharynx. Results: Among 10 ETs, we found an average distance of 23 ± 5 mm from the nasopharynx to the ET genu, distance of 24 ± 3 mm from the genu to the anterior aspect of the tympanic membrane and total ET length of 47 ± 4 mm. Conclusions: Although membranous and petrous components of the ET are important to its function, the genu may be a more useful surgical landmark. Basic surgical parameters for endoscopic ET obliteration are defined.

KW - Cadaver

KW - Catheter

KW - Cerebrospinal leak

KW - Endoscopy

KW - Eustachian tube

UR - http://www.scopus.com/inward/record.url?scp=85055248868&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055248868&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2018.09.123

DO - 10.1016/j.wneu.2018.09.123

M3 - Article

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -