Should the Impact of Postural Change of Intracranial Pressure After Surgical Repair of Skull Base Cerebrospinal Fluid Leaks Be Considered? A Preliminary Survey.
CSF leak
Intracranial pressure
Posture
Skull base surgery
Journal
Acta neurochirurgica. Supplement
ISSN: 0065-1419
Titre abrégé: Acta Neurochir Suppl
Pays: Austria
ID NLM: 100962752
Informations de publication
Date de publication:
2021
2021
Historique:
entrez:
11
4
2021
pubmed:
12
4
2021
medline:
8
6
2021
Statut:
ppublish
Résumé
Managing skull base cerebrospinal fluid (CSF) leaks is often challenging. Postoperative care, especially regarding postural restrictions and bedrest recommendations, is variable and continues to be based on empirical habits. An electronic survey was submitted to French experts in skull base surgery to evaluate current practice of postoperative postural recommendations in patients treated for skull base CSF leaks. Thirty-nine experts completed the survey. Postoperative recommendations were heterogenous. They depended on the size of defects: half of the surgeons did not recommend any constraints of posture for small defects; 84% recommended bed rest for large defects. The most preferred bed-rest modality was Fowler's position (20°-30° tilt). Standing/walking during short periods was allowed in up to 73%. From a physiological viewpoint, head elevation decreases ICP and thus limits the risk of recurrence of CSF leak. However, ICP can fall below 0 in the standing position, favouring pneumocephalus. These results confirmed that postural recommendations for patients surgically treated for skull base CSF leaks remain variable. Recommendations should take into consideration the postural change in ICP. Fowler's position may represent the best compromise between risk of recurrence of CSF leak and the risk of pneumocephalus in large CSF leaks.
Identifiants
pubmed: 33839869
doi: 10.1007/978-3-030-59436-7_63
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
329-333Références
Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116(10):1882–1886
doi: 10.1097/01.mlg.0000234933.37779.e4
Wang W, Vincent A, Sokoya M, Kohlert S, Kadakia S, Ducic Y (2019) Free-flap reconstruction of skull base and orbital defects. Semin Plast Surg 33(01):072–077
doi: 10.1055/s-0039-1677881
Gjuric M, Goede U, Keimer H, Wigand ME (1996) Endonasal endoscopic closure of cerebrospinal fluid fistulas at the anterior cranial base. Ann Otol Rhinol Laryngol 105(8):620–623
doi: 10.1177/000348949610500806
Kaptain GJ, Vincent DA, Laws ER Jr (2001) Cranial base reconstruction after transsphenoidal surgery with bioabsorbable implants: technical note. Neurosurgery 48(1):232–234
pubmed: 11152355
Kenning JA, Toutant SM, Saunders RL (1981) Upright patient positioning in the management of intracranial hypertension. Surg Neurol 15(2):148–152
doi: 10.1016/0090-3019(81)90037-9
Magnaes B (1976) Body position and cerebrospinal fluid pressure. Part 1: clinical studies on the effect of rapid postural changes. J Neurosurg 44(6):687–697
doi: 10.3171/jns.1976.44.6.0687
Wang EW, Zanation AM, Gardner PA et al (2019) ICAR: endoscopic skull-base surgery. Int Forum Allerg Rhinol 9(S3):S145–S365
doi: 10.1177/1945892418817221
Roxbury CR, Lobo BC, Kshettry VR, D’Anza B, Woodard TD, Recinos PF, Snyderman CH, Sindwani R (2018) Perioperative management in endoscopic endonasal skull-base surgery: a survey of the North American Skull Base Society. Int Forum Allerg Rhinol 8(5):631–640
doi: 10.1002/alr.22066
Wannemuehler TJ, Rabbani CC, Burgeson JE, Illing EA, Walgama ES, Wu AW, Ting JY (2018) Survey of endoscopic skull base surgery practice patterns among otolaryngologists. Laryngosc Investig Otolaryngol 3(3):143–155
doi: 10.1002/lio2.149
Magnaes B (1976) Body position and cerebrospinal fluid pressure. Part 2: clinical studies on orthostatic pressure and the hydrostatic indifferent point. J Neurosurg 44(6):698–705
doi: 10.3171/jns.1976.44.6.0698
Antes S, Tschan CA, Heckelmann M, Breuskin D, Oertel J (2016) Telemetric intracranial pressure monitoring with the raumedic neurovent P-tel. World Neurosurg 91:133–148
doi: 10.1016/j.wneu.2016.03.096
Holmlund P, Eklund A, Koskinen L-OD, Johansson E, Sundström N, Malm J, Qvarlander S (2018) Venous collapse regulates intracranial pressure in upright body positions. Am J Phys Regul Integr Comp Phys 314(3):R377–R385
Petersen LG, Petersen JCG, Andresen M, Secher NH, Juhler M (2016) Postural influence on intracranial and cerebral perfusion pressure in ambulatory neurosurgical patients. Am J Phys Regul Integr Comp Phys 310(1):R100–R104
Qvarlander S, Sundström N, Malm J, Eklund A (2013) Postural effects on intracranial pressure: modeling and clinical evaluation. J Appl Physiol Bethesda Md 115(10):1474–1480
Teachey W, Grayson J, Cho D-Y, Riley KO, Woodworth BA (2017) Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks. Laryngoscope 127(9):2011–2016
doi: 10.1002/lary.26612
Haykowsky MJ, Eves ND, R Warburton DE, Findlay MJ (2003) Resistance exercise, the Valsalva maneuver, and cerebrovascular transmural pressure. Med Sci Sports Exerc 35(1):65–68
doi: 10.1097/00005768-200301000-00011
Yadav YR, Parihar V, Janakiram N, Pande S, Bajaj J, Namdev H (2016) Endoscopic management of cerebrospinal fluid rhinorrhea. Asian J Neurosurg 11(3):183–193
doi: 10.4103/1793-5482.145101
Goldmann RW (1986) Pneumocephalus as a consequence of barotrauma. JAMA 255(22):3154–3156
doi: 10.1001/jama.1986.03370220116039
Chapman PH, Cosman ER, Arnold MA (1990) The relationship between ventricular fluid pressure and body position in normal subjects and subjects with shunts: a telemetric study. Neurosurgery 26(2):181–189
doi: 10.1227/00006123-199002000-00001