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Upright CT-based evaluation of the effects of posture on skull-base reconstruction after endoscopic endonasal surgery.

Upright CT-based evaluation of the effects of posture on skull-base reconstruction after endoscopic endonasal surgery.

Authors :
Takahara K
Mizutani K
Yamada Y
Yamada M
Yokoyama Y
Yoshida K
Kosugi K
Ueda R
Toda M
Jinzaki M
Source :
Scientific reports [Sci Rep] 2024 Sep 01; Vol. 14 (1), pp. 20303. Date of Electronic Publication: 2024 Sep 01.
Publication Year :
2024

Abstract

Cerebrospinal fluid (CSF) leakage is a common complication associated with endoscopic endonasal skull-base surgery (EESBS). Postoperative mobilization-associated postural changes are considered to cause CSF leakage. However, no study has demonstrated a robust relationship between postural changes and CSF leakage. We used upright computed tomography (CT) to clarify the effects of postural changes on the reconstructed skull base (RSB) after EESBS. Thirty patients who underwent EESBS at our institution were prospectively included, and their upright and supine CTs were compared to measure morphological changes in the RSB. Patient clinical data were also collected from medical charts and surgical videos, and their relationships with morphological changes were assessed. In upright CTs, the RSB shifted intracranially by 0.94 (0.0-2.9) mm on average. This shift was larger in cases with lesions extending to the sphenoid sinus, dural defects, intraoperative pulsation of the RSB, and large bone windows. The direction of the change was opposite to intuitive movement driven by gravity because of reduced intracranial pressure in the sitting position. Thus, these shifts can be directly associated with postoperative CSF leakage caused by reconstruction material displacement. Skull-base reconstruction and postoperative postural management accounting for these morphological changes may be necessary for preventing CSF leakage.<br /> (© 2024. The Author(s).)

Details

Language :
English
ISSN :
2045-2322
Volume :
14
Issue :
1
Database :
MEDLINE
Journal :
Scientific reports
Publication Type :
Academic Journal
Accession number :
39218916
Full Text :
https://doi.org/10.1038/s41598-024-71185-w