Professional Video on CSF Rhinorrhea (Meningocoele) an Endoscopic Repair

Professional Video on CSF Rhinorrhea (Meningocoele) an Endoscopic Repair

Endoscopic Repair of (Cerebrospinal Fluid) CSF Rhinorrhea (Meningocele) Hadad Flap

CSF rhinorrhea is a condition where Cerebrospinal Fluid, the fluid that surrounds and protects the brain and spinal cord, leaks from the skull base into the nasal cavity. Meningocele, a protrusion of the meninges (membranes surrounding the brain and spinal cord) through the skull base defect, can sometimes accompany CSF rhinorrhea.

Endoscopic repair has become the gold standard for treating these conditions due to its minimally invasive nature and high success rates.

https://youtu.be/dAA1GGI6Pdo

Repair of CSF Rhinorrhea

This video demonstrates Dr. Akbar Abbas and Dr Ahsan Ali Khan performing an endoscopic repair of Cerebrospinal Fluid (CSF) rhinorrhea, a condition where CSF leaks from the skull base into the nasal cavity. The video highlights Dr. Abbas's preferred technique, which utilizes a vascularized Hadad flap for a successful and minimally invasive repair.

Key Steps:

- Identifying the Leak: Dr. Abbas begins by using a high-resolution endoscope to visualize the nasal cavity and pinpoint the exact location of the CSF leak.

- Meningeal Removal: The meningeal tissue (membranes surrounding the brain and spinal cord) is carefully removed to expose the underlying skull base defect, the source of the leak.

- Leak Control: The CSF leak is visualized with the aid of fluorescein dye injected pre-operatively. Dr. Abbas meticulously removes the meningocele to ensure complete control of the CSF leakage.

- Fascia Lata Graft Placement: A patch of fascia lata, a strong connective tissue from the thigh, is used as the first layer to seal the defect directly.

- Haddad Flap Harvest: A key element of Dr. Abbas's technique is the harvest of a Hadad flap. This flap of tissue, derived from the nasal septum, provides vital blood supply and promotes healing at the repair site.

- Flap Elevation: The Hadad flap is meticulously elevated using specialized instruments to ensure its viability and avoid damaging surrounding structures.

- Defect Coverage and Leak Sealing: The harvested Hadad flap is positioned and carefully rotated to cover the repaired skull base defect entirely. This creates a multi-layered closure for a secure and lasting repair.

- Dural Sealant Application: For additional reinforcement, Dr. Abbas applies a layer of Dural Seal, a biocompatible sealant, to further prevent CSF leakage.

- Packing and Closure: Absorbable materials like Surgicel and Gelfoam are strategically placed to maintain pressure on the repair site and promote optimal healing. No additional packing or pressure dressings are needed.

- Post-operative Care: The patient remains in the hospital for observation for a few days and is monitored for any signs of CSF leakage or complications.

Benefits of Dr. Abbas's Technique:

- Minimally invasive endoscopic approach reduces surgical trauma and scarring.

- Haddad flap promotes vascularity and enhances healing at the repair site.

- Multi-layered closure ensures a watertight seal and reduces the risk of CSF recurrence.

- No need for additional packing or pressure dressings for patient comfort.

Disclaimer: This information is for educational purposes only and should not be construed as medical advice. Please consult with Dr. Abbas or a qualified healthcare professional for diagnosis and treatment recommendations.

Conclusion:
Endoscopic repair of CSF rhinorrhea (meningocele) is a highly effective and minimally invasive surgical technique. This guide, along with the accompanying video, aims to provide a valuable resource for both healthcare professionals and patients seeking information about this procedure.

Dr. Akbar Abbas is a highly skilled and experienced endoscopic skull base surgeon. If you are experiencing CSF rhinorrhea or meningocele, please schedule a consultation to discuss your individual case and determine if endoscopic repair is the right treatment option for you.

This is an educational video for students and patients for making informed decisions about their own and others health. Dr Akbar Abbas stands as a leading figure in ENT surgery within Pakistan, offering hope and expertise to countless patients facing similar challenges. He specializes in otolaryngology, cochlear implants, ear surgery and is one of the few experts on pituitary and head and neck cancer surgery in Pakistan. Presently serving at Aga Khan University.

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