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#CEREBROSPINAL FLUID LEAK REPAIR CPT CODE SERIES#

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Future studies should focus on further demonstrating the safety of BMP in the treatment of CSF leak through stronger study designs, such as a randomized controlled trial. Although BMPs are meticulously investigated signaling molecules, more research is required to completely elucidate their function and use in surgery, wound healing, and tissue repair. In our study, none of the complications associated with BMP use was observed. In recent years, articles have been published on complications associated with the use of BMP that includes ectopic bone formation, osteolysis, and malignancies with higher BMP dose formulations.

#CEREBROSPINAL FLUID LEAK REPAIR CPT CODE SERIES#

In our institution, we successfully treated recurrent CSF leaks with BMP in a series of four patients after a transsphenoidal pituitary tumor resection. We believe that this pro-inflammatory BMP-induced response leads to faster scarring and healing of the skull base defect helping prevent a recurrent CSF leak. demonstrated that rhBMP-2 induced an inflammatory state as evident on histologic tissue sections and systemic blood samples of rats with subcutaneously implanted BMP. In 2002, rhBMP-2 was approved by the United States Food and Drug Administration for use in lumbar fusions due to its osteoinductive properties. In our case, we were able to show a safe and effective technique for the repair of CSF leak secondary to the right lateral sphenoid sinus recess encephalocele with the use of BMP. One of the more common complications of either approach is the development of recurrent CSF leak quoted anywhere between 6.6% and 9%. Surgical techniques either endoscopic endonasal or open craniotomy can be utilized to repair the defect. A spontaneous skull base encephalocele in an adult carries significant morbidity and mortality associated with the potential development of CSF fistulas, meningitis, and intractable seizures.

The remaining part of the surgery was completed in the standard manner.Įncephaloceles are uncommon abnormalities of brain tissue herniations through a skull defect that can be of congenital, iatrogenic, posttraumatic, or spontaneous origin. Another piece of DuraGen ® was laid inside the dural defect due to the lack of access to the dural defect for primary repair. A piece of collagen matrix (DuraGen ®) was placed above the BMP sponge to completely cover the BMP. The absorbable sponge from the extra-small BMP kit was soaked with rhBMP-2, cut in half, and laid over the bony defect. The bony defect was then repaired by tamping crushed cancellous cadaver bone into the opening. Following, the encephalocele was resected and was measuring 2 cm × 2 cm × 0.4 cm. The temporal lobe was identified and gently lifted to expose the encephalocele which was protruding through the dural defect. The encephalocele was pulled through the bony defect. Using the microscope, the dura was separated from the middle cranial fossa until the dural defect and encephalocele were identified. A right temporal craniotomy was performed in a standard fashion.

Keywords: Bone morphogenetic protein, cerebrospinal fluid leak, encephalocele, encephalocele repairĪ lumbar drain was inserted before surgery. It is our extrapolation that the pro-inflammatory properties of rhBMP-2 lead to the prevention of recurrent CSF leak. On follow-up computed tomography imaging at 9 months’ postsurgery, there was no evidence of recurrent CSF leak or encephalocele, infection, ectopic bone formation, excessive inflammation, or neoplasm.Ĭonclusion:In this case, we demonstrate the successful use of BMP for the repair of CSF leak due to encephalocele. On postoperative clinic visits at 2 weeks and at 3 months, the patient demonstrated good recovery without evidence of recurrent CSF leak. Following, an absorbable sponge from the extra-small BMP kit was cut in half and soaked with recombinant human BMP-2 (rhBMP-2) before being laid over the bony defect. After resecting the encephalocele, cadaver crushed bone was used to fill the skull base defect. Herein, we demonstrate the safe and effective use of bone morphogenetic protein (BMP) in the repair of CSF leak caused by encephalocele.Ĭase Description:A retrospective chart review was conducted on a 50-year-old female who presented with sudden onset spontaneous right nostril CSF leak due to the right lateral sphenoid sinus recess encephalocele, for which she underwent surgical repair. Due to the rarity and variety in size and location of encephaloceles, no standard technique has been established for the resultant defect. Background:Encephaloceles are rare phenomena which occur when brain parenchyma herniates through a skull defect which, if left untreated, may lead to significant issues such as cerebrospinal fluid (CSF) fistulas, meningitis, and intractable seizures.