Endoscopic Coblator™-assisted management of encephaloceles

Numerous studies have demonstrated the efficacy and safety of endoscopic management of cerebral spinal fluid (CSF) rhinorrhea, encephaloceles, and anterior skull base defects. Techniques have evolved as new instrumentation has developed, but typically involve meticulous bipolar cautery to decrease the potential for intracranial bleeding. The present study evaluated the Coblator™ as a novel tool in transnasal endoscopic management of encephaloceles.

Outcomes study.

A prospective cohort involving 19 patients with 22 encephaloceles (19 spontaneous, 3 traumatic) reduced with the Coblator™ (radiofrequency coblation plus bipolar modality) was compared to a retrospective cohort of six encephaloceles (five spontaneous, one traumatic) removed with endoscopic bipolar cautery. Main outcome measures included duration of encephalocele removal and bleeding events. Bleeding encountered during removal was considered a minor event unless more than one attempt at cauterization was required. Other data collected included standard demographics, encephalocele size, and complications.

Average duration of coblation-assisted encephalocele removal was 15.8 minutes compared to 46 minutes with standard bipolar cautery (P = .0003). Average number of bleeding episodes did not significantly differ between groups (Coblator™, 1.0 ± 1.57 vs. bipolar, 1.17 ± 0.98; P = .80). One episode of major bleeding occurred in the coblation group when an anterior ethmoid artery was encountered during removal. Encephalocele size was similar between groups (Coblator™, 17.4 mm vs. bipolar, 16.6 mm; P = .65).

Radiofrequency coblation significantly increased intraoperative speed during encephalocele removal with similar hemostatic properties when compared to bipolar cautery alone and represents a useful instrument in the management of encephaloceles.