Assessment of frontal lobe sagging after endoscopic endonasal transcribriform resection of anterior skull base tumors: Is rigid structural reconstruction of the cranial base defect necessary?

Eloy, Jean Anderson; Shukla, Pratik A.; Choudhry, Osamah J.; Singh, Rahul; Liu, James K.

doi:10.1002/lary.23539

Cited by 42 publications

(29 citation statements)

References 39 publications

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“…It is arguable if bony or rigid repair of the defect is required at all, however. Herniation appears to be minimal without rigid reconstruction at 10-months postoperatively, 13 although long-term assessment of this possibility is not yet available. From the available literature, rigid reconstruction may be more useful in larger defects, patients who have intracranial hypertension or intermittent pressure elevation as in obstructive sleep apnea, or those who may require future sinus surgery for continued disease (e.g., polyps or tumor).…”

Section: Discussionmentioning

confidence: 99%

Osseous Repair in Minimally Invasive Reconstruction of Anterior Skull Base Defects

Ramakrishnan

Terella

Poonia

et al. 2017

Journal of Craniofacial Surgery

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Management of anterior skull base defects is an area of continued innovation for skull base surgeons. Various grafting materials have been advocated for the repair of skull base defects depending on needs, availability, harvest site morbidity, and surgeon preference. Spontaneous bony closure of small skull defects is known to occur in animal models without bone grafts, but this phenomenon has been unexplored in the human skull base. The objective of this study was to evaluate osseous skull base closure in patients undergoing endoscopic repair of skull base defects. A retrospective review was performed on 13 patients who underwent endoscopic repair of skull base defects with free bone grafts who were followed with post-operative CT scans. This cohort was compared to postoperative radiology from patients undergoing transsphenoidal surgery without rigid reconstruction to evaluate for spontaneous osseous closure of sellar defects. Free bone grafts incorporated into the bony skull base in the majority of cases (84.6% with at least partial incorporation) at mean of 5.3 years postoperatively. By comparison, patients undergoing pituitary surgery did not demonstrate spontaneous osseous closure on postoperative imaging. Human anterior skull base defects do not appear to spontaneously close, even when small, suggesting that there is no “critical size defect” in the human skull base, in contrast to the robust wound healing in animal models of skull convexity and mandibular defects. Free bone grafts incorporate into the skull base over the long-term and may be utilized whenever a rigid skull base reconstruction is desired, regardless of the defect size.

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Section: Discussionmentioning

confidence: 99%

Osseous Repair in Minimally Invasive Reconstruction of Anterior Skull Base Defects

Ramakrishnan

Terella

Poonia

et al. 2017

Journal of Craniofacial Surgery

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“…[45][46][47] With the triple-layer repair, we have found that rigid structural reconstruction of the anterior cranial base (with mesh, Medpor, or bone) is not necessary to prevent frontal lobe sagging or encephalocele formation. 48 …”

Section: Skull Base Reconstructionmentioning

confidence: 97%

Endoscopic Endonasal Approach for Olfactory Groove Meningiomas

Liu

Hattar

Eloy

2015

Neurosurgery Clinics of North America

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“…It appears that even in large defects, rigid skull base reconstruction is not required to prevent subsequent cerebral herniation through the defect [13]. However, in scenarios where repeat surgery may be required in the future (e.g.…”

Section: Rigid (Bone/cartilage) Versus Nonrigidmentioning

confidence: 99%

Treatment of cerebrospinal fluid rhinorrhea

DeConde

Suh

Ramakrishnan

2015

Current Opinion in Otolaryngology & Head and Neck Surgery

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Patients with CSF rhinorrhea require surgical repair to prevent life-threatening complications. Many techniques and materials are effective at achieving closure of CSF fistula across causes. Evidence suggests that patients with high-flow CSF fistulas have improved outcomes with multilayered, vascularized repairs to decrease the risk of postoperative CSF leaks. Patients with idiopathic intracranial hypertension need long-term management of the underlying disease process.

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Assessment of frontal lobe sagging after endoscopic endonasal transcribriform resection of anterior skull base tumors: Is rigid structural reconstruction of the cranial base defect necessary?

Abstract: Rigid structural repair may not be necessary for ASB defect repair after endoscopic endonasal resection of the cribriform plate. Our technique for multilayer cranial base reconstruction appears to be satisfactory in preventing delayed frontal lobe sagging.

Cited by 42 publications

References 39 publications

Osseous Repair in Minimally Invasive Reconstruction of Anterior Skull Base Defects

Osseous Repair in Minimally Invasive Reconstruction of Anterior Skull Base Defects

Endoscopic Endonasal Approach for Olfactory Groove Meningiomas

Treatment of cerebrospinal fluid rhinorrhea

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