Banked Fascia Lata in Sellar Dura Reconstruction after Endoscopic Transsphenoidal Skull Base Surgery

Abstract

Objectives Cerebrospinal fluid (CSF) leakage is an undesirable complication of transsphenoidal skull base surgery. The issue of the most appropriate sellar dura repair remains unresolved, although a multilayer technique using autologous fascia lata is widely used. We describe the novel application of a homologous banked fascia lata graft as an alternative to an autologous one in the reconstruction of sellar dura defects in endoscopic transsphenoidal surgery. Design The clinical records of patients who underwent endoscopic transsphenoidal surgery at our department from June 2012, when we started using homologous fascia lata, up to July 2014 were reviewed retrospectively. The data concerning diagnosis, reconstruction technique, and surgical outcome were analyzed. Results We treated 16 patients successfully with banked fascia lata. Twelve patients presented intraoperative CSF leakage, and four patients were treated for postoperative rhinoliquorrhea. Banked fascia lata was used in a single-to-multilayer technique, depending on the anatomical features of the defect and of the sellar floor. No complications or failures in sella reconstruction occurred. Conclusion A banked fascia lata graft proved reliable and safe in providing an effective sellar dura reconstruction. Used in a multilayer strategy, it should be considered a viable alternative to an autologous fascia lata graft.

Cryopreserved fascia lata allograft use in surgical facial reanimation: a retrospective study of seven cases

“…The absence of any osteotomy in this technique allows a reduction of the operative time and a lower risk of complications. The use of banked fascia lata graft has been described for many purposes: reconstruction of osteo-dural defect in neurosurgery, ptosis surgery, urinary incontinence, and rotator cuff tears repair [14][15][16][17][18]. Harvesting of autologous fascia lata can determine postoperative hematoma, wound infection, muscle herniation, weakness of hip flexion, numbness, pain, superficial phlebitis, and cosmetic concern due to the scar [19].…”

Depending on Synthetic Graft Reason for Failure in Early Period in CSF Rinore Repair

“…6 Fiorindi ve ark.nın yaptığı çalışmada BOS rinore onarımında greft olarak fasya lata kullanılmış ve hastaların hiçbirinde rekürrens izlenmemiştir. 7 Fasya lata ile onarım yapılan bir başka çalışmada ise hastaların 24 aylık takip serisinde %96'lık başarı sağlandığı görülmüştür. 8 Literatürdeki başka bir çalışmada greft tercihi olarak fasya lata kullanılan 110 hastalık seride 106 hastada başarı sağlanırken, 4 hastada revizyon cerrahi gerekmiştir.…”

Fascia Lata: Another Workhorse for Complex Skull Base Reconstruction

“…24 With respect to autologous grafts, fascia lata (FL) has been described as a free autograft in dural reconstruction, initially in open skull base cases, given its inherent pliability, durability, ability to mucosalize readily in the nasal cavity, and low donor-site morbidity. [25][26][27][28] The utility of FL for endonasal reconstruction has also been suggested, with modifications including the FL button graft described by Luginbuhl et al, which provides 2 layers of FL sutured together and sequestered at the level of the bony defect in a dual inlay and onlay fashion . 29 Although the NSF has been firmly established as the workhorse of reconstruction of the mucosal layer of a skull base defect, there has been limited study on the applicability and indications for the use of FL in skull base reconstruction.…”