Clinical Efficacy of the Multilayered Skull Base Reconstruction Using In Situ Bone Flap in Endoscopic Endonasal Approach for Craniopharyngioma

Abstract

Objective The aim of the study is to summarize and analyze the efficacy of the multilayered skull base reconstruction using in situ bone flap in endoscopic endonasal approach (EEA) for craniopharyngiomas. Methods A retrospective review of 65 patients who underwent resection of their histopathology confirmed craniopharyngiomas performed at a single institution. Based on the team's understanding and mastery of skull base reconstruction techniques, patients were divided into two groups according to the methods of reconstruction in two periods. First (March 2015 through August 2016), osseous reconstruction was not adopted and served as the control group (34 cases). Second (September 2016 through July 2019), in situ bone flap repair of the skull base (complete osseous reconstruction) served as observation group (31 cases). The length of hospitalization and nasal exudation, bed rest time of hospital discharge, the incidence of cerebrospinal fluid leaks, lumbar drainage, and intracranial/pulmonary infections were collected and compared. Results Compared with the control group, patients in the observation group had obviously less lumbar drainage and CSF leakage (p < 0.05), but had no significant difference in cases of re-operation, meningitis, and pulmonary infection. At the meantime, cases of nasal exudation, bed rest, and hospitalization of the observation group were significantly reduced (p < 0.05) in the observation group. Conclusion The multilayered reconstruction technique (especially using in situ bone flap, combined with vascularized pedicled nasoseptal flap) is a safe and effective method in achieving watertight closure after EEEA, and can significantly reduce the incidence of cerebrospinal fluid leaks, and facilitate rehabilitation in skull base reconstruction of craniopharyngiomas.

Utilizing In-Situ Bone Flap for Skull Base Reconstruction in Endoscopic Surgery of Invasive Pituitary Adenoma: A Novel Approach

“…(31) Previous studies have demonstrated the effectiveness of applying ISBF for skull base reconstruction in surgery. (31,32) However, there are no studies exploring the role of ISBF in skull base reconstruction in EEA surgery for IPAs. Our investigation revealed that the ISBF technique was also effective in reducing the incidence of postoperative CSF leak in IPA patients.…”

“In situ bone flap” combined with vascular pedicled mucous flap to reconstruction of skull base defect

“…Through the study of this group, we found that the " in situ bone flap" reconstruction technique provides a rigid reconstruction of the saddle bottom, and the results are safe and effective. We conclude that the "in situ bone flap" technique has the following advantages: (1) The application of this " in situ bone flap" technology, the bone flap comes from the operative area, does not need to remove the surgical area, reduces the process of entering and leaving the narrow space of the nasal cavity, reduces the damage of the nasal mucosa, and reduces the operation time[ 34 , 35 ]; (2) The bone flap is the bone of the surgical site, and the size and shape of the bone flap match the bone window of the skull base, which is a kind of anatomical reduction operation and fully meets the requirements of skull base reconstruction[ 36 - 39 ]; (3) After rigid bone reconstruction, the anatomical layers are clearly defined, and there are no disadvantages such as rejection and foreign body, which greatly reduces adhesion and postoperative scar formation in the operative area , and facilitates the expedient healing and re-operation of tumor recurrence[ 30 , 40 , 41 ]; and (4) Through rigid bone reconstruction, the direct impact of cerebrospinal fluid on mucosal flap is slowed down, the reconstruction is enhanced, and the medium is provided for the growth and adhesion of mucosal flap, which has a positive effect on the fixation and survival of mucosal flap after surgery[ 42 , 43 ].…”

Skull base reconstruction using in situ bone flap in patients with pituitary adenomas treated by endoscopic endonasal approach

“…Previous studies have shown that the application of ISBF can significantly reduce the rate of postoperative CSF leakage following EEA ( 30 , 32 , 33 ); however, few of them have focused on pituitary adenoma. Pituitary adenomas are the most common type of pituitary disorder.…”