Dural suturing for repair of cerebrospinal fluid leak in transnasal transsphenoidal surgery

Nishioka, Hiroshi; Izawa, Hitoshi; Ikeda, Yukio; Namatame, Hiroaki; Fukami, Shinjiro; Haraoka, Jo

doi:10.1007/s00701-009-0406-2

Cited by 55 publications

(44 citation statements)

References 11 publications

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“…Usage of vascularized mucosal flaps, dural substitutes and tissue sealants have also been described (1,4,5,9,10,12,13,15,16,17,18,19,21,22,23,27,28,29,33,34,36,37,39,40,41). Even primary suturing of the dural defects has been reported (31). These can be deployed either with or without the assistance of lumbar CSF diversion (6,13,35,37,38).…”

Section: Introductionmentioning

confidence: 99%

Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Yıldırım

Dursun²,

Özdöl³

et al. 2013

Turkish Neurosurgery

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AIm: Postoperative cerebrospinal fluid (CSF) leak following endoscopic endonasal transsphenoidal surgery (EETS) is associated with increased morbidity and mortality. This prospective study is the first evaluation of using autologous fibrin sealant for preventing postoperative CSF leak and related complications. mAterIAl and methOds: 200 endoscopic endonasal transsphenoidal approaches were included in the study and reviewed retrospectively from September 2010 to June 2012. A total of 55 patients who have large skull base and diafragma sella defects, connected with basal cisterns or ventricles, were chosen for the study. The patients were operated via extended or classical endoscopic endonasal transsphenoidal approach. The skull base has been repaired using AFS combined with multilayer reconstruction in all cases. The incidence of CSF leak as a complication of EETS was analyzed. results:The ages of the patients ranged from 20 to 83 years (mean 49.3 years). There were 25 (46%) male patients and 30 (54%) females. All patients had tumors with suprasellar or parasellar extension. Postoperative CSF leak was determined in 2 patients (3.6%). There were no complications and allergic reactions associated with the use of AFS.COnClusIOn: Using of AFS combined with multilayer reconstruction technique is a safe and effective method to prevent CSF leak in large defects following EETS.

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Section: Introductionmentioning

confidence: 99%

Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Yıldırım

Dursun²,

Özdöl³

et al. 2013

Turkish Neurosurgery

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“…To date, numerous attempts have been made to reconstruct sellar defects such as free graft using the fat tissue or fascia lata, packing of collagen sponge, and the use of a variety of solid or semisolid buttress materials such as autologous cartilage and bone, absorbable plates, and nonabsorbable silicone and titanium plates or mesh 2,5,10,11,13) However, when used as dural substitutes, autologous tissues such as abdominal fat or tensor fascia lata require additional skin incisions and prolonged operative time 2) . In addition, autologous septal bone is irregularly shaped and bony reconstruction is difficult to apply as a buttress.…”

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confidence: 99%

Clinical Efficacy of Radiation-Sterilized Allografts for Sellar Reconstruction after Transsphenoidal Surgery

Kim

Jeon

Kong

et al. 2011

J Korean Neurosurg Soc

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Objective : The aim of this study was to assess the safety and efficacy of radiation-sterilized allografts of iliac bone and fascia lata from cadaver specimens to repair skull base defects after transsphenoidal surgery. Methods : Between May 2009 and January 2010, 31 consecutive patients underwent endonasal transsphenoidal surgery and all patients received sellar reconstruction using allografts following tumor removal. The allografts were obtained from the local tissue bank and harvested from cadaver donors. The specimens used in our approach were tensor fascia lata and the flat area of iliac bone. For preparation, allografts were treated with gamma irradiation after routine screening by culture, and then stored at -70°C. Results : The mean follow-up period after surgery was 12.6 months (range, 7.4-16 months). Overall, postoperative cerebrospinal fluid (CSF) leaks occurred in three patients (9.7%) and postoperative meningitis in one patient (3.2%). There was no definitive evidence of wound infection at the routine postoperative follow-up examination or during re-do surgery in three patients. Postoperative meningitis in one patient was improved with the use of antibiotics and prolonged CSF diversion. Conclusion : We suggest that allograft materials can be a feasible alternative to autologous tissue grafts for sellar reconstruction following transsphenoidal surgery under selected circumstances such as no or little intraoperative CSF leaks.

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“…Although there are some techniques that have been described for primary dural closure or bone reconstruction of the skull base following EES, none of them can be used after extensive clival and dural resections. 1,8,11,12 In our experience, primary duraplasty through the endoscopic endonasal route is not feasible. During EES for large clival lesions, extensive skull base exposure is required and usually the paraclival carotid arteries are skeletonized.…”

Section: Future Speculations On Endoscopic Skull Base Reconstructionmentioning

confidence: 93%

“…17 However, there are few techniques described for primary dural closure or bone reconstruction of the skull base through the endoscopic endonasal route, and none of these can be used following extensive resections. 1,8,11,12 We have observed rare postoperative skull base changes on imaging studies after EES for posterior fossa tumor resection, with transclival pontine encephalocele as the most impressive change.…”

mentioning

confidence: 99%

Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery

Koutourousiou

Vaz-Guimarães

Costacou

et al. 2014

JNS

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Object Transclival endoscopic endonasal surgery (EES) has recently been used for the treatment of posterior fossa tumors. The optimal method of reconstruction of large clival defects following EES has not been established. Methods A morphometric analysis of the posterior fossa was performed in patients who underwent transclival EES to compare those with observed postoperative anatomical changes (study group) to 50 normal individuals (anatomical control group) and 41 matched transclival cases with preserved posterior fossa anatomy (case-control group) using the same parameters. Given the absence of clival bone following transclival EES, the authors used the line between the anterior commissure and the basion as an equivalent to the clival plane to evaluate the location of the pons. Four parameters were studied and compared in the two populations: the pontine location/displacement, the maximum anteroposterior (AP) diameter of the pons, the maximum AP diameter of the fourth ventricle, and the cervicomedullary angle (CMA). All measurements were performed on midsagittal 3-month postoperative MR images in the study group. Results Among 103 posterior fossa tumors treated with transclival EES, 14 cases (13.6%) with postoperative posterior fossa anatomy changes were identified. The most significant change was anterior displacement of the pons (transclival pontine encephalocele) compared with the normal location in the anatomical control group (p < 0.0001). Other significant deformities were expansion of the AP diameter of the pons (p = 0.005), enlargement of the fourth ventricle (p = 0.001), and decrease in the CMA (p < 0.0001). All patients who developed these changes had undergone extensive resection of the clival bone (> 50% of the clivus) and dura. Nine (64.3%) of the 14 patients were overweight (body mass index [BMI] > 25 kg/m2). An association between BMI and the degree of pontine encephalocele was observed, but did not reach statistical significance. The use of a fat graft as part of the reconstruction technique following transclival EES with dural opening was the single significant factor that prevented pontine displacement (p = 0.02), associated with 91% lower odds of pontine encephalocele (OR = 0.09, 95% CI 0.01–0.77). The effect of fat graft reconstruction was more pronounced in overweight/obese individuals (p = 0.04) than in normal-weight patients (p = 0.52). Besides reconstruction technique, other noticeable findings were the tendency of younger adults to develop pontine encephalocele (p = 0.05) and the association of postoperative meningitis with the development of posterior fossa deformities (p = 0.05). One patient developed a transient, recurrent subjective diplopia; all others remained asymptomatic. Conclusions Significant changes in posterior fossa anatomy that have potential clinical implications have been observed following transclival transdural EES. These changes are more common in younger patients or those with meningitis and may be associated with BMI. The use of a fat graft combined with the vascularized nasoseptal flap appears to minimize the risk of pontine herniation following transclival EES with dural opening.

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Dural suturing for repair of cerebrospinal fluid leak in transnasal transsphenoidal surgery

Abstract: Direct suturing of the sellar dura is a simple, safe, and reliable surgical technique for repairing CSF leaks after TSS. Using this procedure, more than 70% of patients with an intraoperative CSF leak can avoid autologous tissue grafts.

Cited by 55 publications

References 11 publications

Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

Clinical Efficacy of Radiation-Sterilized Allografts for Sellar Reconstruction after Transsphenoidal Surgery

Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery

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