Endoscopic Nasoseptal Flap Repair of Skull Base Defects: Is Addition of a Dural Sealant Necessary?

Eloy, Jean Anderson; Kuperan, Arjuna B.; Friedel, Mark E.; Patel, Chirag D.; Shukla, Pratik A.; Choudhry, Osama J.; Liu, James K.

doi:10.1055/s-0032-1312069

Cited by 39 publications

(60 citation statements)

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“…2,22,23,37 The skull base dural defect is initially converted from a high-flow CSF leak state to a low-flow CSF leak state by placing a piece of autologous fascia lata to cover the defect (Fig. 1A and B).…”

Section: Multilayer Reconstruction Of Skull Base Defectmentioning

confidence: 99%

Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgery

Liu¹,

Schmidt²,

Choudhry³

et al. 2012

FOC

125

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Extended endoscopic endonasal approaches have allowed for a minimally invasive solution for removal of a variety of ventral skull base lesions, including intradural tumors. Depending on the location of the pathological entity, various types of surgical corridors are used, such as transcribriform, transplanum transtuberculum, transsellar, transclival, and transodontoid approaches. Often, a large skull base dural defect with a high-flow CSF leak is created after endoscopic skull base surgery. Successful reconstruction of the cranial base defect is paramount to separate the intracranial contents from the paranasal sinus contents and to prevent postoperative CSF leakage. The vascularized pedicled nasoseptal flap (PNSF) has become the workhorse for cranial base reconstruction after endoscopic skull base surgery, dramatically reducing the rate of postoperative CSF leakage since its implementation. In this report, the authors review the surgical technique and describe the operative nuances and lessons learned for successful multilayered PNSF reconstruction of cranial base defects with high-flow CSF leaks created after endoscopic skull base surgery. The authors specifically highlight important surgical pearls that are critical for successful PNSF reconstruction, including target-specific flap design and harvesting, pedicle preservation, preparation of bony defect and graft site to optimize flap adherence, multilayered closure technique, maximization of the reach of the flap, final flap positioning, and proper bolstering and buttressing of the PNSF to prevent flap dehiscence. Using this technique in 93 patients, the authors' overall postoperative CSF leak rate was 3.2%. An illustrative intraoperative video demonstrating the reconstruction technique is also presented.

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Section: Multilayer Reconstruction Of Skull Base Defectmentioning

confidence: 99%

Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgery

Liu¹,

Schmidt²,

Choudhry³

et al. 2012

FOC

125

View full text Add to dashboard Cite

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“…We have stopped using dural sealants since we found no benefits to their use in a recent retrospective analysis. 21 A Merocel nasal tampon (Medtronic Xomed, Jacksonville, FL) covered with bacitracin is then used to further support the closure (Fig. 1).…”

Section: Surgical Techniquementioning

confidence: 99%

Assessment of Mucocele Formation after Endoscopic Nasoseptal Flap Reconstruction of Skull Base Defects

Husain¹,

Sanghvi²,

Shukla³

et al. 2013

J Neurol Surg B

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“…Although still not the standard of care, 51 the vascularized PNSF has had considerable success in decreasing postoperative CSF leak rates, and presently is the workhorse of skull base reconstruction of large defects, after endoscopic endonasal approaches, in many academic centers. 16,43,46,47,50,[52][53][54] Unfortunately, despite the success of the PNSF, transplanum defects still remain a challenging location to repair. Some authors have observed an increased risk of postoperative CSF leakage specifically at this site, which may be attributed to arachnoid dissection of the suprasellar cistern.…”

Section: Introductionmentioning

confidence: 99%

Challenges and surgical nuances in reconstruction of large planum sphenoidale tuberculum sellae defects after endoscopic endonasal resection of parasellar skull base tumors

et al. 2013

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Endoscopic Nasoseptal Flap Repair of Skull Base Defects: Is Addition of a Dural Sealant Necessary?

Cited by 39 publications

References 0 publications

Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgery

Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgery

Assessment of Mucocele Formation after Endoscopic Nasoseptal Flap Reconstruction of Skull Base Defects

Challenges and surgical nuances in reconstruction of large planum sphenoidale tuberculum sellae defects after endoscopic endonasal resection of parasellar skull base tumors

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