Endoscopic Reconstruction of Surgically Created Skull Base Defects: A Systematic Review

Soudry, Ethan; Turner, Justin H.; Nayak, Jayakar V.; Hwang, Peter H.

doi:10.1177/0194599814520685

Cited by 163 publications

(177 citation statements)

References 35 publications

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“…3,13 In the review of 38 studies by Harvey et al, 609 patients with large dural defects were identified. From this cohort, 326 underwent free graft reconstruction while 283 underwent vascularized reconstruction, resulting in a statistically significant difference in the rate of CSF leak of 15.6% (51 of 326) and 6.7% (19 of 283) for free graft and vascularized reconstruction, respectively.…”

Section: 13mentioning

confidence: 99%

“…However, cases with high flow rates revealed improved outcomes with vascularized repairs as leak rates of 82% and 94% were found with free grafts/synthetic materials and vascularized repairs, respectively. 13 The immense versatility of the NSF and the ability to cover a reconstructive area averaging 17.12 cm 2 as delineated by anatomical and radiographic studies has led to its broad use in skull base reconstruction. 10 Moreover, CSF leak rates of 5.7% when used for skull base repair in the setting of high intraoperative CSF flow have been reported.…”

Section: 13mentioning

confidence: 99%

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Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak

Thorp

Sreenath²,

Ebert³

et al. 2014

FOC

158

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Endoscopic skull base surgery continues to rapidly evolve, requiring comparable advances in reconstructive techniques. While smaller skull base defects with low intraoperative CSF flow have been successfully managed with a variety of avascular and/or noncellular techniques, larger defects with high CSF flow require more robust repairs often in the form of vascularized flaps, which confer excellent success rates in this setting. Despite these successful outcomes, a paucity of data describing specific patient and operative characteristics and their effects on repair exist. Therefore, a retrospective, consecutive chart review was performed on patients who underwent endoscopic skull base reconstruction with a vascularized flap in the setting of intraoperative CSF leaks. In this series, 151 patients with a mean age of 51 years underwent 152 vascularized flap skull base reconstructions for an array of benign and malignant pathologies. These vascularized flaps included 144 nasoseptal flaps, 6 endoscopic-assisted pericranial flaps, 1 facial artery buccinator flap, and 1 inferior turbinate flap that were used throughout all regions of the skull base. Perioperative (< 3 months) and postoperative (> 3 months) flap complications were assessed and revealed 3 perioperative flap defects (2.0%) defined as a visualized defect within the substrate of the flap and a total of 5 perioperative CSF leaks (3.3%). No patient experienced flap death/complete flap loss in the cohort. Assessed postoperative flap complications included 1 case (0.7%) of mucocele formation, 8 cases (5.3%) of prolonged skull base crusting, and 2 cases (1.3%) of donor-site complication, specifically septal perforation secondary to nasoseptal flap harvest. Among the 152 cases identified, 37 patients received radiation therapy while 114 patients did not undergo radiation therapy as part of the treatment profile. No significant association was found between perioperative complication rates and radiation therapy (p = 0.634). However, a significant association was found between postoperative complication rates and radiation therapy, primarily accounted for by an increased risk for prolonged (> 6 months) skull base crusting (p = 0.025). It is clear that larger skull base defects with high intraoperative CSF flow require thoughtful approach and strong consideration for vascularized repair.

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Section: 13mentioning

confidence: 99%

Section: 13mentioning

confidence: 99%

Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak

Thorp

Sreenath²,

Ebert³

et al. 2014

FOC

158

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“…Similarly to our technique, their reconstruction begins with the placement of the fascia lata graft in an inlay-outlay fashion, and the reconstruction is supported by a nasoseptal flap. The vascularized nasoseptal flaps have quickly become the workhorse for the repair of skull base defects following endoscopic surgery, with a postoperative success rate of 94% in high-flow CSF leaks [13]. However, nasoseptal flaps present some problems, including the resulting large anterior mucosal defect, which can result in crusting and possible nasal valve stenosis as well as olfactory and mucociliary dysfunction [14].…”

Section: Discussionmentioning

confidence: 99%

“…However, nasoseptal flaps present some problems, including the resulting large anterior mucosal defect, which can result in crusting and possible nasal valve stenosis as well as olfactory and mucociliary dysfunction [14]. On the other hand, multilayered closure with free grafts, such as fascia lata and fat, achieves a success rate of 82% even in high-flow CSF leaks [13]. In this series we successfully closed 15 high-flow CSF leaks and 2 large defects (>30 mm) with our multilayered free graft technique.…”

Section: Discussionmentioning

confidence: 99%

Multilayered Closure of Cerebrospinal Fluid Rhinorrhea with Inlay Fascia Lata, Autologous Fat, and Outlay Fascia Lata: Our Experience

Eryılmaz

Arıcıgil²,

Alan³

2016

ORL

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Background/Aims: Since the initial use in 1981 by Wigand, different endoscopic endonasal surgery techniques have been proposed to close ventral skull base defects, all of which include multilayer closure involving vascularized mucoseptal flaps, autologous grafts, and synthetic materials. These methods are used individually or in combination, as required by the operative condition. Methods: In this study we aimed to describe our endoscopic technique using inlay-outlay fascia lata and autologous fat with fibrin sealant to close spontaneous and traumatic cerebrospinal fluid (CSF) rhinorrhea. Results and Conclusion: Twenty-one CSF rhinorrhea patients were operated with this technique in our hospital. Two patients had large skull base defects and 15 patients had high-flow CSF leaks. We reached a 100% success rate in the first attempt without any long-term recurrence. Multilayered endoscopic closure with this technique offers satisfactory results with minimal morbidity even in large defects and high-flow CSF leaks.

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“…Many different techniques have been proposed to repair dural and skull base defects, with success rates ranging from 83% to 95% 4,5 . Recent review articles 6,7 reported 89–92% success for endoscopic repair of skull base defects and identified a potential benefit for vascularized pedicled grafts for large defects or those located in high-flow areas.…”

Section: Introductionmentioning

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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Endoscopic Reconstruction of Surgically Created Skull Base Defects: A Systematic Review

Cited by 163 publications

References 35 publications

Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak

Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak

Multilayered Closure of Cerebrospinal Fluid Rhinorrhea with Inlay Fascia Lata, Autologous Fat, and Outlay Fascia Lata: Our Experience

Osseous Repair in Minimally Invasive Reconstruction of Anterior Skull Base Defects

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