Fascia patchwork closure for endoscopic endonasal skull base surgery

Ishii, Yudo; Tahara, Shigeyuki; Hattori, Yujiro; Teramoto, Akira; Morita, Akio; Matsuno, Akira

doi:10.1007/s10143-015-0614-6

Cited by 18 publications

(12 citation statements)

References 60 publications

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“…Direct closure using suturing (Figs. 2 , 3 ) was reported in 69 papers [ 58 , 64 ]. A variety of suture materials were used (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…Some authors preferred continuous suturing (particularly for high flow ioCSFL and large dural defects) due to even tension distribution, the potential for a tighter seal across the defect, and the requirement of only two knots [ 42 , 67 ]. To offset some of the challenges of this technique (Table 2 ) [ 42 , 64 , 65 , 67 – 69 ], surgeons describe suturing grafts (fat, fascia, gelatin sponge) directly to the dura in a patchwork configuration for larger defects [ 38 , 58 , 64 – 70 , 143 ]. By using specialised suture-tying instruments with a sliding-lock-knot technique, suturing was increasingly feasible [ 58 , 65 , 66 , 68 ].…”

Section: Resultsmentioning

confidence: 99%

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Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

et al. 2021

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Purpose Postoperative cerebrospinal fluid rhinorrhoea (CSFR) remains a frequent complication of endonasal approaches to pituitary and skull base tumours. Watertight skull base reconstruction is important in preventing CSFR. We sought to systematically review the current literature of available skull base repair techniques. Methods Pubmed and Embase databases were searched for studies (2000–2020) that (a) reported on the endonasal resection of pituitary and skull base tumours, (b) focussed on skull base repair techniques and/or postoperative CSFR risk factors, and (c) included CSFR data. Roles, advantages and disadvantages of each repair method were detailed. Random-effects meta-analyses were performed where possible. Results 193 studies were included. Repair methods were categorised based on function and anatomical level. There was absolute heterogeneity in repair methods used, with no independent studies sharing the same repair protocol. Techniques most commonly used for low CSFR risk cases were fat grafts, fascia lata grafts and synthetic grafts. For cases with higher CSFR risk, multilayer regimes were utilized with vascularized flaps, gasket sealing and lumbar drains. Lumbar drain use for high CSFR risk cases was supported by a randomised study (Oxford CEBM: Grade B recommendation), but otherwise there was limited high-level evidence. Pooled CSFR incidence by approach was 3.7% (CI 3–4.5%) for transsphenoidal, 9% (CI 7.2–11.3%) for expanded endonasal, and 5.3% (CI 3.4–7%) for studies describing both. Further meaningful meta-analyses of repair methods were not performed due to significant repair protocol heterogeneity. Conclusions Modern reconstructive protocols are heterogeneous and there is limited evidence to suggest the optimal repair technique after pituitary and skull base tumour resection. Further studies are needed to guide practice.

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“…Direct closure using suturing (Figs. 2 , 3 ) was reported in 69 papers [ 58 , 64 ]. A variety of suture materials were used (e.g.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

et al. 2021

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“…Next, the fascia lata is sutured to the dura with 5-0 Vicryl (Ethicon) using a previously reported needle handling technique (Video). 6 To secure the seal, we performed a 360° closure by suturing 11 points around the defect (Figures 1B and 2). For the second layer, a piece of fascia lata that is 1.5 times larger than the bone defect is placed intracranially and extradurally in the epidural space (Figure 1C).…”

Section: Methodsmentioning

confidence: 99%

Optimal Multiple-Layered Anterior Skull Base Reconstruction Using a 360° Suturing Technique

Omura

Nomura

Mori

et al. 2021

Operative Neurosurgery

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BACKGROUND:Advances in technique and instrumentation have improved outcomes after resection of anterior skull base tumors. However, cerebrospinal fluid (CSF) leak occurs in 4%-20% of patients. To reduce the risk of CSF leak, we have developed a novel reconstruction technique that consists of a 4-layered graft with patchwork suturing and hard material.OBJECTIVE:To evaluate the effectiveness of this reconstruction technique when used for resection of anterior skull base tumors.METHODS:This case series included 59 patients with anterior skull base tumors in whom the 4-layered closure technique was used. The main outcome measures were complications, including CSF leak, meningitis, postoperative bleeding, and infection.RESULTS:There were no CSF leak cases or serious complications after closure of the anterior skull base using the 4-layered technique.CONCLUSION:Closure of the anterior skull base in 4 layers prevented CSF leak and was not associated with any serious complications. However, further studies in larger numbers of patients are needed to confirm our outcomes using this closure method.

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“…The most problematic complication is CSF leakage. As safe and reliable methods have been established, the most rational method is selected for each disease based on the direction of tumor extension, site of origin, and surrounding anatomy, craniotomy, endoscopic surgery, and combined approaches of open and endoscopic surgery can be performed safely in response to clinical variations [15][16][17][18].…”

Section: Skull Base Surgerymentioning

confidence: 99%

Surgical Approach to the Cavernous Sinus and Middle Cranial, Pterygoid Fossa

Watanabe¹,

Froelich²

2022

Skull Base Surgery

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The cavernous sinus is a very complex area, and surgical treatment requires detailed anatomical knowledge and familiarity with its relationship to surrounding structures. By exposing the lateral wall of the cavernous sinus with the extradural approach, it is possible to pass through the triangular corridor of the cavernous sinus and perform surgical treatment for diseases such as trigeminal schwannoma and meningioma inside and outside the cavernous sinus. In addition to the extradural infratemporal fossa approach, the extradural infratemporal fossa to the pterygoid fossa and the approach to the paranasal sinuses can be safely performed by inserting the endoscope into the bone corridor of the middle cranial fossa. Furthermore, in the last decade, transnasal endoscopic skull based approaches have further developed, facilitating surgical access to the cavernous sinus. The cavernous sinus is an unattachable site due to the complex structure of multiple nerves, veins, and internal carotid arteries, but if the anatomy of the cavernous sinus is known well we can treat this complex site. As for the choice of approach to the cavernous sinus, a better understanding of the anatomy surrounding the cavernous sinus will allow a rational choice between transcranial and transnasal approaches.

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Fascia patchwork closure for endoscopic endonasal skull base surgery

Cited by 18 publications

References 60 publications

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

Optimal Multiple-Layered Anterior Skull Base Reconstruction Using a 360° Suturing Technique

Surgical Approach to the Cavernous Sinus and Middle Cranial, Pterygoid Fossa

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