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

Omura, Kazuhiro; Nomura, Kazuhiro; Mori, Ryosuke; Ishii, Yudo; Aoki, Satoshi; Takeda, Teppei; Tochigi, Kosuke; Tanaka, Yasuhiro; Otori, Nobuyoshi; Kojima, Hiromi

doi:10.1227/ons.0000000000000013

Cited by 7 publications

(4 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Septoplasty from the unaffected side with an extended anterior Killian incision. A lateral Y‐shaped nasal septal mucosal incision enables tumor mobilization 7,13 . Most previous studies on olfactory neuroblastoma excision have reported tumor resection via a staged or piecemeal approach 14,15 .…”

Section: Discussionmentioning

confidence: 99%

“…A lateral Y-shaped nasal septal mucosal incision enables tumor mobilization. 7,13 Most previous studies on olfactory neuroblastoma excision have reported tumor resection via a staged or piecemeal approach. 14,15 Although technically demanding, en bloc resection has several theoretical merits, including a lower possibility of tumor dissemination and accurate pathological examination.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Simple and safe resection of the crista galli

Omura,

Nomura,

Aoki

et al. 2023

Head & Neck

Self Cite

View full text Add to dashboard Cite

A critical procedure in the transcribriform approach is the resection of the crista galli. However, the standard technique for crista galli resection has several disadvantages. We reviewed the cases of patients with olfactory neuroblastomas who underwent an endoscopic endonasal transcribriform approach using a newly developed technique for crista galli resection. We performed a cadaveric study to measure the superior accessibility limits using the proposed method. We included 38 patients with olfactory neuroblastomas in this study. The tumor invaded the posterior crista galli in four patients. The anterior end of the crista galli was not invaded by the tumor. Our cadaveric study showed that the dura was approachable to the point that was 7.4 ± 1.3 mm superior and 23.2 ± 7.2 mm lateral to the foramen cecum following crista galli removal. By resecting the crista galli in advance, manipulation of the superior dura became feasible.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Simple and safe resection of the crista galli

Omura,

Nomura,

Aoki

et al. 2023

Head & Neck

Self Cite

View full text Add to dashboard Cite

show abstract

“… 16 , 17 Skull base reconstruction surgery is often associated with complications such as spinal fluid leakage and infection. However, skull base surgery using a 4‐layer reconstruction method was performed in our hospital without postoperative complications, such as spinal fluid leakage, 18 which allowed for quick access to additional postoperative radiation therapy. All patients, except those with a low‐grade Kadish–Hyams classification and complete resection, were treated with additional postoperative radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

The impact of multidisciplinary approaches on the outcomes of olfactory neuroblastoma treated with postoperative radiotherapy

Tsutsumi,

Omura,

Kijima

et al. 2024

Cancer Medicine

Self Cite

View full text Add to dashboard Cite

BackgroundWe investigated the outcomes of postoperative radiation therapy for olfactory neuroblastoma (ONB) and our cross‐departmental collaboration to enhance the effectiveness of cancer treatment.MethodsWe retrospectively evaluated 22 patients with ONB who underwent postoperative radiotherapy after tumor resection. En bloc resection was performed; pathology specimens were prepared in coronal sections; and irradiation fields were determined after discussion with radiation oncologists, head and neck surgeons, and pathologists.ResultsThe overall survival and local control rates were 95.5% and 100%, respectively, at a median 37‐month follow‐up. The 3‐ and 5‐year disease‐free survival (DFS) rates were 64.4% and 56.3%, respectively. Of the 22 patients, 9 (8 Kadish C and 1 Kadish B) had disease recurrence. Of the nine patients, five had positive margins and two had closed margins; cervical lymph node recurrence occurred in six, and distant metastasis with or without cervical lymph node recurrence occurred in three. DFS analysis of risk factors showed no statistically significant differences, but positive margins were a significant recurrence factor in multivariate analysis.ConclusionsThe local control rate of ONB treated with postoperative radiation therapy was 100%. This may be attributed to cross‐departmental cooperation between head and neck surgeons, pathologists, and radiation oncologists, which resulted in accurate matching of CT images for treatment planning with the location of the tumor and positive margins. Longer follow‐up periods are required to evaluate the effectiveness of our strategy.

show abstract

“…In addition, autologous fascia lata and VP-NSF provide good watertight properties to prevent CSF leaks. In recent years, based on the multilayer repair technique, surgeons have also made some suture improvements, such as the technique of continuous suturing of the dura with fascia lata grafts, a method of 360° closure by suturing 11 points around the defect, and a nasal septum bone ap combined with VP-NSF [8][9][10]. These factors have further reduced the rate of CSF leaks and related complications.…”

Section: Introductionmentioning

confidence: 99%

In-situ suture based on a nasoseptal mucosal flap for repair of grade 3 leaks associated with an expanded endoscopic endonasal approach

Song

Xiong

et al. 2022

Preprint

View full text Add to dashboard Cite

Background To investigate the reliability and efficacy of a modified technique for preventing postoperative grade 3 leaks associated with an expanded endoscopic endonasal approach (EEEA). Method This study was a retrospective review of 33 patients who presented with intraoperative grade 3 leaks after the use of an EEEA for resection of skull base lesions from January 2017 to February 2022. Patients who received the conventional method from January 2017 to December 2019 were included in Group A. Patients who received the modified in-situ suture technique from 2020 onward were included in Group B. The Whitney test and chi-square test or Fisher's exact test were conducted to analyze the differences in several postoperative outcomes between the two groups. Result Five cases of postoperative CSF leaks and a single intracranial infection occurred in Group A. No postoperative CSF leaks or intracranial infection occurred in Group B. The in-situ suture technique avoided the need to take autologous fat and fascia lata from the thigh (p < 0.001), reduced postoperative bed rest (p < 0.001), and decreased the incidence of postoperative CSF leaks (p = 0.049) and the total hospital stay (p = 0.011). No significant differences in re-repair, hospitalization costs or postoperative intracranial infection were noted between the two groups. Conclusion This modified technique could represent an effective and safe option for repairing grade 3 leaks associated with the EEEA. In the future, the focus should be on increasing the number of surgeries and continuing follow-up to monitor and evaluate the long-term efficacy of this approach.

show abstract

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

Cited by 7 publications

References 18 publications

Simple and safe resection of the crista galli

Simple and safe resection of the crista galli

The impact of multidisciplinary approaches on the outcomes of olfactory neuroblastoma treated with postoperative radiotherapy

In-situ suture based on a nasoseptal mucosal flap for repair of grade 3 leaks associated with an expanded endoscopic endonasal approach

Contact Info

Product

Resources

About