Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions

One-Piece Modified Gasket Seal Technique

“…22 However, the use of autologous free grafts alone has not been as successful for expanded endonasal approaches. 2,23 Fortunately, the HadadBassegasteguy vascularized nasoseptal flap has served as a valuable addition to multilayered reconstruction, reducing the risk of CSF leaks to that of traditional transcranial approaches. 13 One recent study demonstrated no significant difference in CSF leak rates following endoscopic transsellar or expanded endonasal approaches with the use of a NSF in multilayered closure.…”

“…16 Many other studies have demonstrated a wide range of CSF leak rates following resection of these lesions, as well, ranging from 9.5 to 58% with a variety of multilayered closure methods. 2,[17][18][19][20][21] Previously, autologous free grafts including fat, muscle, fascia lata, and nasal septal bone/cartilage have served as viable options for skull base reconstruction following endoscopic endonasal surgery. Kaptain et al encountered a 2.3% postoperative CSF leak rate among 257 patients with intrasellar pathologies who were reconstructed with autologous tissues after endoscopic surgery.…”

“…As displayed in the literature, numerous options for skull base reconstruction after endoscopic endonasal surgery, including both autologous and synthetic materials, have been described to date. [1][2][3][4][5][6][7][8][9][10][11] The primary goal of skull base reconstruction, regardless of surgical technique, includes watertight separation of the intracranial and sinonasal cavities. Failure to achieve these reconstructive goals can result in life-threatening complications such as CSF leak, meningitis, or tension pneumocephalus.…”

“…[1][2][3][4][5][6][7][8][9][10][11] Many of these methods evolved from lessons learned from microscopic transsphenoidal approaches and incorporate a wide a range of surgical materials, including autologous fascia, muscle, fat, and bone, as well as various synthetic materials and tissue sealants for multilayered closure. The goal of reconstruction is to reduce the incidence of postoperative complications, such as infection and cerebrospinal fluid (CSF) leak.…”

Tetrahedral silicon balloon for endoscopic skull base reconstruction

“…1 The expanded endonasal approach (EEA) and its modifications provide access to the anterior skull base, planum, sphenoid, sella, clivus, cervical spine, and infratemporal fossa via the two nostrils. [2][3][4][5][6][7][8][9] This approach enables endoscopic extradural and intradural tumor resection and skull base reconstruction in a single procedure.…”