Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery

Ishikawa, Takayuki; Takeuchi, Kazuhito; Nagata, Yuichi; Choo, Jungsu; Kawabata, Teppei; Ishizaki, Tomotaka; Wakabayashi, Toshihiko

doi:10.3171/2018.4.jns18366

Cited by 25 publications

(25 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Therefore, different reconstruction concepts and techniques for high-flow CSF leakage through large skull base defects are required. A grading system was proposed and updated to identify an optimally designed reconstruction strategy, and various reconstruction techniques have been introduced [ 13 , 18 , 32 , 42 , 63 ]. A review on endoscopic skull base reconstruction for large dural defects showed a CSF leakage rate as high as 11.5% [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

Multi-Layer Onlay Graft Using Hydroxyapatite Cement Placement without Cerebrospinal Fluid Diversion for Endoscopic Skull Base Reconstruction

Kim

Kang

Dho

et al. 2021

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Objective : The skull base reconstruction step, which prevents cerebrospinal fluid (CSF) leakage, is one of the most challenging steps in endoscopic skull base surgery (ESS). The purpose of this study was to assess the outcomes and complications of a reconstruction technique for immediate CSF leakage repair using multiple onlay grafts following ESS. Methods : A total of 230 consecutive patients who underwent skull base reconstruction using multiple onlay grafts with fibrin sealant patch (FSP), hydroxyapatite cement (HAC), and pedicled nasoseptal flap (PNF) for high-flow CSF leakage following ESS at three institutions were enrolled. We retrospectively reviewed the medical and radiological records to analyze the preoperative features and postoperative results. Results : The diagnoses included craniopharyngioma (46.8%), meningioma (34.0%), pituitary adenoma (5.3%), chordoma (1.6%), Rathke's cleft cyst (1.1%) and others (n=21, 11.2%). The trans-planum/tuberculum approach (94.3%) was the most commonly adapted surgical method, followed by the trans-sellar and transclival approaches. The third ventricle was opened in 78 patients (41.5%). Lumbar CSF drainage was not performed postoperatively in any of the patients. Postoperative CSF leakage occurred in four patients (1.7%) due to technical mistakes and were repaired with the same technique. However, postoperative meningitis occurred in 13.5% (n=31) of the patients, but no microorganisms were identified. The median latency to the diagnosis of meningitis was 8 days (range, 2-38). CSF leakage was the unique risk factor for postoperative meningitis (p<0.001). Conclusion :The use of multiple onlay grafts with FSP, HAC, and PNF is a reliable reconstruction technique that provides immediate and complete CSF leakage repair and mucosal grafting on the skull base without the need to harvest autologous tissue or perform postoperative CSF diversion. However, postoperative meningitis should be monitored carefully.

show abstract

“…19,[24][25][26] In addition, dura suturing has been practiced and proven effective. 25,[27][28][29][30][31][32][33][34][35] It was possible that the dura of the anterior skull base was not fully invaded. Otherwise, abdominal fat could be used as the primary reconstruction material.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal resection of sinonasal teratocarcinosarcoma with intracranial breakthrough: illustrative case

Ni¹,

Xu²,

Zhang³

et al. 2021

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

BACKGROUND Teratocarcinosarcoma traversing the anterior skull base is rarely reported in literature. The heterogenous and invasive features of the tumor pose challenges for surgical planning. With technological advancements, the endoscopic endonasal approach (EEA) has been emerging as a workhorse of anterior skull base lesions. To date, no case has been reported of EEA totally removing teratocarcinosarcomas with intracranial extensions. OBSERVATIONS The authors provided an illustrative case of a 50-year-old otherwise healthy man who presented with left-sided epistaxis for a year. Imaging studies revealed a 31 × 60-mm communicating lesion of the anterior skull base. Gross total resection via EEA was achieved, and multilayered skull base reconstruction was performed. LESSONS The endoscopic approach may be safe and effective for resection of extensive teratocarcinosarcoma of the anterior skull base. To minimize the risk of postoperative cerebrospinal fluid leaks, multilayered skull base reconstruction and placement of lumbar drainage are vitally important.

show abstract

Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery

Cited by 25 publications

References 15 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

Multi-Layer Onlay Graft Using Hydroxyapatite Cement Placement without Cerebrospinal Fluid Diversion for Endoscopic Skull Base Reconstruction

Endoscopic endonasal resection of sinonasal teratocarcinosarcoma with intracranial breakthrough: illustrative case

Contact Info

Product

Resources

About