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Endoscopic reconstruction of large anterior skull base defects with opening of the sellar diaphragm. Experience at a tertiary level university hospital

  • C Carnevale (a1), M Tomás-Barberán (a1), G Til-Pérez (a1), J Ibañez-Domínguez (a2), D Arancibia-Tagle (a1), R Rodríguez-Villalba (a1) and P Sarría-Echegaray (a1)...

Abstract

Background

The indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm.

Method

A prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap.

Results

Twenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent).

Conclusion

The combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.

Copyright

Corresponding author

Author for correspondence: Dr Pedro Sarría-Echegaray, Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Son Espases, Carretera Valldemosa, Palma 07210, Balearic Islands, Spain E-mail: pedrosarria@orlmallorca.com Fax: +34 97 1 17 6745

Footnotes

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Dr P Sarria-Echegaray takes responsibility for the integrity of the content of the paper

Footnotes

References

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1Tabaee, APD, Schwartz, TH, Anand, VJ. Reconstruction after endoscopic skull base surgery. In: Anand, VK, Schwartz, TH, eds. Practical Endoscopic Skull Base Surgery. San Diego: Plural Publishing, 2007; 191202
2Cavallo, LM, de Divitiis, O, Aydin, S, Messina, A, Esposito, F, Iaconetta, G et al. Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: anatomic considerations–part 1. Oper Neurosurg 2007;61:2433
3Dehdashti, AR, Ganna, A, Witterick, I, Gentili, F. Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations. Neurosurgery 2009;64:677–87
4Cappabianca, P, Cavallo, LM, Mariniello, G, de Divitiis, O, Romero, AD, de Divitiis, E. Easy sellar reconstruction in endoscopic endonasal transsphenoidal surgery with polyester-silicone dural substitute and fibrin glue: technical note. Neurosurgery 2001;49:473–5
5Fortes, FS, Carrau, RL, Snyderman, CH, Kassam, A, Prevedello, D, Vescan, A et al. Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches. Laryngoscope 2007;117:970–6
6Hadad, G, Bassagasteguy, L, Carrau, RL, Mataza, JC, Kassam, A, Snyderman, CH et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006;116:1882–6
7Kitano, M, Taneda, M. Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery. Neurosurgery 2004;54:653–60
8Leng, LZ, Brown, S, Anand, VK, Schwartz, TH. “Gasket-seal” watertight closure in minimal-access endoscopic cranial base surgery. Neurosurgery 2008;62:342–3
9Luginbuhl, AJ, Campbell, PG, Evans, J, Rosen, M. Endoscopic repair of high-flow cranial base defects using a bilayer button. Laryngoscope 2010;120:876–80
10Nyquist, GG, Anand, VK, Singh, A, Schwartz, TH. Janus flap: bilateral nasoseptal flaps for anterior skull base reconstruction. Otolaryngol Head Neck Surg 2010;142:327–31
11Fortes, FS, Carrau, RL, Snyderman, CH, Prevedello, D, Vescan, A, Mintz, A et al. The posterior pedicled inferior turbinate flap: a new vascularized flap for skull base reconstruction. Laryngoscope 2007;117:1329–32
12Rivera-Serrano, CM, Bassagaisteguy, LH, Hadad, G, Carrau, RL, Kelly, D, Prevedello, DM et al. Posterior pedicled lateral nasal wall flap: new reconstructive technique for large defects of the skull base. Am J Rhinol Allergy 2011;25:212–16
13Kasemsiri, P, Carrau, RL, Otto, BA, Tang, IP, Prevedello, DM, Muto, J et al. Reconstruction of the pedicled nasoseptal flap donor site with a contralateral reverse rotation flap: technical modifications and outcomes. Laryngoscope 2013;123:2601–4
14Grotenhuis, JA. Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma cases. Surg Neurol 2005;64:490–4
15Esposito, F, Dusick, JR, Fatemi, N, Kelly, DF. Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurgery 2007;60:295304
16Shiley, SG, Limonadi, F, Delashaw, JB, Barnwell, SL, Andersen, PE, Hwang, PH et al. Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery. Laryngoscope 2003;113:1283–8
17Tabaee, A, Anand, VK, Brown, SM, Lin, JW, Schwartz, TH. Algorithm for reconstruction after endoscopic pituitary and skull base surgery. Laryngoscope 2007;117:1133–7
18Couldwell, WT, Weiss, MH, Rabb, C, Liu, JK, Apfelbaum, RI, Fukushima, T. Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 2004;55:539–50
19Kassam, A, Carrau, RL, Snyderman, CH, Gardner, P, Mintz, A. Evolution of reconstructive techniques following endoscopic expanded endonasal approaches. Neurosurg Focus 2005;15:E8
20Snyderman, CH, Kassam, AB, Carrau, R, Mintz, A. Endoscopic reconstruction of cranial base defects following endonasal skull base surgery. Skull Base 2007;17:73–8
21de Divitiis, E, Cavallo, LM, Cappabianca, P, Esposito, F. Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: part 2. Neurosurgery 2007;60:4659
22Zanation, AM, Carrau, RL, Snyderman, CH, Germanwala, AV, Gardner, PA, Prevedello, DM et al. Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy 2009;23:518–21
23Soudry, E, Turner, JH, Nayak, JV, Hwang, PH. Endoscopic reconstruction of surgically created skull base defects: a systematic review. Otolaryngol Head Neck Surg 2014;150:730–8
24Patel, MR, Stadler, ME, Synderman, CH, Carrau, RL, Kassam, AB, Germanwala, AV et al. How to choose? Endoscopic skull base reconstructive options and limitations. Skull Base 2010;20:397404
25Garcia-Navarro, V, Anand, VK, Theodore, H, Schwartz, TH. Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series. World Neurosurg 2013;80:563–8
26Di Maio, S, Cavallo, LM, Esposito, F, Stagno, V, Corriero, OV, Cappabianca, P. Extended endoscopic endonasal approach for selected pituitary adenomas: early experience. J Neurosurg 2011;114:345–53
27Mascarenhas, L, Moshel, YA, Bayad, F, Szentirmai, O, Salek, AA, Leng, LZ et al. The transplanum transtuberculum approaches for suprasellar and sellar-suprasellar lesions: avoidance of cerebrospinal fluid leak and lessons learned. World Neurosurg 2014;82:186–95
28Hu, F, Gu, Y, Zhang, X, Xie, T, Yu, Y, Sun, C et al. Combined use of a gasket seal closure and a vascularized pedicle nasoseptal flap multilayered reconstruction technique for high-flow cerebrospinal leaks after endonasal endoscopic skull base surgery. World Neurosurg 2015;83:181–7

Keywords

Endoscopic reconstruction of large anterior skull base defects with opening of the sellar diaphragm. Experience at a tertiary level university hospital

  • C Carnevale (a1), M Tomás-Barberán (a1), G Til-Pérez (a1), J Ibañez-Domínguez (a2), D Arancibia-Tagle (a1), R Rodríguez-Villalba (a1) and P Sarría-Echegaray (a1)...

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