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. 2016 Aug;77(4):358-63.
doi: 10.1055/s-0036-1579543. Epub 2016 Feb 26.

Principles in Skull Base Reconstruction following Expanded Endoscopic Approaches

Regi Thomas  1 , Ari George Chacko  2
Affiliations

Principles in Skull Base Reconstruction following Expanded Endoscopic Approaches

Regi Thomas et al. J Neurol Surg B Skull Base. 2016 Aug.

Abstract

Objectives: This study aims to describe the types of anterior skull base defects following expanded endoscopic approaches (EEA) and to outline the techniques involved in the repair of these defects.

Design: We retrospectively analyzed 63 cases of endoscopic skull base reconstruction (ESBR) following tumor excision, done from September 2011 to January 2015. These tumors consisted of 14 pituitary adenomas, 20 craniopharyngiomas, and 29 other miscellaneous tumors. The classification of skull base defects by Tabaee et al and the classification of cerebrospinal fluid (CSF) leaks by Esposito et al were considered during the ESBR. Recurrence of CSF leak was considered as failure of reconstruction.

Results: The 63 skull base defects included in this study occurred following EEA for tumor excision. Failure of reconstruction occurred in 6 six patients. All were successfully repaired, however, three patients in this series died due to tumor-related complications.

Conclusion: The adherence to the general principles of reconstruction, appreciating the subtle differences in the nature of the various defects and the ability to adopt different strategies are the prerequisites for the successful closure of skull base defects.

Keywords: CSF leak; cribriform plate; fovea ethmoidalis; skull base; sphenopalatine artery.

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Figures

Fig. 1
Fig. 1
Intraoperative picture of the vascular flaps in skull base reconstruction. White star, inferior turbinate flap; black star, nasoseptal flap.
Fig. 2
Fig. 2
Postoperative anterior cranial fossa floor defect following a combined approach for anterior skull base malignancy excision. White star, posterior wall of frontal sinus; black star, planum sphenoidale; green star, lamina paparacea.
Fig. 3
Fig. 3
Postoperative anterior cranial fossa floor defect repair with multilayered grafting technique. Black star, fascia lata placed as overlay graft over the underlay grafts.
Fig. 4
Fig. 4
Postoperative suprasellar defect following tuberculum sellae meningioma excision. White star, suprasellar cisternal leak; black star, bony margins of the defect.
Fig. 5
Fig. 5
Suprasellar defect repair with bath-plug technique. Black star, fat bath plug tightly sealing the dural defect.
Fig. 6
Fig. 6
Postoperative defect with ventricular communication following a craniopharyngioma excision. White arrow, foramen of Monro; black arrow, cerebral aqueduct of Sylvius.
Fig. 7
Fig. 7
Gasket seal repair of the skull base defect with ventricular communication. White star, fascia lata; black star, septal cartilage pushing the fascia lata.
See this image and copyright information in PMC

References

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