Reconstruction of skull base bone defects using an in situ bone flap after endoscopic endonasal transplanum-transtuberculum approaches

Abstract Objective The aim of the study is to summarize and analyze the efficacy of the multilayered skull base reconstruction using in situ bone flap in endoscopic endonasal approach (EEA) for craniopharyngiomas. Methods A retrospective review of 65 patients who underwent resection of their histopathology confirmed craniopharyngiomas performed at a single institution. Based on the team's understanding and mastery of skull base reconstruction techniques, patients were divided into two groups according to the methods of reconstruction in two periods. First (March 2015 through August 2016), osseous reconstruction was not adopted and served as the control group (34 cases). Second (September 2016 through July 2019), in situ bone flap repair of the skull base (complete osseous reconstruction) served as observation group (31 cases). The length of hospitalization and nasal exudation, bed rest time of hospital discharge, the incidence of cerebrospinal fluid leaks, lumbar drainage, and intracranial/pulmonary infections were collected and compared. Results Compared with the control group, patients in the observation group had obviously less lumbar drainage and CSF leakage (p < 0.05), but had no significant difference in cases of re-operation, meningitis, and pulmonary infection. At the meantime, cases of nasal exudation, bed rest, and hospitalization of the observation group were significantly reduced (p < 0.05) in the observation group. Conclusion The multilayered reconstruction technique (especially using in situ bone flap, combined with vascularized pedicled nasoseptal flap) is a safe and effective method in achieving watertight closure after EEEA, and can significantly reduce the incidence of cerebrospinal fluid leaks, and facilitate rehabilitation in skull base reconstruction of craniopharyngiomas.

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The Application of an “In Situ Bone Flap” in Skull Base Reconstruction after Extended Endoscopic Endonasal Approaches for Craniopharyngioma

10.1055/s-0040-1702444 ◽

2020 ◽

Author(s):

Gang Yang

Keyword(s):

Skull Base ◽

Bone Flap ◽

Endoscopic Endonasal ◽

Skull Base Reconstruction

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The Application of “in Situ Bone Flap” Combined with Free Middle Turbinate Mucosa in Skull Base Reconstruction after Extended Endoscopic Endonasal Approaches for Craniopharyngioma

10.1055/s-0040-1702728 ◽

2020 ◽

Author(s):

Gang Yang

Keyword(s):

Skull Base ◽

Middle Turbinate ◽

Bone Flap ◽

Endoscopic Endonasal ◽

Skull Base Reconstruction

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Subcranial surgery of nasal CSF leak, endoscopic capabilities

OTORHINOLARYNGOLOGY 2-3(2) 2019 - OTORHINOLARYNGOLOGY ◽

10.37219/2528-8253-2020-1-26 ◽

2020 ◽

pp. 26-30

Author(s):

Orest Palamar ◽

Andriy Huk ◽

Dmytro Okonskyi ◽

Ruslan Aksyonov ◽

Dmytro Teslenko

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Bone Defect ◽

Frontal Sinus ◽

Free Flaps ◽

Middle Cranial Fossa ◽

Bone Defects ◽

Csf Leak ◽

Endoscopic Endonasal ◽

Invasive Method

Introduction: The problem of choosing surgical approach in the treatment of CSF leak is the subject of discussion depending of the location and the size of the bone defect of the skull base. Materials and methods: 37 patients with nasal CSF leak were treated. In 17 cases, nasal CSF leak was caused by meningo(encephalo)cele. Spontaneous nasal cerebrospinal fluid occurred in 14 cases. In 3 cases, nasal CSF leak was the result of traumatic brain injury (in one case, the cause of nasal CSF leak was post-traumatic meningoencephalocele of the frontal sinus); in the other 3 cases there was postoperative wound nasal cerebrospinal fluid. Results and discussion: Groups of patients were formed depending on the use of vascularized or moved (free) flaps: 1). Multilayer plastics of bone defects of the anterior and middle cranial fossae using displaced (free) flaps. 2). Multilayer plastic of bone defects of the anterior and middle cranial fossa using a nasoseptal flap or middle nasal concha on the leg. In all cases (100%) nasal CSF leak was eliminated. External lumbar drainage was performed in 6 patients and only in cases where the plastic of the bone defect was performed by displaced free flaps. Conclusions: 1). The use of endoscopic endonasal techniques is a minimally invasive method to close skull base bone defects (including large – more than 20 mm) in the area of the anterior and middle cranial fossae. 2). Subcranial approaches are expedient, effective and technically more convenient for nasal CSF leak defects of the frontal sinus and defects in the anterior cells of the etmoid bone.3). Vascularized flaps is expedient for plastic at middle (11-20 mm) and big (more than 20 mm) bone defects of skull base.

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Effects of Cruciate Embedding Fascia-Bone Flap Technique on Grade II - III Cerebral Spinal Fluid Leak in Endoscopic Endonasal Surgery

10.21203/rs.3.rs-496704/v1 ◽

2021 ◽

Author(s):

WenJi Zhao ◽

Gang Yang ◽

RuiChun Li ◽

Gang Huo ◽

Dong Gao ◽

...

Keyword(s):

Skull Base ◽

Cerebral Spinal Fluid ◽

Spinal Fluid ◽

Bone Flap ◽

Csf Leak ◽

Dural Defect ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

Grade Ii

Abstract Background: Cerebral spinal fluid (CSF) leak remains an important issue in endoscopic endonasal surgery. A standard protocol of skull base closure has not been established yet, and application of rigid buttress has not been given sufficient attention. To emphasize the functions of support and fixation from rigid buttress in reconstruction, we introduce a technique of cruciate embedding fascia-bone flap (CEFB) using autologous bone graft to buttress fascia lata attaching to partially sutured skull base dural defect, and evaluate its efficacy in a consecutive case series of grade II-III CSF leak in EES.METHODS: Data of consecutive patients with grade II-III CSF leak during EES were collected between May 2015 and May 2020. Skull base reconstructions were performed either with the CEFB, conventional PNSF, or combination of 2 methods. Related clinical data were compared and analyzed respectively.RESULTS: There are 110, 65, and 23 patients included in CEFB, PNSF, and combination group respectively. CEFB demonstrated statistically similar effects on postoperative CSF leak (2.7%) and intracranial infection (4.5%) compared to PNSF (3.1%, 3.1%), but with less morbidity of epistaxis (CEFB: 0%, PNSF: 6.2%) and nasal discomforts (CEFB: 0%, PNSF: 7.7%). The bed stay time (CEFB: 5.74d, PNSF: 8.83d) and hospitalization time (CEFB: 10.49d, PNSF: 13.58d) were shortened in CEFB group. Combination of CEFB and PNSF achieved 0 postoperative CSF leak in 23 highly susceptible patients with grade III leak and multiple high risk factors.CONCLUSION: The CEFB technique is reliable and feasible to prevent postoperative CSF leak in EES. It can be used safely without PNSF in suitable cases, or applied in association with PNSF with high compatibility and security when necessary.Trial Registration：Current Controlled Trials ChiCTR2100044764 (Chinese Clinical Trial Registry), as well as the date of registration 27th March, 2020. Retrospectively registered.

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