Augmentation of Dural Defect Repairs Strength With an Acrylic Plate in a Porcine Ex Vivo Model

2019 ◽  
Vol 33 (6) ◽  
pp. 757-762 ◽  
Author(s):  
Philip G. Chen ◽  
Michael R. Clampitt ◽  
Kevin T. Chorath ◽  
Ryan P. Lin ◽  
Erik K. Weitzel ◽  
...  
Keyword(s):  
Skull Base ◽  
Ex Vivo ◽  
Foley Catheter ◽  
Dural Defect ◽  
Ex Vivo Model ◽  
Acrylic Plate ◽  
Direct Support ◽  
Diffuse Support ◽  
Additional Support ◽  
Skull Base Defects

Background Large skull base defects can be challenging to repair. This study uses a controlled ex vivo model to examine the failure pressures of various dural repairs of large skull base defects using mucosa with fibrin glue under 3 conditions: No Additional Support of the repair, support with a Foley catheter (Direct Support), and with Foley catheter contact over a rigid acrylic plate (Diffuse Support). Methods Failure pressures of dural repairs with and without support were determined in a porcine model using an ex vivo closed testing apparatus. In addition, 20 mm × 15 mm dural defects were created. Skull base repairs were performed using porcine dura as an underlay graft followed by a septal mucosa overlay. Saline was infused at 30 mL/h, applying even force to the underside of the graft until repair failure occurred for each condition (none, direct, and diffuse support). Five trials were performed per repair type for a total of 15 repairs. Results The mean failure pressures were as follows: No Additional Support, 6.494 ± 2.553 mm Hg; Direct Support, 5.103 ± 3.913 mm Hg; and Diffuse Support, 15.649 ± 2.638 mm Hg. A post hoc Bonferroni-Holm test demonstrated significant difference between No Additional Support and Diffuse Support ( P = .001), as well as Direct Support and Diffuse Support ( P = .002). Conclusion Support of dural repairs in this model withstood higher pressures when the Foley catheter’s support is distributed evenly using a flat acrylic plate. Use of this plate is the only repair tested in this model that tolerated normal adult supine intracranial pressures.

scholarly journals Failure Pressures of Dural Repairs in a Porcine Ex Vivo Model: Novel Use of Titanium Clips Versus Tissue Glue

2019 ◽  
Vol 10 ◽  
pp. 215265671987967
Author(s):  
Kevin Chorath ◽  
Mason Krysinski ◽  
Leonid Bunegin ◽  
Jacob Majors ◽  
Erik Kent Weitzel ◽  
...  
Keyword(s):  
Skull Base ◽  
Fibrin Glue ◽  
Ex Vivo ◽  
Cerebrospinal Fluid Leak ◽  
Collagen Matrix ◽  
Fascia Lata ◽  
Dural Defect ◽  
Ex Vivo Model ◽  
Failure Pressure ◽  
Titanium Clips

Objective Endoscopic skull base surgery is advancing, and it is important to have reliable methods to repair the resulting defect. The objective of this study was to determine the failure pressures of 2 commonly used methods to repair large dural defects: collagen matrix underlay with fibrin glue and collagen matrix underlay with polyethylene glue, as well as a novel repair method: fascia lata with nonpenetrating titanium vascular clips. Methods The failure pressure of the 3 dural repairs was determined in a closed testing apparatus. Defects in porcine dura were created and collagen matrix grafts were used as an underlay followed by either fibrin glue (FG/CMG) or polyethylene glycol glue (PEG/CMG). A third condition using a segment of fascia lata was positioned flush with the edges of the dural defect and secured with titanium clips (TC/FL). Saline was infused to simulate increasing intracranial pressure (ICP) applied to the undersurface of the grafts until the repairs failed. Results The mean failure pressure of the PEG/CMG repair was 34.506 ± 14.822 cm H2O, FG/CMG was 12.413 ± 5.114 cm H2O, and TC/FL was 8.330 ± 3.483 cm H2O. There were statistically significant differences in mean failure pressures among the 3 repair methods. Conclusion In this ex vivo model comparing skull base repairs’ ability to withstand cerebrospinal fluid leak, the repairs that utilized PEG/CMG tolerated the greatest amount of pressure and was the only repair that exceeded normal physiologic ICP’s. Repair methods utilizing glues generally tolerated higher pressures compared to the novel repair using clips alone.

Closure of large skull base defects after endoscopic transnasal craniotomy

2009 ◽  
Vol 111 (2) ◽  
pp. 371-379 ◽  
Author(s):  
Richard J. Harvey ◽  
João F. Nogueira ◽  
Rodney J. Schlosser ◽  
Sunil J. Patel ◽  
Eduardo Vellutini ◽  
...  
Keyword(s):  
Skull Base ◽  
Csf Leak ◽  
Dural Defect ◽  
Medical Centers ◽  
Dural Defects ◽  
Ventral Skull Base ◽  
Skull Base Defects ◽  
Reconstructive Techniques ◽  
Csf Leaks

Object The authors describe the utility of and outcomes after endoscopic transnasal craniotomy and skull reconstruction in the management of skull base pathologies. Methods The authors conducted a observational study of patients undergoing totally endoscopic, transnasal, transdural surgery. The patients included in the study underwent treatment over a 12-month period at 2 tertiary medical centers. The pathological entity, region of the ventral skull base resected, and size of the dural defect were recorded. Approach-related complications were documented, as well as CSF leaks, infections, bleeding-related complications, and any minor complications. Results Thirty consecutive patients were assessed during the study period. The patients had a mean age of 45.5 ± 20.2 years and a mean follow-up period of 182.4 ± 97.5 days. The dural defects reconstructed were as large as 5.5 cm (mean 2.49 ± 1.36 cm). One patient (3.3%) had a CSF leak that was managed endoscopically. Two patients had epistaxis that required further care, but there were no complications related to intracranial infections or bleeding. Some minor sinonasal complications occurred. Conclusions Skull base endoscopic reconstructive techniques have significantly advanced in the past decade. The use of pedicled mucosal flaps in the reconstruction of large dural defects resulting from an endoscopic transnasal craniotomy permits a robust repair. The CSF leak rate in this study is comparable to that achieved in open approaches. The ability to manage the skull base defects successfully with this approach greatly increases the utility of transnasal endoscopic surgery.

Various modifications of a vascularized nasoseptal flap for repair of extensive skull base dural defects

2020 ◽  
Vol 132 (2) ◽  
pp. 371-379 ◽  
Author(s):  
Ju Hyung Moon ◽  
Eui Hyun Kim ◽  
Sun Ho Kim
Keyword(s):  
Skull Base ◽  
Inferior Turbinate ◽  
Lateral Nasal Wall ◽  
Dural Defect ◽  
Nasoseptal Flap ◽  
Endonasal Surgery ◽  
Csf Rhinorrhea ◽  
Nasal Floor ◽  
Dural Defects ◽  
Skull Base Defects

OBJECTIVEEndonasal surgery of the skull base requires watertight reconstruction of the skull base that can seal the dural defect to prevent postoperative CSF rhinorrhea and consequent intracranial complications. Although the incidence of CSF leakage has decreased significantly since the introduction in 2006 of the vascularized nasoseptal flap (the Hadad-Bassagasteguy flap), reconstruction of extensive skull base dural defects remains challenging. The authors describe a new, modified vascularized nasoseptal flap for reconstruction of extensive skull base dural defects.METHODSA retrospective review was conducted on 39 cases from 2010 to 2017 that involved reconstruction of the skull base with an endonasal vascularized flap. Extended nasoseptal flaps were generated by adding the nasal floor and inferior meatus mucosa, inferior turbinate mucosa, or entire lateral nasal wall mucosa. The authors specifically highlight the surgical techniques for flap design and harvesting of these various modifications of the vascularized nasoseptal flap.RESULTSThirty-nine endonasal vascularized flaps were used to reconstruct skull base defects in 37 patients with nonsurgical or postoperative CSF rhinorrhea. Of the 39 procedures, extended nasoseptal flaps were used in 5 cases (13%). These included 2 extended nasoseptal flaps including the inferior turbinate mucosa and 3 extended nasoseptal flaps including the entire lateral nasal wall mucosa. These 5 extended nasoseptal flaps were used in patients who had nonsurgical CSF rhinorrhea due to extensive skull base destruction by invasive pituitary tumors. All flaps healed completely and sealed off the CSF leaks. Olfactory function slightly decreased in the 3 patients with extended nasoseptal flaps including the entire lateral nasal wall mucosa. One patient experienced nasolacrimal duct obstruction, which was treated by dacryocystorhinostomy. The authors encountered no wound complication in this series, while crusting at the donor site required daily nasal toilette and frequent debridement until the completion of mucosalization, which usually takes 8 to 12 weeks after surgery.CONCLUSIONSExtended nasoseptal flaps are a reliable and versatile option that can be used to reconstruct extensive skull base dural defects resulting from destruction by large invasive tumors or complex endoscopic endonasal surgery. An extended nasoseptal flap that includes the entire lateral nasal wall mucosa (360° flap) is the largest endonasal vascularized flap reported to date and may be an alternative for the reconstruction of extensive skull base defects while avoiding the need for additional external approaches.

1849: Systematic Evaluation of 21μm Thulium Laser Device for Treatment of Benign Prostatic Enlargement in an Ex-VIVO Model

2007 ◽  
Vol 177 (4S) ◽  
pp. 614-614 ◽  
Author(s):  
Gunnar Wendt-Nordahl ◽  
Stefanie Huckele ◽  
Patrick Honeck ◽  
Peter Aiken ◽  
Thomas Knoll ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Systematic Evaluation ◽  
Thulium Laser ◽  
Laser Device ◽  
Benign Prostatic Enlargement ◽  
Ex Vivo Model ◽  
Prostatic Enlargement

Failure of Skull Base Defects Reconstruction after Endonasal Surgery. Complications, Treatment Options and Outcomes

2016 ◽  
Vol 77 (S 01) ◽  
Author(s):  
Bakhtuyar Pashaev ◽  
Valery Danilov ◽  
Gulnar Vagapova ◽  
Vladimir Bochkarev ◽  
Arseniy Pichugin ◽  
...  
Keyword(s):  
Skull Base ◽  
Treatment Options ◽  
Surgery Complications ◽  
Endonasal Surgery ◽  
Skull Base Defects

The Surgical Management of Temporal Bone and Lateral Skull Base Defects

2016 ◽  
Vol 77 (S 02) ◽  
Author(s):  
Hannah North ◽  
Simon Freeman ◽  
Scott Rutherford ◽  
Andrew King ◽  
Chorlatte Hammerbeck-Ward ◽  
...  
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Surgical Management ◽  
Lateral Skull Base ◽  
Skull Base Defects

Porcine small intestine, a good ex vivo model to investigate absorption and metabolism of natural products

2017 ◽  
Author(s):  
J Houriet ◽  
YE Arnold ◽  
C Petit ◽  
YN Kalia ◽  
JL Wolfender
Keyword(s):  
Natural Products ◽  
Small Intestine ◽  
Ex Vivo ◽  
Ex Vivo Model

Effects of Two Different Doses of Hirudin on APTT, Determined with Eight Different Reagents

1995 ◽  
Vol 73 (02) ◽  
pp. 219-222 ◽  
Author(s):  
Manuel Monreal ◽  
Luis Monreal ◽  
Rafael Ruiz de Gopegui ◽  
Yvonne Espada ◽  
Ana Maria Angles ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Anticoagulant Activity ◽  
Subcutaneous Administration ◽  
In Vitro Study ◽  
Ex Vivo Model ◽  
Suitable Candidate ◽  
Significant Prolongation ◽  
High Doses ◽  
Different Doses

SummaryThe APTT has been considered the most suitable candidate to monitor the anticoagulant activity of hirudin. However, its use is hampered by problems of standardization, which make the results heavily dependent on the responsiveness of the reagent used. Our aim was to investigate if this different responsiveness of different reagents when added in vitro is to be confirmed in an ex vivo study.Two different doses of r-hirudin (CGP 39393), 0.3 mg/kg and 1 mg/kg, were administered subcutaneously to 20 New Zealand male rabbits, and the differences in prolongation of APTT 2 and 12 h later were compared, using 8 widely used commercial reagents. All groups exhibited a significant prolongation of APTT 2 h after sc administration of hirudin, both at low and high doses. But this prolongation persisted 12 h later only when the PTTa reagent (Boehringer Mannheim) was used. In general, hirudin prolonged the APTT most with the silica- based reagents.In a further study, we compared the same APTT reagents in an in vitro study in which normal pooled plasma was mixed with increasing amount of hirudin. We failed to confirm a higher sensitivity for silica- containing reagents. Thus, we conclude that subcutaneous administration of hirudin prolongs the APTT most with the silica-based reagents, but this effect is exclusive for the ex vivo model.

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