Endoscopic Reconstruction of Large Anterior Skull Base Defects using Acellular Dermal Allograft

Background Endoscopic repair of small- to medium-sized anterior skull base (ASB) defects using bone, cartilage, fascia, fibrin glue, lipolized dura, and, more recently, acellular dermal allograft have all been described with equal efficacy. The purpose of this study was to review our experience with the use of acellular dermis as the sole graft material in endoscopic reconstruction of large ASB defects. Methods A retrospective chart review of all patients who underwent endoscopic repair of ASB defects at the University of Miami between the years of 2001 and 2006 was conducted. Fifty-six patients were identified who met these criteria. All repairs were performed by a transnasal, endoscopic approach. Outcome measures included success of graft take and incidence of major and minor complications. Dural defect size was defined as small (<0.4 cm), intermediate (0.4–2.0 cm), and large (>2.0 cm). Results AlloDerm (AlloDerm. LifeCell Corp. Woodlands, TX) was used as the primary graft material in 30/55 (55%) cases; 16/55 (29%) of the repaired defects were classified as large. Graft success was 97% in the AlloDerm group and 92% in the non-AlloDerm group. The incidence of major and minor complications in the AlloDerm group was 0 and 3.3%, respectively. In the non-AlloDerm group, the incidence of major and minor complications was 4 and 12%, respectively. There were no statistical differences in the complication rates based on the type of repair or defect size. Conclusion Alloderm can be used successfully to repair ASB defects, including large defects that are >2 cm in size with little or no morbidity.

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Endoscopic reconstruction of large anterior skull base defects using acellular dermal allograft

Yearbook of Otolaryngology-Head and Neck Surgery ◽

10.1016/s1041-892x(08)79110-8 ◽

2008 ◽

Vol 2008 ◽

pp. 246-247

Author(s):

R. Sindwani

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Endoscopic Reconstruction ◽

Skull Base Defects ◽

Acellular Dermal

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Endoscopic Reconstruction of Large Anterior Skull Base Defects using Single Layer of Acellular Dermal Allograft

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0035-1546544 ◽

2015 ◽

Vol 76 (S 01) ◽

Author(s):

Ralph Abi Hachem ◽

Mallory Raymond ◽

Mohammad Al-Bar ◽

Zoukaa Sargi ◽

Roy Casiano

Keyword(s):

Skull Base ◽

Single Layer ◽

Anterior Skull Base ◽

Endoscopic Reconstruction ◽

Skull Base Defects ◽

Acellular Dermal

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Free Flap Reconstruction of the Anterior Skull Base: A Systematic Review

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1718909 ◽

2021 ◽

Author(s):

Rajan P. Dang ◽

Abhinav R. Ettyreddy ◽

Zain Rizvi ◽

Michelle Doering ◽

Angela L. Mazul ◽

...

Keyword(s):

Systematic Review ◽

Skull Base ◽

Free Flap ◽

High Reliability ◽

Anterior Skull Base ◽

Microvascular Reconstruction ◽

Complication Rates ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Comprehensive Search

Abstract Objectives Given the limitations in the available literature, the precise indications, techniques, and outcomes of anterior skull base free flap reconstruction remain uncertain. The objective of this study was to perform a systematic review of published literature and evaluate indications, methods, and complications for anterior skull base free flap reconstruction. Methods A systematic review of the literature was performed using a set of search criteria to identify patients who underwent free flap reconstruction of the anterior skull base. Articles were reviewed for inclusion based on relevance, with the primary outcome being surgical complications. Results After a comprehensive search, 406 articles were obtained and 16 articles were ultimately found to be relevant to this review—79 patients undergoing free flap reconstruction were identified. Overall complication rates were 17.7% (95% confidence interval [CI]: 16.6–33.1%) for major complications and 19.0% (95% CI: 17.8–35.5%) for minor complications. Conclusion Microvascular reconstruction of the anterior skull base is feasible with high reliability reported in the literature.

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The “Parachute” technique for the endoscopic repair of high-flow anterior skull-base CSF leaks

World Neurosurgery ◽

10.1016/j.wneu.2021.05.006 ◽

2021 ◽

Author(s):

Giorgio Fiore ◽

Giulio Andrea Bertani ◽

Giorgio Giovanni Carrabba ◽

Claudio Guastella ◽

Giovanni Marfia ◽

...

Keyword(s):

Skull Base ◽

High Flow ◽

Anterior Skull Base ◽

Endoscopic Repair ◽

Csf Leaks

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Incidence of Postoperative CSF Leak Using a Single-Layer Closure with Acellular Dermal Allograft for Anterior Skull Base Defects

10.1055/s-0041-1725464 ◽

2021 ◽

Author(s):

Pawina Jiramongkolchai ◽

Jake J. Lee ◽

Cristine N. Klatt-Cromwell ◽

Albert H. Kim ◽

Michael R. Chicoine ◽

...

Keyword(s):

Skull Base ◽

Single Layer ◽

Anterior Skull Base ◽

Csf Leak ◽

Skull Base Defects ◽

Acellular Dermal

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Residual and Recurrent Disease Following Endoscopic Endonasal Approach as a Reflection of Anatomic Limitation for the Resection of Midline Anterior Skull Base Meningiomas

Operative Neurosurgery ◽

10.1093/ons/opab244 ◽

2021 ◽

Author(s):

Pradeep Setty ◽

Juan C Fernandez-Miranda ◽

Eric W Wang ◽

Carl H Snyderman ◽

Paul A Gardner

Keyword(s):

Optic Nerve ◽

Skull Base ◽

Retrospective Chart Review ◽

Residual Tumor ◽

Average Diameter ◽

Anterior Skull Base ◽

Endoscopic Endonasal ◽

Olfactory Groove ◽

Orbital Roof ◽

Skull Base Meningiomas

Abstract BACKGROUND Endoscopic endonasal approaches (EEAs) to anterior skull base meningiomas have grown in popularity, though anatomic limitations remain unclear. OBJECTIVE To show the anatomic limits of EEA for meningiomas. METHODS Retrospective chart review for all patients that underwent EEA for anterior skull base meningiomas from 2005 to 2014. RESULTS A total of 100 patients averaged follow-up of 46.9 mo (24-100 mo). A total of 35 patients (35%) had olfactory groove, 33 planum sphenoidale (33%), and 32 tuberculum sella (32%) meningiomas. The average diameter was 2.9 cm (0.5-8.1 cm). Vascular encasement was seen in 11 patients (11%) and calcification in 20 (20%). Simpson Grade 1 (SG1) resection was achieved in 64 patients (64%). Only calcification impacted degree of resection (40% SG1, P = .012). The most common residual was on the anterior clinoid dura (11 patients [11%]). Six (6%) had residual superior/lateral to the optic nerve. Residual tumor was adherent to the optic apparatus or arteries in 5 patients (5%) each, and 3 patients (3%) had residual lateral to the mid-orbit. Rates of residual decreased over time. A total of 11 patients (11%) had tumor recurrence (mean of 40 mo): 4 (4%) on the anterior clinoid, 2 (2%) each on the lateral orbital roof, adherent to optic apparatus and superolateral to the optic nerve, and 1 (1%) was at the anterior falx. CONCLUSION Anterior skull base meningiomas can effectively be approached via EEA in most patients; tumors extending to the anterior clinoid, anterior falx, or superolateral to the optic nerve or orbital roof, especially if calcified, may be difficult to reach via EEA.

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Audit of Complications in an Otolaryngology Led Skull-Base Surgical Practice

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1676793 ◽

2018 ◽

Vol 80 (06) ◽

pp. 586-592

Author(s):

Uma Patnaik ◽

Smriti Panda ◽

Alok Thakar

Keyword(s):

Skull Base ◽

Surgical Complications ◽

Skull Base Surgery ◽

Major Complication ◽

Anterior Skull Base ◽

Complication Rates ◽

Permanent Disability ◽

Lateral Skull Base ◽

Significant Difference ◽

Surgical Complexity

Objective This study was aimed to classify and study complications of surgery of the cranial base, primarily from an otorhinolaryngology perspective. Design This study was designed with consecutive cohort of skull base surgical cases. Setting Tertiary referral academic center. Participants Patients having skull-base surgery at a otorhinolaryngology based skull-base unit, from 2002 to 2015. Main Outcome Measures Enumeration of complications is the main outcome of this study. Surgical procedures, categorized for complexity as per a unified system, are applicable to endoscopic and open procedures. Complications were categorized as per the British Association of Otolaryngologists coding of surgical complications. Complication classified as major if life-threatening, causing permanent disability, or compromising the result of surgery. Results A total of 342 patients (n = 342) were operated; 13 patients' records were excluded due to < 6 months posttreatment follow-up. The study group constituted 204 anterior skull-base (endoscopic, 120; open/external, 84) and 125 lateral skull-base procedures. Complication rates noted to increase in both groups with increasing complexity of surgical intervention. Anterior skull-base surgery (total complications, 11%; major, 3%; death, 0.5%) noted to have significantly less surgical complications than lateral skull-base surgery (total complications, 33%; major, 15%; death, 1.6%; p < 0.001). Among the anterior procedures no significant difference noted among endoscopic and external approaches when compared across similar surgical complexity. Conclusion Despite improvement in surgical and perioperative care, the overall major complication rate in a contemporary otolaryngology led, primarily extradural, skull-base practice is noted at 8%. Perioperative mortality, though rare, was encountered in 1%. A standard method for categorization of surgical complexity and the grade of complications as reported here is recommended.

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

Journal of Neurosurgery ◽

10.3171/2018.4.jns18366 ◽

2019 ◽

Vol 131 (5) ◽

pp. 1625-1631 ◽

Cited By ~ 2

Author(s):

Takayuki Ishikawa ◽

Kazuhito Takeuchi ◽

Yuichi Nagata ◽

Jungsu Choo ◽

Teppei Kawabata ◽

...

Keyword(s):

Skull Base ◽

Transsphenoidal Surgery ◽

Skull Base Surgery ◽

Sella Turcica ◽

High Flow ◽

Anterior Skull Base ◽

Csf Leak ◽

Dural Defect ◽

Csf Leakage ◽

Dural Suturing

OBJECTIVETranssphenoidal surgery (TSS) is commonly used for anterior skull base surgery, especially in the sella turcica (sellar) region. However, because of its anatomical position, CSF leakage is a major complication of this approach. The authors introduced a new grading reconstruction strategy for anterior skull base surgery with continuous dural suturing in 2013. In this paper the authors report on their methods and results.METHODSAll patients with sellar or anterior skull base lesions that were removed with TSS or extended TSS by a single neurosurgeon between April 2013 and March 2017 at Nagoya University Hospital and several cooperating hospitals were retrospectively identified. Three methods of suturing dura were considered, depending on the dural defect.RESULTSThere were 176 TSS cases (141 conventional TSS cases and 35 extended endoscopic TSS cases) and 76 cases of Esposito’s grade 2 or 3 intradural high-flow CSF leakage. In the high-flow CSF leak group, there were 3 cases of CSF leakage after the operation. The rates of CSF leakage after surgery corresponding to grades 2 and 3 were 2.9% (1/34) and 4.7% (2/42), respectively.CONCLUSIONSDural suturing is a basic and key method for reconstruction of the skull base, and continuous suturing is the most effective approach. Using this approach, the frequency of cases requiring a nasoseptal flap and lumbar drainage can be reduced.

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