Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-18T06:57:06.955Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  09 September 2019

C Carnevale ,
M Tomás-Barberán ,
G Til-Pérez ,
J Ibañez-Domínguez ,
D Arancibia-Tagle ,
R Rodríguez-Villalba  and
P Sarría-Echegaray
C Carnevale
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
M Tomás-Barberán
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
G Til-Pérez
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
J Ibañez-Domínguez
Affiliation:
Department of Neurosurgery, Son Espases University Hospital, Palma de Mallorca, Spain
D Arancibia-Tagle
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
R Rodríguez-Villalba
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
P Sarría-Echegaray*
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Son Espases University Hospital, Palma de Mallorca, Spain
*
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: [email protected] Fax: +34 97 1 17 6745
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Skull BaseCerebrospinal Fluid LeakPituitary NeoplasmsEndoscopyFascia Lata
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 10 , October 2019 , pp. 889 - 894
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

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

References

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; 191–202Google Scholar
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;61:24–33Google Scholar
3Dehdashti, AR, Ganna, A, Witterick, I, Gentili, F. Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations. Neurosurgery 2009;64:677–87Google Scholar
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;49:473–5Google Scholar
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;117:970–6Google Scholar
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;116:1882–6Google Scholar
7Kitano, M, Taneda, M. Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery. Neurosurgery 2004;54:653–60Google Scholar
8Leng, LZ, Brown, S, Anand, VK, Schwartz, TH. “Gasket-seal” watertight closure in minimal-access endoscopic cranial base surgery. Neurosurgery 2008;62:342–3Google Scholar
9Luginbuhl, AJ, Campbell, PG, Evans, J, Rosen, M. Endoscopic repair of high-flow cranial base defects using a bilayer button. Laryngoscope 2010;120:876–80Google Scholar
10Nyquist, GG, Anand, VK, Singh, A, Schwartz, TH. Janus flap: bilateral nasoseptal flaps for anterior skull base reconstruction. Otolaryngol Head Neck Surg 2010;142:327–31Google Scholar
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;117:1329–32Google Scholar
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;25:212–16Google Scholar
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;123:2601–4Google Scholar
14Grotenhuis, JA. Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma cases. Surg Neurol 2005;64:490–4Google Scholar
15Esposito, F, Dusick, JR, Fatemi, N, Kelly, DF. Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurgery 2007;60:295–304Google Scholar
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;113:1283–8Google Scholar
17Tabaee, A, Anand, VK, Brown, SM, Lin, JW, Schwartz, TH. Algorithm for reconstruction after endoscopic pituitary and skull base surgery. Laryngoscope 2007;117:1133–7Google Scholar
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;55:539–50Google Scholar
19Kassam, A, Carrau, RL, Snyderman, CH, Gardner, P, Mintz, A. Evolution of reconstructive techniques following endoscopic expanded endonasal approaches. Neurosurg Focus 2005;15:E8Google Scholar
20Snyderman, CH, Kassam, AB, Carrau, R, Mintz, A. Endoscopic reconstruction of cranial base defects following endonasal skull base surgery. Skull Base 2007;17:73–8Google Scholar
21de Divitiis, E, Cavallo, LM, Cappabianca, P, Esposito, F. Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: part 2. Neurosurgery 2007;60:46–59Google Scholar
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;23:518–21Google Scholar
23Soudry, E, Turner, JH, Nayak, JV, Hwang, PH. Endoscopic reconstruction of surgically created skull base defects: a systematic review. Otolaryngol Head Neck Surg 2014;150:730–8Google Scholar
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;20:397–404Google Scholar
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;80:563–8Google Scholar
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;114:345–53Google Scholar
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;82:186–95Google Scholar
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;83:181–7Google Scholar