Challenges and surgical nuances in reconstruction of large planum sphenoidale tuberculum sellae defects after endoscopic endonasal resection of parasellar skull base tumors

Abstract

Repair of large transplanum defects after EETT resection of parasellar SB tumors presents a unique challenge. Using a PNSF along with meticulous multilayer closure may help decrease postoperative CSF leaks.

Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients

“…12 Multilayer closures also hold merit and recapitulate open techniques. 16,17 However, all of these have been supplemented successfully with vascularized tissue. This has become universally accepted as the critical step in successful endonasal skull base reconstruction, and the nasoseptal flap has become routine in recent years, with excellent results in preventing postoperative CSF rhinorrhea.…”

Banked Fascia Lata in Sellar Dura Reconstruction after Endoscopic Transsphenoidal Skull Base Surgery

“…Standard and extended transsphenoidal approaches to the sella and the anterior cranial base often entail the opening of a large communication channel between the intradural space and the nasal cavity, with the risk of CSF leak and related complications such as meningitis and tension pneumocephalus. [1][2][3]6,7,[11][12][13][14][15][16][17] The rationale of sellar dura repair in CSF leakage is to create a watertight-protective barrier. The issue of the most appropriate intraoperative reconstruction of the anterior skull base, as well as of the repair of postoperative CSF fistulas, remains unresolved.…”

“…[2][3][4][5]8,13,14,[18][19][20][21][22][23][24][25][26] Several authors advocate the use of a pedicled flap, especially in extended approaches. 7,22,27,28 In the decision-making process, the endoscopic surgeon should consider the potential morbidity and technical difficulty of a vascularized flap versus free tissue grafts. 4 According to the literature, the fascia lata seems to be the preferred autologous free grafting material and is most effective when used in a multilayer technique.…”

“…A multilayer technique with autologous fascia lata seems to be the most effective among the free grafts, due to its characteristics of texture and consistency that are similar to dura. 1,4,7 Homologous banked cadaveric fascia lata offers these same advantages, avoiding the complication of autologous harvesting. 9,10 In our preliminary series of 16 patients who underwent transsphenoidal endoscopic skull base surgery, we present the novel application of banked cadaveric fascia lata used successfully to repair intraoperative or postoperative CSF leaks.…”

“…1 Over the past few years, several materials-autologous, eterologous, and synthetic-have been proposed in the repair of CSF leaks, [2][3][4][5][6] especially since the wider indication for extended transsphenoidal approaches has focused the attention on this issue. 1,2,7,8 Synthetic materials tend to be used less often. A multilayer technique with autologous fascia lata seems to be the most effective among the free grafts, due to its characteristics of texture and consistency that are similar to dura.…”