Endonasal approaches to the sellar and parasellar regions: closure techniques using biomaterials

Abstract

The development of biomaterials for closure of the sellar floor offers a viable alternative to traditional techniques using autologous materials.

Using an autologous fibrin sealant in the preventing of cerebrospinal fluid leak with large skull base defect following endoscopic endonasal transsphenoidal surgery

“…Our aim in this study is to discuss the results of 55 patients, who underwent EETS surgery for multilayer skull base reconstruction by using only autologous grafts. As is known, autologous grafts interact with the normal anatomical tissues, stimulating the migration of fibroblasts, and maintain to complete recovery of the anatomical barrier (30). patients, where 2 patients (9.5%) experienced CSF leakage (7).…”

“…and/or some form of rigid/semi-rigid buttressing (nasal septum, sphenoid bone, titanium mesh, biodegradable plates or Foley catheter). Usage of vascularized mucosal flaps, dural substitutes and tissue sealants have also been described (1,4,5,9,10,12,13,15,16,17,18,19,21,22,23,27,28,29,33,34,36,37,39,40,41). Even primary suturing of the dural defects has been reported (31).…”

Injectable hydroxyapatite cement patch as an on-lay graft for the sellar reconstructions following endoscopic endonasal approach

“…Limitation of sellar reconstruction has been regarded as obstacle to the evolution from microscopic surgery to endoscopic surgery despite the advantages of the endoscope, such as a wider and panoramic view [5]. Various reconstructive techniques using a lot of materials have been introduced to repair the skull base defects following endoscopic endonasal surgery [1,16]. Despite these efforts, repair of CSF leaks following transsphenoidal surgery is still a challenging issue among neurosurgeons.…”

Primary Closure of a Cerebrospinal Fluid Fistula by Nonpenetrating Titanium Clips in Endoscopic Endonasal Transsphenoidal Surgery: Technical Note

“…Various techniques have been proposed for the repair of CSF leakage in transsphenoidal surgery. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] Although primary closure of the fistula by stitching would be ideal, it is very difficult to achieve through such a deep and narrow surgical corridor. Therefore, most of the reported techniques employed some kind of graft materials to cover the fistula point or to pack up the free space adjacent to it, usually without secure fixation.…”