Experience and modification of skull base reconstruction results in lower complications rates

Luo, Chuanming; Liu, Xiaohong; Xie, Shenhao; Hong, Tao; Tang, Bin

doi:10.1007/s00701-021-05082-w

Cited by 5 publications

(7 citation statements)

References 21 publications

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“…In situ bone flap or nasal septum bone flap + VP-NSF were used to repair the bony structure of the skull base after September 2018 ( Table 5 ). Among the 104 patients who used bone reconstruction combined with membranous reconstruction, 1 case developed postoperative CSF leakage (0.9%, 1/104) and 4 cases developed intracranial infection (3.8%, 4/104), consistent with previous studies ( 12 ), suggesting the reconstruction effect is reliable. Furthermore, the univariate and multivariate analyses results confirmed that bone flap reconstruction was the protective factor of postoperative CSF leakage (OR = 0.313, 95% CI: 0.099–0.694, P = 0.019).…”

Section: Discussionsupporting

confidence: 86%

“…All these results suggest that postoperative LD does not reduce the incidence of postoperative CSF leakage. Our data suggest that the bone flap combined with the mucosal flap is sufficient to resist intraoperative grade 3 flow CSF leakage without the need for postoperative LD ( 12 ). However, we do not deny the role of postoperative LD in reconstruction strategy.…”

Section: Discussionmentioning

confidence: 73%

“…Although the incidence of postoperative CSF leakage was significantly reduced by 5%-10% with reconstruction using the VP-NSF multilayer reconstruction technique (8,(12)(13)(14), the complications still remained unacceptable. Thus, it is imperative to explore the causes of postoperative CSF leakage and potential influencing factors.…”

Section: Discussionmentioning

confidence: 99%

“…Decision of harvesting a vascularized pedicle nasoseptal flap (VP-NSF) or a free mucosal flap was made according to the surgery approach (classic EES or expend EES). After harvesting the NSF, the posterior nasal tract was opened and the nasal septum bone flap was made; the details are described in our previous article ( 12 ). Wide opening of the sphenoid sinus after the nasal procedure, exposing the posterior and lateral walls of the sphenoid sinus, with the sellar floor at the center, the sphenoethmoid planum above, and the clival indentation below.…”

Section: Methodsmentioning

confidence: 99%

“…

Hong T and Tang B (2022) Exploration of the causes of cerebrospinal fluid leakage after endoscopic endonasal surgery for sellar and suprasellar lesions and analysis of risk factors.

…”

mentioning

confidence: 99%

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Exploration of the causes of cerebrospinal fluid leakage after endoscopic endonasal surgery for sellar and suprasellar lesions and analysis of risk factors

et al. 2022

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ObjectivePostoperative cerebrospinal fluid (CSF) leakage following endoscopic endonasal surgery (EES) is a frequent complication. This study aims to identify potential risk factors of postoperative CSF leakage.MethodsA retrospective review of 360 patients who underwent EES was included. The associations between postoperative CSF leakage and patient demographics, medical history, tumor characteristics, and intraoperative repair techniques were analyzed; the diagnosis and repair of postoperative CSF leakage were also introduced.ResultsPostoperative CSF leakage occurred in 14 patients (3.9%), 2 of them cured by lumbar cistern drainage, 12 underwent endoscopic repair. Among these 12 cases, 3 were repaired twice, and the rest were cured the first time. During the repair surgery, insufficient embedded fat was detected in one case detected, seven with breached inner artificial dura, three had vascularized pedicle nasoseptal flap (VP-NSF) displacement, two with VP-NSF perforation, two with VP-NSF inactivation, and one with imperfect adherence to VP-NSF to the skull base. Eight cases had intracranial infections. Excluding one case who died of severe intracranial infection, the rest were cured and discharged without obvious sequelae. Multivariate analysis revealed that the suprasellar lesion, subarachnoid invasion, and intraoperative grade 3 flow CSF leakage were the risk factors of CSF leakage after operation, while the bone flap was a protective factor.ConclusionBone flap combined with VP-NSF and iodoform gauze for skull base reconstruction is recommended in high-risk patients, while postoperative lumbar cistern drain remains dispensable.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…

Hong T and Tang B (2022) Exploration of the causes of cerebrospinal fluid leakage after endoscopic endonasal surgery for sellar and suprasellar lesions and analysis of risk factors.

…”

mentioning

confidence: 99%

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Exploration of the causes of cerebrospinal fluid leakage after endoscopic endonasal surgery for sellar and suprasellar lesions and analysis of risk factors

et al. 2022

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Free temporalis muscle fascia graft in dural reconstruction following surgical resection of intermediate and malignant skull base tumors: A 10‐year experience from a single center

Jurlina,

Mamic,

Pupic‐Bakrac

et al. 2024

Head & Neck

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BackgroundData from patients with post‐ablative dural defects reconstructed using a free temporalis muscle fascia graft (FTFG) after resection of anterior or central skull base tumors were retrospectively analyzed.MethodsThe primary predictor and outcome variables were the reconstructive methods for dural repair and postoperative cerebrospinal fluid (CSF) leakage rate, respectively.ResultsEighty patients were included, and 94 postoperative dural reconstructions were performed using FTFG. The postoperative CSF leakage rate was 3.19%. The postoperative CSF leakage rates did not significantly differ between open and endonasal endoscopic surgeries (1.92% vs. 4.88%; p > 0.05). In cases completed using the endonasal endoscopic approach, the postoperative CSF leakage rate was significantly associated with the intraoperative CSF leak flow (p < 0.05).ConclusionsPost‐ablative dural defect reconstruction using FTFG resulted in low postoperative CSF leakage and complication rates comparable to those of free fascia lata graft from available literature.

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Extended Endoscopic Endonasal Approach for Giant Pediatric Craniopharyngiomas: Technical Note and Case Series

Bao,

Pan,

et al. 2024

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Giant pediatric craniopharyngiomas are rare tumors whose clinical and surgical management is extremely challenging. A variety of open transcranial approaches has been used to resect these lesions. Although there has been an increasing acceptance of the endoscopic endonasal approach (EEA) for the resection of pediatric craniopharyngiomas in recent years, many surgeons continue to recommend against the use of the EEA for giant pediatric craniopharyngiomas. This study aimed to evaluate the feasibility of extended EEA for giant craniopharyngiomas in the pediatric population. METHODS: All consecutive pediatric patients with giant craniopharyngiomas (diameter >4 cm) who underwent endoscopic endonasal surgery at our institution were retrospectively reviewed. Data on demographic information, preoperative assessment, imaging features, surgical results, complications, and recurrences were recorded and analyzed. RESULTS: A total of 16 pediatric patients with an average age of 12 years were identified. The mean maximum diameter and volume of the tumors were 4.35 cm and 24.1 cm3, respectively. Gross total resection was achieved in 13 patients (81.3%) and subtotal resection in 3 patients (18.7%). Postoperatively, partial or complete anterior pituitary insufficiency occurred in 100% of patients, and 62.5% developed new-onset diabetes insipidus. Visual function improved in 9 patients (56.3%) and remained stable in 7 patients (43.7%). Postoperative cerebrospinal fluid leakage occurred in 2 patients and was successfully repaired through the EEA. During a mean follow-up of 44.3 months, 18.8% of patients had a >9% increase in body mass index, and 93.8% of patients successfully returned to school or work. Two patients (12.5%) suffered a recurrence. Disease control was achieved in 16 patients (100%) at final follow-up. CONCLUSION: The extended EEA allows adequate access to this challenging tumor and enables complete resection and visual improvement with a reasonable approach-related complication rate.

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Experience and modification of skull base reconstruction results in lower complications rates

Cited by 5 publications

References 21 publications

Exploration of the causes of cerebrospinal fluid leakage after endoscopic endonasal surgery for sellar and suprasellar lesions and analysis of risk factors

Exploration of the causes of cerebrospinal fluid leakage after endoscopic endonasal surgery for sellar and suprasellar lesions and analysis of risk factors

Free temporalis muscle fascia graft in dural reconstruction following surgical resection of intermediate and malignant skull base tumors: A 10‐year experience from a single center

Extended Endoscopic Endonasal Approach for Giant Pediatric Craniopharyngiomas: Technical Note and Case Series

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