One-Piece Modified Gasket Seal Technique

Wessell, Aaron; Singh, Ameet; Litvack, Zachary

doi:10.1055/s-0033-1336278

Cited by 3 publications

(6 citation statements)

References 28 publications

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“…2 , 3 ). The most common autologous graft was composed of fat (Table 2 ) from the abdomen or thigh (137 studies) [ 50 – 57 ]. Techniques to mitigate the potential disadvantages (Table 3 ) of this material included robust dural repair underlying the fat graft with clips [ 51 ] or sutures to protect neurovascular structures from overpacking [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, it requires a suitable bony rim and may not be possible in multiplanar defects [ 110 , 112 ]. A modified version, the “one-piece gasket-seal” used a unitized (via sutures) Medpor and fascia construct, reducing the technical demand of placement, decreasing the time required of manoeuvring the two components into position intra-nasally, and avoiding the need for an underlying fat graft to provide counterpressure during countersinking of the rigid buttress [ 57 ].…”

Section: Resultsmentioning

confidence: 99%

“…Medpor, titanium mesh) [ 92 , 109 , 131 , 137 – 140 ]. Medpor buttresses were commonly used, having the advantage of being mouldable, porous and relatively inert [ 57 , 92 , 137 , 139 ]. Titanium mesh, although strong and mouldable, is not porous.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, nasal packing was described in 96 studies, being balloon or non-balloon based. Balloon-based methods included Foley catheters, Merocel sponges and Rapid Rhino balloons [ 37 , 44 , 46 , 57 , 115 ]. The shape of the balloons may be important for support distribution, stability and patient comfort—with tubular-shaped balloons (e.g.…”

Section: Resultsmentioning

confidence: 99%

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Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

et al. 2021

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Purpose Postoperative cerebrospinal fluid rhinorrhoea (CSFR) remains a frequent complication of endonasal approaches to pituitary and skull base tumours. Watertight skull base reconstruction is important in preventing CSFR. We sought to systematically review the current literature of available skull base repair techniques. Methods Pubmed and Embase databases were searched for studies (2000–2020) that (a) reported on the endonasal resection of pituitary and skull base tumours, (b) focussed on skull base repair techniques and/or postoperative CSFR risk factors, and (c) included CSFR data. Roles, advantages and disadvantages of each repair method were detailed. Random-effects meta-analyses were performed where possible. Results 193 studies were included. Repair methods were categorised based on function and anatomical level. There was absolute heterogeneity in repair methods used, with no independent studies sharing the same repair protocol. Techniques most commonly used for low CSFR risk cases were fat grafts, fascia lata grafts and synthetic grafts. For cases with higher CSFR risk, multilayer regimes were utilized with vascularized flaps, gasket sealing and lumbar drains. Lumbar drain use for high CSFR risk cases was supported by a randomised study (Oxford CEBM: Grade B recommendation), but otherwise there was limited high-level evidence. Pooled CSFR incidence by approach was 3.7% (CI 3–4.5%) for transsphenoidal, 9% (CI 7.2–11.3%) for expanded endonasal, and 5.3% (CI 3.4–7%) for studies describing both. Further meaningful meta-analyses of repair methods were not performed due to significant repair protocol heterogeneity. Conclusions Modern reconstructive protocols are heterogeneous and there is limited evidence to suggest the optimal repair technique after pituitary and skull base tumour resection. Further studies are needed to guide practice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

et al. 2021

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“…So genügt an der vorderen Schädelbasis oft ein 1-bis 2-faches "inlay" von Faszia lata mit einem zusätzlichen "overlay" der Faszie [562]. Ein kombinierter Verschluss von Duradefekten mit Weichgewebe und Hartmaterial nach dem Vorbild einer Dichtungsscheibe ("gasket-seal") hat in der Literatur viel Zuspruch gefunden [115,326,540,551,563]. Diese Technik hat jedoch plane Defekte mit stabilen knöchernen Rändern zur Voraussetzung und ist z.…”

Section: Materialien Und Verfahrenunclassified

Rhino-Neurochirurgie

Hosemann

Schroeder

2015

Laryngo-Rhino-Otol

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In the past 2 decades, an innovative and active field of surgical collaboration has been evolved and established combining the expertise of Neurosurgery and Rhinosurgery in treatment of different lesions affecting the anterior skull base together with the adjacent intranasal and intradural areas. Important prerequesites for this development were improvements of technical devices, definitions of transnasal surgical corridors and approvements in endonasal reconstruction e. g. by use of pedicled nasal mucosal flaps. Interdisciplinary surgical teams have been established constituting specialized centers of "rhino-neurosurgery". With growing experience of these groups, it could be shown that oncological results and perioperative complications were comparable to traditional surgery while at the same time, patient's morbidity could be reduced.The present review encompasses the recent literature focussing on the development, technical details, results and complications of "rhino-neurosurgery".

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Endoscopic endonasal resection of sinonasal teratocarcinosarcoma with intracranial breakthrough: illustrative case

Ni¹,

Xu²,

Zhang³

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Teratocarcinosarcoma traversing the anterior skull base is rarely reported in literature. The heterogenous and invasive features of the tumor pose challenges for surgical planning. With technological advancements, the endoscopic endonasal approach (EEA) has been emerging as a workhorse of anterior skull base lesions. To date, no case has been reported of EEA totally removing teratocarcinosarcomas with intracranial extensions. OBSERVATIONS The authors provided an illustrative case of a 50-year-old otherwise healthy man who presented with left-sided epistaxis for a year. Imaging studies revealed a 31 × 60-mm communicating lesion of the anterior skull base. Gross total resection via EEA was achieved, and multilayered skull base reconstruction was performed. LESSONS The endoscopic approach may be safe and effective for resection of extensive teratocarcinosarcoma of the anterior skull base. To minimize the risk of postoperative cerebrospinal fluid leaks, multilayered skull base reconstruction and placement of lumbar drainage are vitally important.

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One-Piece Modified Gasket Seal Technique

Cited by 3 publications

References 28 publications

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

Rhino-Neurochirurgie

Endoscopic endonasal resection of sinonasal teratocarcinosarcoma with intracranial breakthrough: illustrative case

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