Size-adjustable titanium plate for reconstruction of the sella turcica

Arita, Kazunori; Kurisu, Kaoru; Tominaga, Atsushi; Ikawa, Fusao; Iida, Koji; Hama, Selji; Watanabe, H

doi:10.3171/jns.1999.91.6.1055

Cited by 57 publications

(36 citation statements)

References 12 publications

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“…Other groups use a various combination of fat, fascia, and muscle in addition to other types of synthetic materials to reconstruct the sella. 7 Some have used a dural suture 34 for closure of the sella as well as various other techniques, including incorporation of rigid buttresses such as titanium, 3 bone, 9 or cartilage to hold the sellar packing in place. 7 For larger sellar defects often encountered after extended transsphenoidal approaches, Hadad et al 14 used the combination of fascia lata, abdominal fat, mucoperiosteum, and fibrin sealants followed by a vascularized nasal septal mucosal flap as a final layer, with reinforcement of this construct via an inflated Foley catheter balloon.…”

Section: Discussionmentioning

confidence: 99%

Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

Dlouhy¹,

Madhavan²,

Clinger³

et al. 2012

JNS

119

145

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ObjectPostoperative CSF leakage can be a serious complication after a transsphenoidal surgical approach. An elevated body mass index (BMI) is a significant risk factor for spontaneous CSF leaks. However, there is no evidence correlating BMI with postoperative CSF leak after transsphenoidal surgery. The authors hypothesized that patients with elevated BMI would have a higher incidence of CSF leakage complications following transsphenoidal surgery.MethodsThe authors conducted a retrospective review of 121 patients who, between August 2005 and March 2010, underwent endoscopic endonasal transsphenoidal surgeries for resection of primarily sellar masses. Patients requiring extended transsphenoidal approaches were excluded. A multivariate statistical analysis was performed to investigate the association of BMI and other risk factors with postoperative CSF leakage.ResultsIn 92 patients, 96 endonasal endoscopic transsphenoidal surgeries were performed that met inclusion criteria. Thirteen postoperative leaks occurred and required subsequent treatment, including lumbar drainage and/or reoperation. The average BMI of patients with a postoperative CSF leak was significantly greater than that in patients with no postoperative CSF leak (39.2 vs 32.9 kg/m2, p = 0.006). Multivariate analyses indicate that for every 5-kg/m2increase in BMI, patients undergoing a transsphenoidal approach for a primarily sellar mass have 1.61 times the odds (95% CI 1.10–2.29, p = 0.016, by multivariate logistic regression) of having a postoperative CSF leak.ConclusionsElevated BMI is an independent predictor of postoperative CSF leak after an endonasal endoscopic transsphenoidal approach. The authors recommend that patients with BMI greater than 30 kg/m2have meticulous sellar reconstruction at surgery and close monitoring postoperatively.

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Section: Discussionmentioning

confidence: 99%

Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

Dlouhy¹,

Madhavan²,

Clinger³

et al. 2012

JNS

119

145

View full text Add to dashboard Cite

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“…In this series, Lang reported the use of intracranial fat packing, which was not used in any of our button grafted patients. Multiple other repair techniques have been proposed in the current literature, ranging from synthetic material 6,11 to reconstruction of bony defects 12,13,14 . The use of vascularized tissue has allowed considerable improvement in closure of cranial base defects 3,5,15,16,17 .…”

Section: Resultsmentioning

confidence: 99%

Endoscopic repair of high‐flow cranial base defects using a bilayer button

et al. 2010

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Objectives/Hypothesis:Repair of the skull base still begins with a direct repair of the dural defect. We present a new button closure for primary repair of the dura for high flow defects.Study Design:Retrospective review.Methods:We reviewed our 20 cases of primary button grafts and compared the results to the previous 20 high‐flow open‐cistern cerebrospinal fluid (CSF) cases. Subjects were excluded if they had no violation of the arachnoid space or potential for low‐flow CSF leak. The button is constructed so that the inlay portion is at least 25% larger than the dural defect, and the onlay portion is just large enough to cover the dural defect. The two grafts are sutured together using two 4‐0 Neurolon sutures and placed with the inlay portion intradurally and the onlay portion extradurally.Results:The button graft repair of open‐cisternal defects had a drop in CSF leak complications to 10% (2/20), and these two leaks were repaired with the button technique as the salvage surgery. This is a significant improvement over the 45% leak rate in the prebutton graft group (P < .03). In our button graft group we used nasoseptal flaps on 16/20 repairs, and 1/2 repairs that leaked in the button group did not have a nasoseptal flap. Lumbar drains were used in ∼38% in both groups (P = .83).Conclusions:The button graft can be used in conjunction with the nasal septal flap or as a stand‐alone repair with good results reducing the postoperative leak rate to 10% for high‐flow CSF repairs. Laryngoscope, 2010

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“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Yıldırım

Dursun²,

Özdöl³

et al. 2013

Turkish Neurosurgery

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AIm: Postoperative cerebrospinal fluid (CSF) leak following endoscopic endonasal transsphenoidal surgery (EETS) is associated with increased morbidity and mortality. This prospective study is the first evaluation of using autologous fibrin sealant for preventing postoperative CSF leak and related complications. mAterIAl and methOds: 200 endoscopic endonasal transsphenoidal approaches were included in the study and reviewed retrospectively from September 2010 to June 2012. A total of 55 patients who have large skull base and diafragma sella defects, connected with basal cisterns or ventricles, were chosen for the study. The patients were operated via extended or classical endoscopic endonasal transsphenoidal approach. The skull base has been repaired using AFS combined with multilayer reconstruction in all cases. The incidence of CSF leak as a complication of EETS was analyzed. results:The ages of the patients ranged from 20 to 83 years (mean 49.3 years). There were 25 (46%) male patients and 30 (54%) females. All patients had tumors with suprasellar or parasellar extension. Postoperative CSF leak was determined in 2 patients (3.6%). There were no complications and allergic reactions associated with the use of AFS.COnClusIOn: Using of AFS combined with multilayer reconstruction technique is a safe and effective method to prevent CSF leak in large defects following EETS.

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Size-adjustable titanium plate for reconstruction of the sella turcica

Cited by 57 publications

References 12 publications

Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

Endoscopic repair of high‐flow cranial base defects using a bilayer button

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

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