The 3F (Fat, Flap, and Flash) Technique For Skull Base Reconstruction After Endoscopic Endonasal Suprasellar Approach

Cavallo, Luigi Maria; Solari, Domenico; Somma, Teresa; Cappabianca, Paolo

doi:10.1016/j.wneu.2019.03.125

Cited by 71 publications

(47 citation statements)

References 21 publications

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“…However, the CSF leak rate has significantly dropped from 25% to 3.6% (P < 0.05) after using vascularized nasoseptal flaps and proper skull base reconstruction, especially in extended EES cases, and the results were comparable with similar studies. 23,25,28,29,33,[41][42][43]56,57 Of our patients, 7.1% experienced meningitis, whereas the prevalence of this in other studies generally ranged from 0%e4.1%. The 30-day mortality rate was 0%, and in the other studies it ranged from 0%e4%.…”

Section: Perioperative Outcomescontrasting

confidence: 54%

Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital

et al. 2020

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BACKGROUND AND OBJECTIVE: Endoscopic endonasal surgery (EES) for the management of sellar, suprasellar, and anterior skull base lesions is gaining popularity. Our aim was to analyze and present the clinical outcomes of EES for the management of these lesions in a community hospital setting.-METHODS: We retrospectively reviewed the charts of 56 patients with sellar, suprasellar, and anterior skull base lesions who underwent EES between 2010 and 2018.-RESULTS: There was male predominance (53.6%) with a mean age of 54.9 AE 13.7 years. Lesions were 45 pituitary adenomas, 5 meningiomas, 3 metastatic, 1 craniopharyngioma, 1 Rathke cyst, and 1 mucocele. Gross total excision was achieved in 57.1%, subtotal excision occurred in 37.5%, and decompression and biopsy were achieved in 5.4% patients. Postoperative vision normalized or improved in 27 patients (86.1%) and was stable in 4 patients (13.9%). Recovery of a preexisting hormonal deficit occurred in 13 (23.2%) patients, and a new hormonal deficit occurred in 9 patients (16.1%). The mean hospital stay was 6.1 AE 4.9 days. Postoperative complications included cerebrospinal fluid leak in 8 patients (14.3%). Four patients (7.1%) had meningitis. Diabetes insipidus was present in 19 patients (33.9%), and postoperative intracranial hematoma requiring evacuation was necessary in 2 patients (3.6%). The mean follow-up duration was 47.5 AE 25.8 months. Lesion progression or recurrence requiring redo surgery occurred in 5 patients (8.9%). Regarding the learning curve, the postoperative cerebrospinal fluid leak, meningitis, new hormonal deficits, and diabetes insipidus decreased in the second half of the patients.-CONCLUSIONS: EES provides an effective and safe surgical option with low morbidity and mortality for the treatment of sellar, suprasellar, and anterior skull base lesions in a community hospital setting.

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Section: Perioperative Outcomescontrasting

confidence: 54%

Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital

et al. 2020

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“…The second F (flap) is the placement of the NSF, bolstered with cellulose sponges, and secured with nasal tamponades for 72 h. The authors mobilize the patient to a sitting position as soon as possible after surgery and they are encouraged to walk and stand as much as possible, the third F (flash). Using this skull base reconstruction protocol, the authors reported a post-operative CSF leak rate of 4% in 25 patients who had large osteodural defects following EEA ( 44 ). Post-operative lumbar drainage was not used.…”

Section: Discussionmentioning

confidence: 99%

Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

2020

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Following the introduction of fully endoscopic techniques for the resection of pituitary tumors, there was a rapid expansion of the indications for endonasal endoscopic surgery to include extrasellar tumors of the skull base. These techniques offer significant advantages over traditional open surgical approaches to the skull base, including improved tumor resection, and better post-operative neurological outcomes. Following their introduction, however, the initial rate of post-operative CSF leak was unacceptably high. Post-operative CSF leak following skull base surgery is a major source of morbidity, and can lead to the development of life-threatening intracranial infection. The use of vascularized naso-septal flaps transformed the management of these patients, significantly reducing the rate of post-operative CSF leak and increasing the number of patients that could benefit from this less invasive treatment modality. Adequate repair of iatrogenic defects in the skull base is of crucial importance for patients with skull base tumors, as the development of a post-operative CSF leak, and the associated complications can significantly delay the administration of the adjunctive oncological therapies these patients require. In this review, we provide an overview of the latest evidence regarding skull base reconstruction following endoscopic skull base surgery, and describe the skull base repair technique in use at our institution.

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“…The main drawback remains the skull base reconstruction, whose failure results in cerebrospinal fluid leakage and its related complications. In recent years, skull base repairing techniques including fat grafts, synthetic materials, and vascular flaps (e.g., the pedicled nasal-septal flap) continue to improve, expanding the indications for these approaches [82][83][84] .…”

Section: Endoscopic Endonasal Surgerymentioning

confidence: 99%

Meningiomas: criteria for modern surgical indications

Cappabianca¹,

d’Avella²,

Cavallo³

et al. 2020

Mini-invasive Surg

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The contemporary management of meningiomas is the result of the continuous evolution of neurosurgical techniques, along with the refinement of dedicated instrumentations. Above all, it is the magnification of the surgical view, thanks to the microscope and the endoscope, and their advancements, which allowed the improvement of surgical outcomes, in terms of both extent of resection and morbidity rates. Because of the benign nature of the vast majority of meningiomas, complete tumor resection is curative, and it is the gold-standard treatment. However, in the case of high risk of surgical morbidity, a less aggressive surgical treatment may be justified, also upon tailored analysis of the meningiomas’ biological behavior and the improvements in postoperative strategies. The endoscopic technique plays a role, as a unique visualization tool or in combination with the microscope, in granting so-called maximum allowed resection. Considering the above, the most challenging task confronting modern meningioma surgery remains the selection of the most appropriate surgical approach, the latter greatly depending on location, anatomic tumor features, and relationships with critical neurovascular structures. Herein, we present a cogent analysis of the modern multifaceted indications for the endoscopic treatment of meningiomas, with a glimpse into the adjacent fields.

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The 3F (Fat, Flap, and Flash) Technique For Skull Base Reconstruction After Endoscopic Endonasal Suprasellar Approach

Cited by 71 publications

References 21 publications

Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital

Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital

Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

Meningiomas: criteria for modern surgical indications

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