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Fascia patchwork closure for endoscopic endonasal skull base surgery

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Abstract

With the development of endoscopic technology and surgery, resection of midline skull base tumors has been achieved using endoscopic endonasal skull base (EESB) approaches. EESB approaches reportedly have a greater risk of postoperative cerebrospinal fluid (CSF) leakage. Recently, the introduction of the nasoseptal flap (NSF) decreased dramatically the incidence of CSF leakage, but the use of an NSF increases the risk of disturbing the function of the nose. Here, we report our new technique called “fascia patchwork closure” for closure after EESB surgery and its outcome. All 48 cases involved midline skull base tumors resected via EESB approaches. Of them, 32 cases were closed by the fascia patchwork technique after tumor resection, and there was no incidence of CSF leakage. Moreover, 6 of the 32 cases were closed without the use of an NSF, indicating that the fascia patchwork closure approach is effective as part of a multilayer closure for the prevention of CSF leakage. The establishment and popularization of this technique might result in the further development of EESB surgery and also an improvement of postoperative nasal function.

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Acknowledgments

None of the authors received a financial assistance or has a remunerative association with any of the manufacturers mentioned in the manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan

    Yudo Ishii & Akira Matsuno

  2. Department of Neurosurgery, Nippon Medical School, Tokyo, Japan

    Shigeyuki Tahara, Yujiro Hattori & Akio Morita

  3. Department of Neurosurgery, Japan Labour Health and Welfare Organization Tokyo Rosai Hospital, Tokyo, Japan

    Akira Teramoto

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  1. Yudo Ishii
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  2. Shigeyuki Tahara
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  3. Yujiro Hattori
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  4. Akira Teramoto
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  5. Akio Morita
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  6. Akira Matsuno
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Corresponding author

Correspondence to Yudo Ishii.

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Comments

Luigi Maria Cavallo, Domenico Solari, and Paolo Cappabianca, Naples, Italy

In recent times, neurosurgical community has been observing the widespread and refinement of the extended endonasal surgery for the treatment of intradural lesions, especially with the endoscopic technique, lately attributing a role in the armamentarium of skull base approaches. On the other hand, lights have been pointed toward its major drawback, i.e., the postoperative CSF leakage. Skull base reconstruction techniques after extended approaches are developing to respond to the almost inadmissible initial postoperative CSF leak rates. In the attempt to fix the problem, many ideas have been proposed in regard to reconstruction techniques, which can be used in several different methods, individually or combined in a multilayer fashion. In these terms, the present contribution should be considered praiseworthy as it offers another option to be considered for osteodural repair for those who are involved in such continuously evolving kind of surgery. The idea of suturing dura, as in conventional transcranial surgery, seems though effective and has been already described by different authors [1, 3, 5, 8, 9]. However, the fact that this technique is very technically demanding and time consuming prevents at the moment its wide acceptance and diffusion. Both these factors could increase the risk of failure without an adequate expertise, especially considering that these maneuvers should be carried out at the end of a surgical procedure. For such a reason, a surgical team made up by a neurosurgeon and an otolaryngologist, sharing fatigues and increasing competences, is advisable. Moreover, the effectiveness showed by their results makes the authors able to afford the use of this technique only as a step of a multilayer reconstruction technique, being the success related to a combined strategy.

No consensus has been yet established in regard to the material or materials’ combination that can be considered ideal for the repairing of osteo-dural defects. Nowadays, we can assess that after an endoscopic endonasal approach extended to the skull base, a multilayer reconstruction technique, addressing properly each compartment from the subarachnoidal to the epidural, is required. Indeed, this careful and peer attitude for this aspect of the surgery has permitted to render postoperative CSF leakage rates acceptable [2, 4, 6, 7].

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Ishii, Y., Tahara, S., Hattori, Y. et al. Fascia patchwork closure for endoscopic endonasal skull base surgery. Neurosurg Rev 38, 551–557 (2015). https://doi.org/10.1007/s10143-015-0614-6

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