Skip to main content
SpringerLink
Log in

Our Experience in Trans Nasal Endoscopic Repair of Anterior Skull Base Defects Reinforced with Multiple Layers of Graft Materials

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Aims: To determine the best technique to repair anterior skull base defects using various grafts. Materials & Methods: This Ambi-directional cohort study was carried out at a tertiary care hospital from May 2019 to October 2021. A total of 17 patients who underwent Endoscopic Repair of Anterior Skull Base Defects using various grafts were included in the study. Detailed history and clinical evaluation followed by Diagnostic Nasal Endoscopy, Biochemical and Radiological investigations were done for all patients with postoperative follow-up for at least 6 months. Results: Most common site of anterior skull base defect in our study group was the posterior wall of the sphenoid sinus. Various graft materials used in our study were fascia lata, thigh fat, Hadad flap, Septal cartilage, nasal septal bone chip, septal mucosal free flap, surgicel and fibrin glue. The most commonly used sequence of graft materials used is the fat(underlay) - fascia lata - fat(overlay). Various complications that occurred were nasal bleeding, residual CSF leak, localized collection of pus in the Septal region, cerebral oedema and Alar trauma. Conclusions: The success of Anterior skull base defect repair depends on watertight Dural closure with multiple layers of grafts to prevent postoperative CSF leak. Although dependent on the Surgeon’s preference, usually the sequence of an underlay fat - fascia lata - overlay fat followed by glue/gel foam/Hadad flap works well. Even after discharging the patient, regular follow-up and evaluation ensure that the graft is in situ and there is no CSF leak or other complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. “Endoscopic repair of anterior or middle skull base cerebrospinal fluid leaks after tumour resection”;Article by G.Mortuaire, S.Vandeville, R.Assaker, D.Chevalier

  2. “Surgical technique for repair of complex anterior skull base defects”article by Kevin Reinard and Jack Rock

  3. “Anterior skull base defects reconstructed using three layer method” article by Murat Geyik,Ibrahim Iruku and Abdulvahap Gok

  4. “Management of anterior skull base defect depending on size and location” (Volume 2014) Article by Manuel Bernal-Sprekelsen, Elena Rioja, Joaquim Enseñat, Karla Enriquez, Liza Viscovich, Freddy Enrique, Agredo-Lemos, and Isam Alobid. Biomed Research International. Article ID 346873

  5. “CSF Leaks” Chap. 108, Sect. 3-Rhinology, Volume 1, 8th Edition, Scott- Brown’s Otorhinolaryngology, Head and Neck Surgery

  6. Rhinorrhea” “CSF Chap. 48, Part IV, Volume 1, 7th Edition, Cummings Otolaryngology, Head and Neck Surgery

  7. “Anterior skull base reconstruction: a contemporary Review”; article by, Akash N, Naik, Peter J, Lancione, Anuraag S, Parikh C, Lin DA, Silverman RL, Carrau Kyle K. VanKoevering, Nolan B. Seim, Matthew O. Old, Stephen Y. Kang

  8. “Age-related and Gender-related occurrence of pituitary adenomas” ; Article by Thomas Mindermann and Charles B. Wilson, Department of Neurological Surgery, School of Medicine,University of California, San Francisco, California, USA

  9. “Endoscopic endonasal repair, Nyquist G, Vijay MD, Anand K, Saral MD, Mehra MD, Ashutosh Kacker MBA, Theodore MD, Schwartz H (2010) Of anterior skull base non-traumatic cerebrospinal fluid leaks, meningoceles, and encephaloceles”; article by Gurston. M D J Neurosurg 113:961–966

    Article  Google Scholar 

  10. “Management of spontaneous CSF Rhinorrhea : An institutional experience”; article by Amit Keshari, Rajat Jain, Ravi Shankar Manogaran, Sanjay Behari, Deepak Khatri and Arulaben Mathialagan,Journal of Neurological Surgery B Skull Base, 2019 Oct, 80(5):493–499. DOI: https://doi.org/10.1055/s-0038

  11. “Spontaneous CSF, Vidyasagar D, Naveen Kumar M, Sudhakshin P, Chandra SVSharath, Hameed S (2013 Aug) Indian J Otolaryngol Head Neck Surg 65(Supp2):271–275 Published online 2012 Feb 1. https://doi.org/10.1007/s12070-011-0431-3

Download references

Author information

Authors and Affiliations

  1. Department of E.N.T and Head-Neck Surgery, Govt. Medical College and S.S.G. Hospital, Vadodara, Gujarat, India

    Yethin Yedukumar, Rahul Gupta, Yamini Patel & R. G. Aiyer

Authors
  1. Yethin Yedukumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rahul Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yamini Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. G. Aiyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rahul Gupta.

Ethics declarations

Conflict of interest

All the authors declare that they have no conflict of interest in the submission of this manuscript.

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Ethical Approval

All procedures performed in the studies involving human participants were by the ethical standards of the institutional research committee.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yedukumar, Y., Gupta, R., Patel, Y. et al. Our Experience in Trans Nasal Endoscopic Repair of Anterior Skull Base Defects Reinforced with Multiple Layers of Graft Materials. Indian J Otolaryngol Head Neck Surg 75, 2814–2822 (2023). https://doi.org/10.1007/s12070-023-03866-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-023-03866-3

Keywords

Search

Navigation