Skull base reconstruction after extended transsphenoidal surgery is essential to prevent postoperative cerebrospinal fluid leakage.
A novel and simple technique for skull base reconstruction termed “shoelace dural closure” was devised. The dura mater was closed with a fat graft using a continuous running suture with both ends of a double-armed suture.
The shoelace dural closure is an effective method for achieving watertight closure of the anterior skull base without the use of lumbar drains, fascia lata grafts, or nasoseptal flaps.
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Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.
1. Shoelace dural closure technique is simple and effective for skull base reconstruction after extended transsphenoidal surgery.
2. Fat graft can eliminate the dead space after tumor removal and the gap between the open ends of dura mater.
3. Both sides of dura mater and fat graft are threaded to each other with a running suture.
4. After suturing the dura mater, we confirmed that there was no CSF leakage by performing a Valsalva maneuver.
5. Nasoseptal flap and fascia lata are not used in this technique, and this can avoid the potential risks of postoperative olfactory disturbance and discomfort of surgical site.
6. Spinal drains are not used intra- and postoperatively.
7. The patients are allowed to walk around in their room on postoperative day 1 and freely after postoperative day 2.
8. Nasal endoscopy should be performed to confirm no postoperative CSF leakage after surgery.
9. A paraseptal approach without building a nasoseptal flap is recommended to build the flap immediately and easily if it is required, just in case the shoelace dural closure fails.
10. Shoelace dural closure technique can be adopted to almost all suprasellar lesions but should not be employed in patients with large dural defects.
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Both sides of dura are sutured in running fashion. Fat graft is also sutured to both sides of the dural incision to fill in any gap between the dura. After suturing the dura, Valsalva maneuver is performed to confirm a watertight closure. (MP4 45641 kb)
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Takeuchi, K., Nagatani, T. & Wakabayashi, T. How I do it: shoelace watertight dural closure in extended transsphenoidal surgery. Acta Neurochir 157, 2089–2092 (2015). https://doi.org/10.1007/s00701-015-2612-4
- Extended transsphenoidal surgery
- CSF leakage
- Planum sphenoidale
- Skull base
- Tuberculum sella