Abstract
Management of cerebrospinal fluid (CSF) leak due to a variety of clinical conditions is a challenging problem for the neurosurgeon, and life-threatening complications can arise unless the CSF leak is handled appropriately. Numerous methods have been described and used for prevention of CSF rhinorrhea, including vascularized pedicle flaps, free vascularized flaps, grafts, and alloplastic materials. The primary objective of this study is to evaluate the role of Cortoss, which provides three-dimensional reconstruction with watertight and weight-bearing support in the treatment of anterior cranial base bony defects. Ten consecutive patients with anterior skull base defects including frontal bone, frontal sinus, cribriform plate, orbital roof, ethmoid sinus, planum sphenoidale, sphenoid sinus, secondary to tumor invasion or traumatic injury were included in this study. The surgical technique is simple and effective, and consists of filling the bony defect with Cortoss. Surgical glue was required for dural repair only. Lumbar CSF drainage in the postoperative period was performed in two patients. These patients had fractures in the lateral walls of their sphenoid sinuses, which were managed via intracranial route. At a mean postoperative follow-up time of 8.9 months, none of the patients had developed complications including infections, meningocele, or recurrent CSF fistula. The use of Cortoss in the case of anterior skull base defects seems to be safe, effective, quick, and a feasible method for reconstruction. This technique may eliminate the use of adjunct materials including fat, muscle, fascia, and bone.
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Badie B, Preston JK, Hartig GK (2000) Use of titanium mesh for reconstruction of large anterior cranial base defects. J Neurosurg 93:711–714
Bowman CN, Peppas NA (1991) Coupling kinetics and volume relaxation during polymerizations of multiacrylates and multimethacrylates. Macromolecules 24:1914–1920
Bronson JG (2003) Tissue transplantation and engineering: what is happening? Orthop Technol Rev 5(5). http://www.orthopedictechreview.com
Costantino PD, Friedman CD, Jones K, Chow LC, Sisson GA (1992) Experimental hydroxyapatite cement cranioplasty. Plast Reconstr Surg 90:174–185
Costantino PD, Friedman CD, Jones K, Chow LC, Pelzer HJ, Sisson GA (1999) Hydroxyapatite cement, I: basic chemistry and histologic properties. Arch Otolaryngol Head Neck Surg 117:379–384
Costantino PD, Chaplin JM, Wolpoe ME et al. (2000) Applications of fast-setting hydroxyapatite cement: cranioplasty. Otolaryngol Head Neck Surg 123:409–412
Costantino PD, Hiltzik DH, Sen C et al. (2001) Sphenoethmoid cerebrospinal fluid leak repair with hydroxyapatite cement. Arch Otolaryngol Head Neck Surg 127:588–593
Deramond H, Depriester C, Galibert P, Le Gars D (1998) Percutaneous vertebroplasty with polymethylmethacrylate, technique, indications, and results. Radiol Clin N Am 36:533–546
Erbe EM, Clineff TD, Gualtieri G (2001) Comparison of a new bisphenol-a-glycidyl dimethacrylate-based cortical bone void filler polymethyl methacrylate. Eur Spine J 10:S147–S152
Goel A, Gupta S (2000) Reconstruction of the skull base: a review of personal technique. Neurol India 48:208–215
Jackson IT, Adham NM, Marsh WR (1986) Use of the galea frontalis myofacial flap in craniofacial surgery. Plast Reconstr Surg 77:905–910
Jones NF, Sekar LN, Schramm VL (1986) Free rectus abdominis muscle flap reconstruction of the middle and posterior cranial base. Plast Reconstr Surg 78:471–477
Kawanabe K, Tamura J, Yamamuro T, Nakamura T, Kokubo T, Yoshihara S (1993) A new bioactive bone cement consisting of bis-GMA resin and bioactive glass powder. J Appl Biomater 4:135–141
Kawaura M, Nameki H, Fujii M, Kanzaki J (1997) Use of vertical median forehead flap in the reconstruction of the anterior skull base: report of two cases. Auris Nasus Larynx 24:379–383
Kobayashi M, Nakamura T, Tamura J, Kikutani T, Nishiguchi S, Mousa WF, Takahashi M, Kokubo T (1999) Osteoconductivity and bone-bonding strength of high- and low-viscous bioactive bone cements. J Biomed Mater Res (Appl Biometer) 48:265–276
Krishman KG, Winkler PA, Müller A, Grevers G, Steiger HJ (2000) Closure of recurrent frontal skull base defects with vascularized flaps: a technical report. Acta Neurochir (Wien) 142:1353–1358
Mathur K, Tatum SA, Kellman RM (2003) Carbonated apatite and hydroxyapatite in craniofacial reconstruction. Arch Facial Plast Surg 5:379–383
Mori K, Nakajima M, Maeda M (2003) Simple reconstruction of frontal sinus opened during craniotomy using small autogeneous bone piece: technical note. Surg Neurol 60:326–328
Pomrink GJ, DiCicco MP, Clineff TD, Erbe EM (2003) Evaluation of the reaction kinetics of Cortoss, a thermoset cortical bone void filler. Biomaterials 24:1023–1031
Price JC, Loury M, Carson B, et al. (1998) The pericranial flap for reconstruction of anterior skull base defects. Laryngoscope 98:1159–1164
Ross DA, Marentette LJ, Thompson G, Haller J (1999) Use of bone cement to prevent cerebrospinal fluid leakage through the frontal sinus: technical report. Neurosurgery 45:401–403
Senyuva C, Yucel A, Okur I, Cansız H, Sanus GZ (1996) Free rectus abdominis muscle flap for the treatment of complications after neurosurgical procedures. J Craniofac Surg 7(4):317–321
Shindo ML, Costantino PD, Friedman CD, Chow JC (1993) Facial skeletal augmentation using hydroxyapatite cement. Arch Otolaryngol Head Neck Surg 119:185–190
Weissman JL, Synderman CH, Hirsch BE (1996) Hydroxyapatite cement to repair skull base defects: radiologic appearance. Am J Neuroradiol 17:1569–1574
Yamamuro T, Nakamura T, Iida H, Kawanabe K, Matsuda Y, Ido K, Tamura J, Senaha Y (1998) Development of bioactive bone cement and its clinical applications. Biomaterials 19:1479–1482
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An erratum to this article can be found at http://dx.doi.org/10.1007/s00238-005-0807-2
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Sanus, G.Z., Tanriverdi, T., Kafadar, A.M. et al. Use of Cortoss for reconstruction of anterior cranial base: a preliminary clinical experience. Eur J Plast Surg 27, 371–377 (2005). https://doi.org/10.1007/s00238-004-0711-1
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DOI: https://doi.org/10.1007/s00238-004-0711-1