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Quick and simple dural threading technique for transsphenoidal surgery — dural tenting, haemostasis and skull base reconstruction

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Abstract

Background

Dural suturing is one of the most robust reconstruction methods in transsphenoidal surgery; however, the technique is considered difficult, primarily due to the restricted range of needle movement.

Method

We performed dural threading during transsphenoidal surgery by holding the needle with forceps as a hook and moving the needle in a distal to proximal direction.

Conclusion

Our dural suturing technique is simple and quick. It can be used not only for dural closure but also for other procedures, such as controlling haemostasis from the intercavernous sinus and dural tenting.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

TSA:

Transsphenoidal approach

AIS:

Anterior intercavernous sinus

CSF:

Cerebro-spinal fluid

References

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Nagoya City, , Aichi, 466-8550, Japan

    Kazuhito Takeuchi, Yuichi Nagata, Kuniaki Tanahashi & Ryuta Saito

Authors
  1. Kazuhito Takeuchi
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  2. Yuichi Nagata
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  3. Kuniaki Tanahashi
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  4. Ryuta Saito
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Contributions

KT had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: KT, YN. Literature Review: KT, KT. Drafting of the manuscript: KT. Critical revision of the manuscript for important intellectual content: All authors. Supervision: RS.

Corresponding author

Correspondence to Kazuhito Takeuchi.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Institutional Review Board at Nagoya University.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Key Points

1. Dural suturing is one of the most robust skull base reconstruction techniques in transsphenoidal surgery.

2. Conventional suturing techniques are not widely used because they are thought to be difficult and time consuming.

3. Difficulty in suturing the dura is the result of insufficient manipulation space when performing a twisting motion of the needle in the nasal cavity.

4. In the proposed technique, the needle is held like a hook, and then the dura is hooked with a simple pulling movement.

5. A knot is made external to the nostril and tied by advancing towards the surgical site.

6. Dura suturing can also be applied for haemostasis at the anterior intercavernous sinus.

7. Meticulous attention must be taken to avoid damaging the internal carotid artery, optic nerve, and other vital structures while passing the needle through the dura.

8. The use of an angled endoscope can enhance safety by improving intracranial visualization during suturing.

9. A double head needle is useful for skullbase dural reconstruction.

10. The dural suturing technique can also be used for haemostasis from the anterior intercavernous sinus without shrinkage of the dura.

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Supplementary Information

Below is the link to the electronic supplementary material.

Introduction of the suturing technique and applications

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Takeuchi, K., Nagata, Y., Tanahashi, K. et al. Quick and simple dural threading technique for transsphenoidal surgery — dural tenting, haemostasis and skull base reconstruction. Acta Neurochir 164, 1619–1622 (2022). https://doi.org/10.1007/s00701-022-05227-5

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  • DOI: https://doi.org/10.1007/s00701-022-05227-5

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