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Reconstruction of skull base bone defects using an in situ bone flap after endoscopic endonasal transplanum-transtuberculum approaches

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Abstract

Purpose

The creation of bone flaps which can be later repositioned and fixed in situ for repairing the bone defects during the endoscopic endonasal approaches (EEAs)—similar to transcranial craniotomies—is still a challenge. We present an in situ bone flap (ISBF) closure for the repair of bone defects after endoscopic endonasal transplanum-transtuberculum approaches (EETAs).

Methods

A retrospective analysis of consecutive patients who underwent the EETAs between January 2016 and February 2019 was performed. According to whether or not to use ISBF for skull base reconstruction, these patients were divided into the ISBF group or the non-ISBF group.

Results

Of 47 patients in the ISBF group, only one patient (2.1%) developed postoperative cerebrospinal fluid (CSF) leakage, yielding a significantly lower leakage rate in the ISBF group than in the non-ISBF group (6 of 38, 15.8%, P = 0.042). Besides, when only comparing cases of hydrocephalus in the two groups, the CSF leakage rate in the ISBF group was 8.3% (1/12), which was still significantly lower than that in the non-ISBF group (62.5%, 6/8) (P = 0.018). Postoperative CSF leakages in both groups were successfully treated with lumbar drainage alone, and no cases of injury to the internal carotid arteries or optic nerves occurred in either group.

Conclusions

An ISBF closure similar to transcranial craniotomies with repositioning bone flap in situ—is feasible, safe, and reliable. The ISBF closure combining with a pedicled nasoseptal flap (PNSF) provides the cranial base surgeon with an additional repair method that has demonstrated effectiveness at facilitating a more stable and durable reconstruction and reducing CSF leaks.

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The authors declared that this study has received no financial support.

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Authors and Affiliations

  1. Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuzhong District, Chongqing, People’s Republic of China

    Biao Jin, Xiao-shu Wang, Gang Huo, Jia-min Mou & Gang Yang

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  1. Biao Jin
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  2. Xiao-shu Wang
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  3. Gang Huo
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  4. Jia-min Mou
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  5. Gang Yang
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Correspondence to Gang Yang.

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All procedures performed in studies were in accordance with the ethical standards of Institutional Review Board of the First Affiliated Hospital of Chongqing Medical University and with the 1964 Helsinki Declaration and its later amendments.

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Jin, B., Wang, Xs., Huo, G. et al. Reconstruction of skull base bone defects using an in situ bone flap after endoscopic endonasal transplanum-transtuberculum approaches. Eur Arch Otorhinolaryngol 277, 2071–2080 (2020). https://doi.org/10.1007/s00405-020-05911-1

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