Top

European Archives of Oto-Rhino-Laryngology

Published in:

01-07-2020 | Craniotomy | Head and Neck

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

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

Published in: European Archives of Oto-Rhino-Laryngology | Issue 7/2020

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.

Available only for authorised users

Mou J, Wang X, Huo G, Ruan L, Jin K, Tan S, Wang F, Hua H, Yang G (2019) Endoscopic endonasal surgery for craniopharyngiomas: a series of 60 patients. World Neurosurg 124:e424–e430. https://doi.org/10.1016/j.wneu.2018.12.110 CrossRef

Koutourousiou M, Fernandez-Miranda JC, Stefko ST, Wang EW, Snyderman CH, Gardner PA (2014) Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg 120(6):1326. https://doi.org/10.3171/2014.2.Jns13767 CrossRefPubMed

Eloy JA, Shukla PA, Choudhry OJ, Singh R, Liu JK (2013) Challenges and surgical nuances in reconstruction of large planum sphenoidale tuberculum sellae defects after endoscopic endonasal resection of parasellar skull base tumors. Laryngoscope 123(6):1353–1360. https://doi.org/10.1002/lary.23766 CrossRefPubMed

Wood JW, Eloy JA, Vivero RJ, Sargi Z, Civantos FJ, Weed DT, Morcos JJ, Castaño J, Lo MPHK, Casiano RR (2012) Efficacy of transnasal endoscopic resection for malignant anterior skull-base tumors. Int Forum Allergy Rh 2(6):487–495. https://doi.org/10.1002/alr.21062 CrossRef

Kitano M, Taneda M (2009) Extended transsphenoidal surgery for suprasellar craniopharyngiomas: infrachiasmatic radical resection combined with or without a suprachiasmatic trans-lamina terminalis approach. Surg Neurol 71(3):290–298. https://doi.org/10.1016/j.surneu.2007.11.014discussion 298 CrossRefPubMed

Cavallo LM, Prevedello DM, Solari D, Gardner PA, Esposito F, Snyderman CH, Carrau RL, Kassam AB, Cappabianca P (2009) Extended endoscopic endonasal transsphenoidal approach for residual or recurrent craniopharyngiomas. J Neurosurg 111(3):578. https://doi.org/10.3171/2009.2.Jns081026 CrossRefPubMed

Thomas A, Mintz AH, Prevedello DM, Gardner PA, Kassam AB, Snyderman CH, Carrau RL (2008) Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 63(1):36–54. https://doi.org/10.1227/01.Neu.0000335069.30319.1e CrossRefPubMed

Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A, de Divitiis E (2008) Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery. In: Pickard JD, Akalan N, Di Rocco C, et al. (eds) Advances and technical standards in neurosurgery. Springer, Vienna, pp 151–199CrossRef

Cavallo LM, Messina A, Esposito F, Divitiis Od, Fabbro MD, Divitiis ED, Cappabianca P (2007) Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions. J Neurosurg 107(4):713. https://doi.org/10.3171/jns-07/10/0713 CrossRefPubMed

10.

Frank G, Sciarretta V, Calbucci F, Farneti G, Mazzatenta D, Pasquini E (2006) The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas. Neurosurgery 59(1 Suppl 1):ONS50–57. https://doi.org/10.1227/01.NEU.0000219914.17221.55 CrossRefPubMed

11.

Eloy JA, Vivero RJ, Hoang K, Civantos FJ, Weed DT, Morcos JJ, Casiano RR (2009) Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base. Laryngoscope 119(5):834–840. https://doi.org/10.1002/lary.20186 CrossRefPubMed

12.

Catapano D, Sloffer CA, Frank G, Pasquini E, D’Angelo VA, Lanzino G (2006) Comparison between the microscope and endoscope in the direct endonasal extended transsphenoidal approach: anatomical study. J Neurosurg 104(3):419. https://doi.org/10.3171/jns.2006.104.3.419 CrossRefPubMed

13.

Thorp BD, Sreenath SB, Ebert CS, Zanation AM (2014) Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak. Neurosurg Focus 37(4):E4. https://doi.org/10.3171/2014.7.FOCUS14350 CrossRefPubMed

14.

Bernal-Sprekelsen M, Rioja E, Ensenat J, Enriquez K, Viscovich L, Agredo-Lemos FE, Alobid I (2014) Management of anterior skull base defect depending on its size and location. Biomed Res Int 2014:346873. https://doi.org/10.1155/2014/346873 CrossRefPubMedPubMedCentral

15.

Eloy JA, Choudhry OJ, Shukla PA, Kuperan AB, Friedel ME, Liu JK (2012) Nasoseptal flap repair after endoscopic transsellar versus expanded endonasal approaches: is there an increased risk of postoperative cerebrospinal fluid leak? The Laryngoscope 122(6):1219–1225. https://doi.org/10.1002/lary.23285 CrossRefPubMed

16.

Kassam A, Carrau RL, Snyderman CH, Gardner P, Mintz A (2005) Evolution of reconstructive techniques following endoscopic expanded endonasal approaches. Neurosurg Focus 19(1):E8PubMed

17.

Hara T, Akutsu H, Yamamoto T, Tanaka S, Takano S, Ishikawa E, Matsuda M, Matsumura A (2015) Cranial base repair using suturing technique combined with a mucosal flap for cerebrospinal fluid leakage during endoscopic endonasal surgery. World Neurosurg 84(6):1887–1893. https://doi.org/10.1016/j.wneu.2015.08.025 CrossRefPubMed

18.

Garcia-Navarro V, Anand VK, Schwartz TH (2013) Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series. World Neurosurg 80(5):563–568. https://doi.org/10.1016/j.wneu.2011.08.034 CrossRefPubMed

19.

Schmalbach CE, Webb DE, Weitzel EK (2010) Anterior skull base reconstruction: a review of current techniques. Curr Opin Otolaryngol 18(4):238–243. https://doi.org/10.1097/MOO.0b013e32833a4706 CrossRef

20.

Luginbuhl AJ, Campbell PG, Evans J, Rosen M (2010) Endoscopic repair of high-flow cranial base defects using a bilayer button. Laryngoscope 120(5):876–880. https://doi.org/10.1002/lary.20861 CrossRefPubMed

21.

Zanation AM, Snyderman CH, Carrau RL, Kassam AB, Gardner PA, Prevedello DM (2009) Minimally invasive endoscopic pericranial flap: a new method for endonasal skull base reconstruction. Laryngoscope 119(1):13–18. https://doi.org/10.1002/lary.20022 CrossRefPubMed

22.

Fortes FS, Carrau RL, Snyderman CH, Prevedello D, Vescan A, Mintz A, Gardner P, Kassam AB (2007) The posterior pedicle inferior turbinate flap: a new vascularized flap for skull base reconstruction. Laryngoscope 117(8):1329–1332. https://doi.org/10.1097/mlg.0b013e318062111f CrossRefPubMed

23.

Esposito F, Dusick JR, Fatemi N, Kelly DF (2007) Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurgery 60(4 Suppl 2):295–303. https://doi.org/10.1227/01.NEU.0000255354.64077.66 CrossRef

24.

Kelly DF, Oskouian RJ, Fineman I (2001) Collagen sponge repair of small cerebrospinal fluid leaks obviates tissue grafts and cerebrospinal fluid diversion after pituitary surgery. Neurosurgery 49(4):885–889. https://doi.org/10.1097/00006123-200110000-00020 CrossRefPubMed

25.

Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116(10):1882–1886. https://doi.org/10.1097/01.mlg.0000234933.37779.e4 CrossRefPubMed

26.

Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Thomas A, Gardner P, Zanation A, Duz B, Stefko ST, Byers K, Horowitz MB (2011) Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients. J Neurosurg 114(6):1544–1568. https://doi.org/10.3171/2010.10.JNS09406 CrossRefPubMed

27.

Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, Mintz A, Gardner P (2008) Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63(1):44–52. https://doi.org/10.1227/01.Neu.0000297074.13423.F5 CrossRef

28.

Eloy JA, Shukla PA, Choudhry OJ, Singh R, Liu JK (2012) Assessment of frontal lobe sagging after endoscopic endonasal transcribriform resection of anterior skull base tumors: is rigid structural reconstruction of the cranial base defect necessary? Laryngoscope 122(12):2652–2657. https://doi.org/10.1002/lary.23539 CrossRefPubMed

29.

Zanation AM, Carrau RL, Snyderman CH, Germanwala AV, Gardner PA, Prevedello DM, Kassam AB (2009) Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy 23(5):518–521. https://doi.org/10.2500/ajra.2009.23.3378 CrossRefPubMed

30.

Park JH, Choi JH, Kim YI, Kim SW, Hong YK (2015) Modified graded repair of cerebrospinal fluid leaks in endoscopic endonasal transsphenoidal surgery. J Korean Neurosurg Soc 58(1):36–42. https://doi.org/10.3340/jkns.2015.58.1.36 CrossRefPubMedPubMedCentral

31.

Carrau RL, Snyderman CH, Kassam AB (2005) The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus. Laryngoscope 115(2):205–212. https://doi.org/10.1097/01.mlg.0000154719.62668.70 CrossRefPubMed

Title: Reconstruction of skull base bone defects using an in situ bone flap after endoscopic endonasal transplanum-transtuberculum approaches
Authors: Biao Jin
Xiao-shu Wang
Gang Huo
Jia-min Mou
Gang Yang
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Craniotomy
Bone Defect
Hydrocephalus
Hydrocephalus
Hydrocephalus
Published in: European Archives of Oto-Rhino-Laryngology / Issue 7/2020
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-020-05911-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2020

Nasal, pharyngeal and laryngeal endoscopy procedures during COVID-19 pandemic: available recommendations from national and international societies

COVID-19 in otolaryngologist practice: a review of current knowledge

Vestibular drop attacks in Ménière’s disease and its association with migraine

Bilateral medialization thyroplasty in patients with vocal fold atrophy with or without sulcus

Possible link between anosmia and COVID-19: sniffing out the truth

Olfactory training ball improves adherence and olfactory outcomes in post-infectious olfactory dysfunction