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Published in: Neurosurgical Review 3/2015

01-07-2015 | Original Article

Fascia patchwork closure for endoscopic endonasal skull base surgery

Authors: Yudo Ishii, Shigeyuki Tahara, Yujiro Hattori, Akira Teramoto, Akio Morita, Akira Matsuno

Published in: Neurosurgical Review | Issue 3/2015

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Abstract

With the development of endoscopic technology and surgery, resection of midline skull base tumors has been achieved using endoscopic endonasal skull base (EESB) approaches. EESB approaches reportedly have a greater risk of postoperative cerebrospinal fluid (CSF) leakage. Recently, the introduction of the nasoseptal flap (NSF) decreased dramatically the incidence of CSF leakage, but the use of an NSF increases the risk of disturbing the function of the nose. Here, we report our new technique called “fascia patchwork closure” for closure after EESB surgery and its outcome. All 48 cases involved midline skull base tumors resected via EESB approaches. Of them, 32 cases were closed by the fascia patchwork technique after tumor resection, and there was no incidence of CSF leakage. Moreover, 6 of the 32 cases were closed without the use of an NSF, indicating that the fascia patchwork closure approach is effective as part of a multilayer closure for the prevention of CSF leakage. The establishment and popularization of this technique might result in the further development of EESB surgery and also an improvement of postoperative nasal function.
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Literature
2.
go back to reference Arai H, Sato K, Okuda, Miyajima M, Hishii M, Nakanishi H, Ishii H (2000) Transcranial transsphenoidal approach for tuberculum sellae meningiomas. Acta Neurochir (Wien) 142:751–756CrossRef Arai H, Sato K, Okuda, Miyajima M, Hishii M, Nakanishi H, Ishii H (2000) Transcranial transsphenoidal approach for tuberculum sellae meningiomas. Acta Neurochir (Wien) 142:751–756CrossRef
5.
go back to reference Cappabianca P, Cavallo LM, Colao A, Del Basso De Caro M, Esposito F, Cirillo S, Lombardi G, de Divitiis E (2002) Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 45:193–200. doi:10.1055/s-2002-36197 PubMedCrossRef Cappabianca P, Cavallo LM, Colao A, Del Basso De Caro M, Esposito F, Cirillo S, Lombardi G, de Divitiis E (2002) Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 45:193–200. doi:10.​1055/​s-2002-36197 PubMedCrossRef
6.
go back to reference Cappabianca P, Cavallo LM, de Divitiis E (2004) Endoscopic endonasal transsphenoidal surgery. Neurosurgery 55:933–940PubMedCrossRef Cappabianca P, Cavallo LM, de Divitiis E (2004) Endoscopic endonasal transsphenoidal surgery. Neurosurgery 55:933–940PubMedCrossRef
8.
go back to reference Cavallo LM, Messina A, Esposito F, de Divitiis O, Dal Fabbro M, de Divitiis E, Cappabianca P (2007) Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions. J Neurosurg 107:713–720. doi:10.3171/jns-07/10/0713 PubMedCrossRef Cavallo LM, Messina A, Esposito F, de Divitiis O, Dal Fabbro M, de Divitiis E, Cappabianca P (2007) Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions. J Neurosurg 107:713–720. doi:10.​3171/​jns-07/​10/​0713 PubMedCrossRef
10.
go back to reference Choudhari KA (2001) ‘In-lay’ duraplasty: a useful method of effective dural closure. Br J Neurosurg 15:533–535PubMedCrossRef Choudhari KA (2001) ‘In-lay’ duraplasty: a useful method of effective dural closure. Br J Neurosurg 15:533–535PubMedCrossRef
11.
go back to reference Coleman JJ 3rd (1989) Microvascular approach to function and appearance of large orbital maxillary defects. Am J Surg 158:337–341PubMedCrossRef Coleman JJ 3rd (1989) Microvascular approach to function and appearance of large orbital maxillary defects. Am J Surg 158:337–341PubMedCrossRef
12.
go back to reference Cook SW, Smith Z, Kelly DF (2004) Endonasal transsphenoidal removal of tuberculum sellae meningiomas: technical note. Neurosurgery 55:239–244PubMedCrossRef Cook SW, Smith Z, Kelly DF (2004) Endonasal transsphenoidal removal of tuberculum sellae meningiomas: technical note. Neurosurgery 55:239–244PubMedCrossRef
13.
go back to reference Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T (2004) Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55:539–547PubMedCrossRef Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T (2004) Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55:539–547PubMedCrossRef
17.
go back to reference Doglietto F, Prevedello DM, Jane JA Jr, Han J, Laws ER Jr (2005) Brief history of endoscopic transsphenoidal surgery—from Philipp Bozzini to the first world congress of endoscopic skull base surgery. Neurosurg Focus 19:E3PubMedCrossRef Doglietto F, Prevedello DM, Jane JA Jr, Han J, Laws ER Jr (2005) Brief history of endoscopic transsphenoidal surgery—from Philipp Bozzini to the first world congress of endoscopic skull base surgery. Neurosurg Focus 19:E3PubMedCrossRef
21.
22.
go back to reference Fraioli MF, Moschettoni L, Floris R, Catena E, Fraioli B (2009) Extended transsphenoidal microsurgical approach for diaphragma sellae and tuberculum meningiomas. Minim Invasive Neurosurg 52:267–270. doi:10.1055/s-0028-1104612 PubMedCrossRef Fraioli MF, Moschettoni L, Floris R, Catena E, Fraioli B (2009) Extended transsphenoidal microsurgical approach for diaphragma sellae and tuberculum meningiomas. Minim Invasive Neurosurg 52:267–270. doi:10.​1055/​s-0028-1104612 PubMedCrossRef
28.
go back to reference Gonzalez LF, Crawford NR, Horgan MA, Deshmukh P, Zabramski JM, Spetzler RF (2002) Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach. Neurosurgery 50:550–555PubMed Gonzalez LF, Crawford NR, Horgan MA, Deshmukh P, Zabramski JM, Spetzler RF (2002) Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach. Neurosurgery 50:550–555PubMed
30.
31.
go back to reference Horiguchi K, Murai H, Hasegawa Y, Hanazawa T, Yamakami I, Saeki N (2010) Endoscopic endonasal skull base reconstruction using a nasal septal flap: surgical results and comparison with previous reconstructions. Neurosurg Rev 33:235–241. doi:10.1007/s10143-010-0247-8 PubMedCrossRef Horiguchi K, Murai H, Hasegawa Y, Hanazawa T, Yamakami I, Saeki N (2010) Endoscopic endonasal skull base reconstruction using a nasal septal flap: surgical results and comparison with previous reconstructions. Neurosurg Rev 33:235–241. doi:10.​1007/​s10143-010-0247-8 PubMedCrossRef
34.
go back to reference Kaptain GJ, Vincent DA, Laws ER Jr (2001) Cranial base reconstruction after transsphenoidal surgery with bioabsorbable implants. Neurosurgery 48:232–233PubMed Kaptain GJ, Vincent DA, Laws ER Jr (2001) Cranial base reconstruction after transsphenoidal surgery with bioabsorbable implants. Neurosurgery 48:232–233PubMed
35.
go back to reference Kassam A, Carrau RL, Snyderman CH, Gardner P, Mintz A (2005) Evolution of reconstructive techniques following endoscopic expanded endonasal approaches. Neurosurg Focus 19:E8PubMed Kassam A, Carrau RL, Snyderman CH, Gardner P, Mintz A (2005) Evolution of reconstructive techniques following endoscopic expanded endonasal approaches. Neurosurg Focus 19:E8PubMed
36.
go back to reference Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 19:E3PubMed Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 19:E3PubMed
37.
go back to reference Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM (2008) Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108:715–728. doi:10.3171/jns/2008/108/4/0715 PubMedCrossRef Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM (2008) Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108:715–728. doi:10.​3171/​jns/​2008/​108/​4/​0715 PubMedCrossRef
39.
go back to reference Kim BY, Kang SG, Kim SW, Hong YK, Jeun SS, Kim SW, Kim HB, Kim M, Maeng JH, Lee DC, Cho JH, Park YJ (2014) Olfactory changes after endoscopic endonasal transsphenoidal approach for skull base tumors. Laryngoscope. doi:10.1002/lary.24674 Kim BY, Kang SG, Kim SW, Hong YK, Jeun SS, Kim SW, Kim HB, Kim M, Maeng JH, Lee DC, Cho JH, Park YJ (2014) Olfactory changes after endoscopic endonasal transsphenoidal approach for skull base tumors. Laryngoscope. doi:10.​1002/​lary.​24674
40.
41.
go back to reference Kinoshita M, Tanaka S, Nakada M, Ozaki N, Hamada J, Hayashi Y (2012) What bone part is important to remove in accessing the suprachiasmatic region with less frontal lobe retraction in frontotemporal craniotomies. World Neurosurg 77:342–348. doi:10.1016/j.wneu.2011.03.040 PubMedCrossRef Kinoshita M, Tanaka S, Nakada M, Ozaki N, Hamada J, Hayashi Y (2012) What bone part is important to remove in accessing the suprachiasmatic region with less frontal lobe retraction in frontotemporal craniotomies. World Neurosurg 77:342–348. doi:10.​1016/​j.​wneu.​2011.​03.​040 PubMedCrossRef
42.
go back to reference Kumar A, Maartens NF, Kaye AH (2003) Reconstruction of the sellar floor using Bioglue following transsphenoidal procedures. J Clin Neurosci 10:92–95PubMedCrossRef Kumar A, Maartens NF, Kaye AH (2003) Reconstruction of the sellar floor using Bioglue following transsphenoidal procedures. J Clin Neurosci 10:92–95PubMedCrossRef
45.
go back to reference Leong JL, Citardi MJ, Batra PS (2006) Reconstruction of skull base defects after minimally invasive endoscopic resection of anterior skull base neoplasms. Am J Rhinol 20:476–482PubMedCrossRef Leong JL, Citardi MJ, Batra PS (2006) Reconstruction of skull base defects after minimally invasive endoscopic resection of anterior skull base neoplasms. Am J Rhinol 20:476–482PubMedCrossRef
46.
go back to reference Liu JK, Christiano LD, Patel SK, Tubbs RS, Eloy JA (2011) Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach. Neurosurg Focus 30:E2. doi:10.3171/2011.3.focus115 PubMedCrossRef Liu JK, Christiano LD, Patel SK, Tubbs RS, Eloy JA (2011) Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach. Neurosurg Focus 30:E2. doi:10.​3171/​2011.​3.​focus115 PubMedCrossRef
50.
51.
go back to reference Patel KS, Komotar RJ, Szentirmai O, Moussazadeh N, Raper DM, Starke RM, Anand VK, Schwartz TH (2013) Case-specific protocol to reduce cerebrospinal fluid leakage after endonasal endoscopic surgery. J Neurosurg 119:661–668. doi:10.3171/2013.4.jns13124 PubMedCrossRef Patel KS, Komotar RJ, Szentirmai O, Moussazadeh N, Raper DM, Starke RM, Anand VK, Schwartz TH (2013) Case-specific protocol to reduce cerebrospinal fluid leakage after endonasal endoscopic surgery. J Neurosurg 119:661–668. doi:10.​3171/​2013.​4.​jns13124 PubMedCrossRef
53.
go back to reference Reisch R, Perneczky A (2005) Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 57:242–255PubMedCrossRef Reisch R, Perneczky A (2005) Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 57:242–255PubMedCrossRef
55.
go back to reference Shin M, Kondo K, Saito N (2012) Neuroendoscopic transnasal surgery for skull base tumors: basic approaches, avoidance of pitfalls, and recent innovations. Neurol Med Chir (Tokyo) 52:697–703CrossRef Shin M, Kondo K, Saito N (2012) Neuroendoscopic transnasal surgery for skull base tumors: basic approaches, avoidance of pitfalls, and recent innovations. Neurol Med Chir (Tokyo) 52:697–703CrossRef
59.
go back to reference Yessenow RS, McCabe BF (1989) The osteo-mucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea: a 20-year experience. Otolaryngol Head Neck Surg 101:555–558PubMed Yessenow RS, McCabe BF (1989) The osteo-mucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea: a 20-year experience. Otolaryngol Head Neck Surg 101:555–558PubMed
61.
go back to reference 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 23:518–521. doi:10.2500/ajra.2009.23.3378 PubMedCrossRef 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 23:518–521. doi:10.​2500/​ajra.​2009.​23.​3378 PubMedCrossRef
62.
go back to reference Zhang MZ, Wang L, Zhang W, Qi W, Wang R, Han XD, Zhao JZ (2004) The supraorbital keyhole approach with eyebrow incisions for treating lesions in the anterior fossa and sellar region. Chin Med J (Engl) 117:323–326 Zhang MZ, Wang L, Zhang W, Qi W, Wang R, Han XD, Zhao JZ (2004) The supraorbital keyhole approach with eyebrow incisions for treating lesions in the anterior fossa and sellar region. Chin Med J (Engl) 117:323–326
Metadata
Title
Fascia patchwork closure for endoscopic endonasal skull base surgery
Authors
Yudo Ishii
Shigeyuki Tahara
Yujiro Hattori
Akira Teramoto
Akio Morita
Akira Matsuno
Publication date
01-07-2015
Publisher
Springer Berlin Heidelberg
Published in
Neurosurgical Review / Issue 3/2015
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-015-0614-6

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