OBJECTIVE: Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented. METHODS: To achieve watertight closure of the anterior cranial base, autologous fascia lata was used to create a "gasket seal" around a bone buttress, followed by application of a tissue sealant such as DuraSeal (Confluent Surgical, Inc., Waltham, MA). The gasket-seal closure was used to seal the anterior cranial base in a series of 10 patients with intradural surgery for suprasellar craniopharyngiomas (n = 5), planum meningiomas (n = 3), clival chordoma (n = 1), and recurrent iatrogenic cerebrospinal fluid leak (n = 1). Lumbar drains were placed intraoperatively in five patients and remained in place for 3 days postoperatively. RESULTS: After a mean follow-up period of 12 months, there were no cerebrospinal fluid leaks. CONCLUSION: The gasket-seal closure is an effective method for achieving watertight closure of the anterior cranial base after endoscopic intradural surgery.
OBJECTIVE: Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented. METHODS: To achieve watertight closure of the anterior cranial base, autologous fascia lata was used to create a "gasket seal" around a bone buttress, followed by application of a tissue sealant such as DuraSeal (Confluent Surgical, Inc., Waltham, MA). The gasket-seal closure was used to seal the anterior cranial base in a series of 10 patients with intradural surgery for suprasellar craniopharyngiomas (n = 5), planum meningiomas (n = 3), clival chordoma (n = 1), and recurrent iatrogenic cerebrospinal fluid leak (n = 1). Lumbar drains were placed intraoperatively in five patients and remained in place for 3 days postoperatively. RESULTS: After a mean follow-up period of 12 months, there were no cerebrospinal fluid leaks. CONCLUSION: The gasket-seal closure is an effective method for achieving watertight closure of the anterior cranial base after endoscopic intradural surgery.
Authors: Lili Laleva; Toma Spiriev; Iacopo Dallan; Alberto Prats-Galino; Giuseppe Catapano; Vladimir Nakov; Matteo de Notaris Journal: J Neurol Surg B Skull Base Date: 2018-09-06
Authors: Christoph P Hofstetter; Michael J Nanaszko; Lynn L Mubita; John Tsiouris; Vijay K Anand; Theodore H Schwartz Journal: Pituitary Date: 2012-09 Impact factor: 4.107
Authors: Neil C-W Tan; Yuresh Naidoo; Sakiko Oue; Hamish Alexander; Simon Robinson; Agadha Wickremesekera; Steve Floreani; Nick Vrodos; Steve Santoreneos; Eng Ooi; Matthew McDonald; Peter-John Wormald Journal: J Neurol Surg B Skull Base Date: 2012-08-29