Novel techniques and the future of skull base reconstruction.

The field of endoscopic skull base surgery has evolved considerably in recent years fueled largely by advances in both imaging and instrumentation. While the indications for these approaches continue to be extended, the ability to reconstruct the resultant defects has emerged as a rate-limiting obstacle. Postoperative failures with current multilayer grafting techniques remain significant and may increase as the indications for endoscopic resections continue to expand. Laser tissue welding represents a novel method of wound repair in which laser energy is applied to a chromophore doped biologic solder at the wound edge to create a laser weld (fig. 1). These repairs are capable of withstanding forces far exceeding those exerted by intracranial pressure with negligible collateral thermal tissue injury. Recent clinical trials have demonstrated the safety and feasibility of endoscopic laser welding while exposing the limitations of first generation hyaluronic acid based solders. Novel supersaturated gel based solders are currently being tested in clinical trials and appear to possess significantly improved viscoelastic properties. While laser tissue welding remains an experimental technique, continued success with these novel solder formulations may catalyze the widespread adoption of this technique for skull base repair in the near future.