Circumferential watertight dural repair using nitinol U-clips in expanded endonasal and sublabial approaches to the cranial base.

Abstract

BACKGROUND:

In recent years, significant advances have been made in the field of expanded endonasal approaches that permit treatment of different cranial base intradural lesions.

OBJECTIVE:

To report our technique of cranial base dural repair by the application of nitinol U-Clips in endoscope-assisted extended endonasal or sublabial approaches. Closure techniques and postoperative cerebrospinal (CSF) leaks are reported.

METHODS:

We reviewed 11 patients with different kinds of cranial base tumors or vascular diseases (2 tuberculum sellae meningiomas, 1 planum sphenoidale meningioma, 4 craniopharyngiomas, 1 recurrent clival chordoma, 1 esthesioneuroblastoma, 1 ethmoidal melanoma metastasis, 1 basilar trunk aneurysm) who underwent an endoscope-assisted extended endonasal or sublabial approach. Dural repair was performed using nitinol U-Clips to circumferentially suture AlloDerm or fascia lata directly to the existing dural borders. Lumbar drainage was not used in 9 patients and was used in 2 patients for 5 days. Patients were evaluated for the appearance of CSF leaks.

RESULTS:

Postoperative CSF leak was observed in 1 patient (9%). This required a second transnasal repair.

CONCLUSION:

Circumferential dural closure with U-Clips is a useful adjunct to prevent CSF leaks after expanded endonasal or sublabial approaches to the cranial base for treatment of intracranial pathology.

• Authors: Francesco Acerbi, Eric Genden, Joshua Bederson
• Journal: Neurosurgery (Neurosurgery) Vol. 67 Issue 2 Suppl Operative Pg. 448-56 (Dec 2010) ISSN: 1524-4040 [Electronic] United States
• PMID: 21099571 (Publication Type: Journal Article)

Chemical References

• Alloys
• nitinol

Topics

• Adult
• Aged
• Alloys (therapeutic use)
• Cerebrospinal Fluid Leak
• Cerebrospinal Fluid Rhinorrhea (physiopathology, prevention & control, surgery)
• Craniotomy (instrumentation, methods)
• Dura Mater (anatomy & histology, surgery)
• Female
• Humans
• Lip (anatomy & histology, surgery)
• Male
• Middle Aged
• Neurosurgical Procedures (instrumentation, methods)
• Retrospective Studies
• Skull Base (anatomy & histology, surgery)
• Surgical Instruments (standards)
• Treatment Outcome