Utilization of Polydioxanone Plate for Endoscopic Anterior Skull Base Repair: Operative Technique and Long-Term Cohort Outcomes

Abstract

Objective The purpose of this study is to report the technical procedure and our experience using a polydioxanone suture (PDS) plate with dural substitute as part of a fully resorbable gasket seal technique to repair anterior skull base defects.

Methods A series of patients undergoing anterior skull base reconstruction utilizing our resorbable gasket seal technique from January 2014 to July 2022 was reviewed.

Results A total of 155 patients were included. Nine (5.8%) of the included patients developed postoperative cerebrospinal fluid (CSF) leaks requiring reoperation. There were no cases of intraoperative cranial nerve injury or internal carotid artery injury. A total of 103 (66.5%) patients were observed to have an intraoperative CSF leak, including 57 low-flow leaks and 46 high-flow leaks; 1 of 57 (1.8%) patients with low-flow leaks and 8 of 46 (17.4%) patients with high-flow leaks developed a postoperative CSF leak. During the first 3 years that this technique was utilized at our center for the management of high-flow intraoperative CSF leaks, postoperative CSF leaks were documented in 4 of 12 (33.3%) patients, in comparison to 4 of 34 (11.8%) in the following years.

Conclusion PDS plate reconstruction confers several advantages and can be used in a diverse set of operative scenarios in conjunction with other reconstruction options. There appeared to be an associated learning curve as surgeons at our center gained experience with this new technique. Our findings show that the PDS plate reconstruction is safe and effective in repairing the skull base.

Keywords

anterior skull base reconstruction - endoscopic skull base - polydioxanone plate - gasket seal

Publikationsverlauf

Eingereicht: 17. Juni 2023

Angenommen: 04. Februar 2024

Accepted Manuscript online:
06. Februar 2024

Artikel online veröffentlicht:
01. März 2024

• References

• 1 Wang EW, Zanation AM, Gardner PA. et al. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2019; 9 (S3): S145-S365
• 2 Oakley GM, Alt JA, Schlosser RJ, Harvey RJ, Orlandi RR. Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Int Forum Allergy Rhinol 2016; 6 (01) 8-16
• 3 Harvey RJ, Parmar P, Sacks R, Zanation AM. Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope 2012; 122 (02) 452-459
• 4 Kassam AB, Prevedello DM, Carrau RL. et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients. J Neurosurg 2011; 114 (06) 1544-1568
• 5 Leng LZ, Brown S, Anand VK, Schwartz TH. “Gasket-seal” watertight closure in minimal-access endoscopic cranial base surgery. Neurosurgery 2008; 62 (5, suppl 2): ONSE342-3 , discussion ONSE343
• 6 Khan DZ, Ali AMS, Koh CH. et al. Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review. Pituitary 2021; 24 (05) 698-713
• 7 Al-Asousi F, Okpaleke C, Dadgostar A, Javer A. The use of polydioxanone plates for endoscopic skull base repair. Am J Rhinol Allergy 2017; 31 (02) 122-126
• 8 Zeden JP, Baldauf J, Schroeder HWS. Repair of the sellar floor using bioresorbable polydioxanone foils after endoscopic endonasal pituitary surgery. Neurosurg Focus 2020; 48 (06) E16
• 9 Jolly K, Okonkwo O, Tsermoulas G, Ahmed SK. A novel technique for endoscopic repair of large anterior skull base defects: the PDS wrap. Am J Rhinol Allergy 2020; 34 (01) 70-73
• 10 Mohd Slim MA, Jasem H, Melia L, McGarry G. Polydioxanone sheet as a rigid framework in skull-base repair: our experience in thirteen patients. Clin Otolaryngol 2019; 44 (05) 856-860
• 11 Qi Q, Zhang Y, Wang J. et al. Deployment of a bioabsorbable plate as the rigid buttress for skull base repair after endoscopic pituitary surgery. Gland Surg 2021; 10 (03) 1010-1017
• 12 Boenisch M, Mink A. Clinical and histological results of septoplasty with a resorbable implant. Arch Otolaryngol Head Neck Surg 2000; 126 (11) 1373-1377
• 13 Soudry E, Psaltis AJ, Lee KH, Vaezafshar R, Nayak JV, Hwang PH. Complications associated with the pedicled nasoseptal flap for skull base reconstruction. Laryngoscope 2015; 125 (01) 80-85
• 14 Roca E, Penn DL, Safain MG, Burke WT, Castlen JP, Laws ER. Abdominal fat graft for sellar reconstruction: retrospective outcomes review and technical note. Oper Neurosurg (Hagerstown) 2019; 16 (06) 667-674
• 15 Zwagerman NT, Wang EW, Shin SS. et al. Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial. J Neurosurg 2018; 131 (04) 1-7
• 16 Caggiano C, Penn DL, Laws Jr ER. The role of the lumbar drain in endoscopic endonasal skull base surgery: a retrospective analysis of 811 cases. World Neurosurg 2018; 117: e575-e579
• 17 Ransom ER, Palmer JN, Kennedy DW, Chiu AG. Assessing risk/benefit of lumbar drain use for endoscopic skull-base surgery. Int Forum Allergy Rhinol 2011; 1 (03) 173-177
• 18 Kim JS, Hong SD. Risk factors for postoperative CSF leakage after endonasal endoscopic skull base surgery: a meta-analysis and systematic review. Rhinology 2021; 59 (01) 10-20
• 19 Kong DS, Kim HY, Kim SH. et al. Challenging reconstructive techniques for skull base defect following endoscopic endonasal approaches. Acta Neurochir (Wien) 2011; 153 (04) 807-813
• 20 Stapleton AL, Tyler-Kabara EC, Gardner PA, Snyderman CH, Wang EW. Risk factors for cerebrospinal fluid leak in pediatric patients undergoing endoscopic endonasal skull base surgery. Int J Pediatr Otorhinolaryngol 2017; 93: 163-166
• 21 Thorp BD, Sreenath SB, Ebert CS, Zanation AM. 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 2014; 37 (04) E4
• 22 Karnezis TT, Baker AB, Soler ZM. et al. Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery. Int Forum Allergy Rhinol 2016; 6 (11) 1117-1125
• 23 Boling CC, Karnezis TT, Baker AB. et al. Multi-institutional study of risk factors for perioperative morbidity following transnasal endoscopic pituitary adenoma surgery. Int Forum Allergy Rhinol 2016; 6 (01) 101-107
• 24 Roxbury CR, Saavedra T, Ramanathan Jr M. et al. Layered sellar reconstruction with avascular free grafts: acceptable alternative to the nasoseptal flap for repair of low-volume intraoperative cerebrospinal fluid leak. Am J Rhinol Allergy 2016; 30 (05) 367-371
• 25 Jalessi M, Sharifi G, Mirfallah Layalestani MR. et al. Sellar reconstruction algorithm in endoscopic transsphenoidal pituitary surgery: experience with 240 cases. Med J Islam Repub Iran 2013; 27 (04) 186-194