Objective: To evaluate the use of Permacol® as a dural substitute in endoscopic skull base reconstruction.
Study Design: A retrospective review of all patients who underwent endoscopic skull base reconstruction
with the use of Permacol®.
Methods: Patients were identified through our prospective Skull Base Database. Medical records
and pre- and postoperative imaging were reviewed. Note was made of the reason for
skull base reconstruction, whether it was a primary repair or revision, and the size
of the skull base defect. The incidence of CSF leak, meningitis, use of a lumbar drain,
and the need for further reconstruction were recorded.
Results: Six patients were identified for whom Permacol® was used as a dural substitute. All patients underwent endoscopic reconstruction
following resection of a skull base tumor. The size of the skull base defects ranged
from 2.3cm to 4.8 cm (mean, 4.1 cm). All patients were reconstructed using an underlay
technique with a layer of Permacol® (0.5 mm thickness) placed extradurally. Fibrin glue was used in all cases. In most
cases, a pedicled nasoseptal flap was used, but where this was not available, a free
graft of mucosa was used.
In this cohort of patients, there were no CSF leaks, no lumbar drains were used, no
cases of meningitis occurred, and none of the patients required revision surgery.
Conclusions: We have found that Permacol® presents benefits over other synthetic and homologous dural substitutes, and in our
experience it provides a suitable alternative for use in skull base reconstruction.
