Primary Dural Repair Using Titanium Microclips following Lateral Skull Base Surgery

Objective: Standard techniques for primary dural repair following lateral skull base surgery are both technically challenging and time consuming. However, inadequate closure may result in postoperative CSF leak and local infection. Numerous methods and techniques have been described to address this issue. Here we report a novel technique for primary dural closure following lateral skull base surgery using nonpenetrating titanium microclips. A case example is provided.

Technique: Following completion of surgical tumor resection, the margins of the dural opening were identified. A free tissue synthetic dural graft was tailored to the dural defect. Using nonpenetrating titanium microclips, a primary dural repair was performed. As the clips do not penetrate the dura or the synthetic dural graft, clips are applied along all margins of the defect without concerns for damaging adjacent neurovascular structures.

Case Report: A 17-year-old male presented to our institution with a large vagal schwannoma extending into the carotid sheath. He presented acutely with diplopia, nystagmus, papilledema, and obstructive hydrocephalus. Gross total resection was achieved using a trans-temporal trans-jugular approach, and surgical pathology confirmed the diagnosis of schwannoma. As an adjunct to standard surgical repair techniques, primary dural closure was performed using nonpenetrating titanium microclips and a free tissue synthetic dural graft. Postoperative MRI demonstrated minimal clip artifact. No postoperative complications were observed.

Conclusion: To our knowledge, this is the first report on the use of microclips in repairing dural defects following lateral skull base surgery. Surgical outcomes for this small case series suggest that dural repair of the later skull base with nonpenetrating, titanium microclips is a feasible alternative to suturing dura in confined spaces with limited maneuverability.

Fig. 1 Case Report MRI. Preoperative axial T1 MRI (A) and sagittal T2 MRI (B). Postoperative axial T1 MRI (C) and sagittal T1 FLAIR MRI (D) for resection of large vagal schwannoma. Minimal postoperative clip artifact is demonstrated.

Fig. 2 Primary dural repair with nonpenetrating titanium microclips. Sequential intraoperative photographs (A-C) demonstrate the use of our novel dural closure technique following lateral skull base surgery. Black arrow indicates clip applier.