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J Neurol Surg B Skull Base 2022; 83(S 02): e306-e311
DOI: 10.1055/s-0041-1729903
Original Article

Primary Dural Repair Using Titanium Microclips Following Lateral Skull Base Surgery

Camille K. Milton 
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Alexander G. Bien
2   Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Greg A. Krempl
2   Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Jose A. Sanclement
2   Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Rachad Mhawej
2   Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
,
Chad A. Glenn
1   Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
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Abstract

Objective Standard techniques for primary dural repair following lateral skull base surgery are both technically challenging and time consuming without the potential for primary dural repair. Inadequate closure may result in postoperative cerebrospinal fluid (CSF) leak infectious sequalae. Traditional methods of dural repair rely on secondary obliteration of the CSF fistula. We hypothesized that the use of nonpenetrating titanium microclips may serve as a useful adjunct in primary dural repair or the establishment of an immobile repair layer following lateral skull base surgery.

Methods Here, we report a novel technique for primary dural repair using nonpenetrating titanium microclips as an adjunct to standard techniques in a series of six patients with lateral skull base pathologies.

Results A total of six consecutive lateral skull base tumor patients with titanium microclip dural reconstruction were included in our case series. Lateral skull base pathologies represented in this group included two jugular foramen schwannomas, one vestibular schwannoma, one petroclival meningioma, one glomus jugulare paraganglioma, and one jugular foramen chordoid meningioma.

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 useful adjunct in dural repair following lateral skull base surgery.

Keywords

lateral skull base - dural closure - titanium microclip - tumor

Note

This work has been previously presented as an abstract/poster at the 2020 North American Skull Base Society Meeting. No other disclosures.




Publication History

Received: 10 June 2020

Accepted: 24 February 2021

Article published online:
03 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Xu J, Yi H, Li X, Chen W, Xu J. Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases. Acta Otolaryngol 2017; 137 (02) 131-135
    CrossrefPubMedGoogle Scholar
  • 2 Marzo SJ, Benscoter B, Leonetti JP. Contemporary options for lateral skull base reconstruction following tumor extirpation. Curr Opin Otolaryngol Head Neck Surg 2011; 19 (05) 330-334
    CrossrefPubMedGoogle Scholar
  • 3 Leverstein-van Hall MA, Hopmans TE, van der Sprenkel JW. et al. A bundle approach to reduce the incidence of external ventricular and lumbar drain-related infections. J Neurosurg 2010; 112 (02) 345-353
    CrossrefPubMedGoogle Scholar
  • 4 Glenn CA, Baker CM, Burks JD, Conner AK, Smitherman AD, Sughrue ME. Dural closure in confined spaces of the skull base with nonpenetrating titanium clips. Oper Neurosurg (Hagerstown) 2018; 14 (04) 375-385
    CrossrefPubMedGoogle Scholar
  • 5 Allen KP, Isaacson B, Purcell P, Kutz Jr JW, Roland PS. Lumbar subarachnoid drainage in cerebrospinal fluid leaks after lateral skull base surgery. Otol Neurotol 2011; 32 (09) 1522-1524
    CrossrefPubMedGoogle Scholar
  • 6 Indorewala S, Nemade G, Indorewala A, Mahajan G. Repair of bony lateral skull base defects equal to or larger than 10 mm by extracorporeally sewed unit-sandwich graft. Eur Arch Otorhinolaryngol 2018; 275 (08) 2177-2186
    CrossrefPubMedGoogle Scholar
  • 7 Schwam ZG, Michaelides E, Kuo P, Hajek MA, Judson BL, Schutt C. Thirty-day morbidity and mortality following otologic/neurotologic surgery: analysis of the national surgical quality improvement program. Laryngoscope 2018; 128 (06) 1431-1437
    CrossrefPubMedGoogle Scholar
  • 8 Thompson NJ, Roche JP, Schularick NM, Chang KE, Hansen MR. Reconstruction outcomes following lateral skull base resection. Otol Neurotol 2017; 38 (02) 264-271
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 McRackan TR, Brackmann DE. Historical perspective on evolution in management of lateral skull base tumors. Otolaryngol Clin North Am 2015; 48 (03) 397-405
    CrossrefPubMedGoogle Scholar
  • 11 Zanoletti E, Mazzoni A, Martini A. et al. Surgery of the lateral skull base: a 50-year endeavour. Acta Otorhinolaryngol Ital 2019; 39 (Suppl. 01) S1-S146
    CrossrefPubMedGoogle Scholar
  • 12 Zanoletti E, Martini A, Emanuelli E, Mazzoni A. Lateral approaches to the skull base. Acta Otorhinolaryngol Ital 2012; 32 (05) 281-287
    PubMedGoogle Scholar
  • 13 House JW, Cullen RD. Chapter 15: Complications of Neurotologic Surgery. In: Friedman RA. ed. Lateral Skull Base Surgery: the House Clinic Atlas. 1st ed.. New York, NY: Thieme; 2012: 165-172
    Google Scholar
  • 14 Narotam PK, Reddy K, Fewer D, Qiao F, Nathoo N. Collagen matrix duraplasty for cranial and spinal surgery: a clinical and imaging study. J Neurosurg 2007; 106 (01) 45-51
    CrossrefPubMedGoogle Scholar
  • 15 Marzo SJ, Leonetti JP, Petruzzelli GJ, Vandevender D. Closure of complex lateral skull base defects. Otol Neurotol 2005; 26 (03) 522-524
    CrossrefPubMedGoogle Scholar
  • 16 Maier W. Biomaterials in skull base surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg 2009; 8: Doc07
    PubMedGoogle Scholar
  • 17 Patel NS, Modest MC, Brobst TD. et al. Surgical management of lateral skull base defects. Laryngoscope 2016; 126 (08) 1911-1917
    CrossrefPubMedGoogle Scholar
  • 18 Schick B, Dlugaiczyk J. Surgery of the ear and the lateral skull base: pitfalls and complications. GMS Curr Top Otorhinolaryngol Head Neck Surg 2013; 12: Doc05
    PubMedGoogle Scholar
  • 19 Schick B, Ibing R, Brors D, Draf W. Long-term study of endonasal duraplasty and review of the literature. Ann Otol Rhinol Laryngol 2001; 110 (02) 142-147
    CrossrefPubMedGoogle Scholar
  • 20 Gray ST, Wu AW. Pathophysiology of iatrogenic and traumatic skull base injury. Adv Otorhinolaryngol 2013; 74: 12-23
    PubMedGoogle Scholar
  • 21 Copeland WR, Mallory GW, Neff BA, Driscoll CLW, Link MJ. Are there modifiable risk factors to prevent a cerebrospinal fluid leak following vestibular schwannoma surgery?. J Neurosurg 2015; 122 (02) 312-316
    CrossrefPubMedGoogle Scholar
  • 22 Selesnick SH, Liu JC, Jen A, Newman J. The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol 2004; 25 (03) 387-393
    CrossrefPubMedGoogle Scholar