Endoscopic Reconstruction of Cranial Base Defects following Endonasal Skull Base Surgery

ABSTRACT

The expanded endonasal approach provides access to the entire ventral skull base for resection of neoplasms involving the skull base and brain. The creation of large defects of the bone and dura endoscopically presents unique reconstructive challenges. A layered reconstruction of the dura with inlay and onlay fascial grafts covered with fat grafts is an effective technique for repair. An intranasal balloon catheter is used to provide counterpressure in the early phase of healing and a lumbar spinal drain is a useful adjunct in patients at increased risk of a cerebrospinal fluid leak. Vascularized flaps may be necessary in some patients receiving radiation therapy. Continued advances in surgical technology and the introduction of new biomaterials will facilitate the reconstruction of skull base defects following endonasal brain surgery.

Skull base reconstruction - endonasal skull base surgery - cerebrospinal fluid leak - mucosal flap - dural reconstruction

REFERENCES

• 1 Hegazy H M, Carrau R L, Snyderman C H, Kassam A, Zweig J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis.  Laryngoscope. 2000;  110 1166-1172
• 2 Zweig J L, Carrau R L, Celin S E et al.. Endoscopic repair of CSF leaks to the sinonasal tract: predictors of success.  Otolaryngol Head Neck Surg. 2000;  123 195-201
• 3 Carrau R L, Snyderman C H, Kassam A B. The management of CSF leaks in patients at risk for high-pressure hydrocephalus.  Laryngoscope. 2005;  115 205-212
• 4 Kassam A, Snyderman C H, Mintz A, Gardner P, Carrau R L. Expanded endonasal approach: the rostrocaudal axis. Part I Crista galli to the sella turcica.  Neurosurg Focus. 2005;  19 E3. Available at: http://www.aans.org/education/journal/neurosurgical/July05/19-1-3.pdf
• 5 Kassam A, Snyderman C H, Mintz A, Gardner P, Carrau R L. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum.  Neurosurg Focus. 2005;  19 E4. Available at: http://www.aans.org/education/journal/neurosurgical/July05/19-1-4.pdf
• 6 Kassam A B, Gardner P, Snyderman C H, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa.  Neurosurg Focus. 2005;  19 E6. Available at: http://www.aans.org/education/journal/neurosurgical/July05/19-1-6.pdf
• 7 Kassam A, Carrau R L, Snyderman C H, Gardner P, Mintz A. Evolution of reconstructive techniques following endoscopic expanded endonasal approaches.  Neurosurg Focus. 2005;  19 E8. Available at: http://www.aans.org/education/journal/neurosurgical/July05/19-1-8.pdf