Skull base reconstruction barrier in endoscopic endonasal approaches
Keywords:
cerebrospinal fluid leak, endoscopy, platelet-rich fibrin and leukocytes, skull base.Abstract
Introduction: Endoscopic endonasal approaches are the procedures of choice for medial tumors in the cranial base given their safety and effectiveness. Repair of the cranial base constitutes a high challenge.
Objective: To evaluate the effectiveness of constructing a cranial base reconstruction barrier in patients with cranial base tumors operated on by endoscopic endonasal approaches.
Method: A descriptive study was carried out, which included 70 patients from the Hermanos Ameijeiras Hospital operated on for cranial base tumors using endoscopic endonasal approaches. A cranial base repair barrier was constructed to isolate the sinonasal and intracranial compartments. The efficiency of the repair barrier was determined through clinical and endoscopic aspects. Aspects were defined to be evaluated in relation to the vitality of the repair barrier with the use of fibrin rich in platelets and leukocytes.
Results: An efficient repair barrier was evident in 98.6%. In relation to the state of vitality of the barrier, adhesion and granulation were observed in 98.6% of patients, while angiogenesis was observed in 97.1%. The incidence of postoperative cerebrospinal fluid leak was only 1.4%.
Conclusions: The present study shows the positive effect of the construction of an efficient repair barrier of the cranial base in endoscopic endonasal approaches with a significant reduction in cerebrospinal fluid leak and its complications.
Downloads
References
1. Özer MI, Kutlay AM, Durmaz MO, Kirik A, Yasar S, Tehli Ö, et al. Extended endonasal endoscopic approach for anterior midline skull base lesions. Clin Neurol Neurosurg. 2020; 196:106024. DOI: 10.1016/j.clineuro.2020.106024
2. Mårtensson A, Cervin-Hoberg C, Huygens F, Lindstedt M, Sakellariou C, Greiff L, et al. Upper airway microbiome transplantation for patients with chronic rhinosinusitis. Int Forum Allergy Rhinol. 2023;13(6):979-988. DOI: 10.1002/alr.23122
3. Hannan CJ, Kelleher E, Javadpour M. Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review. Front Oncol. 2020; 10:1614. DOI: 10.3389/fonc.2020.01614
4. Kessler RA, Garzon-Muvdi T, Kim E, Ramanathan M, Lim M. Utilization of the Nasoseptal Flap for Repair of Cerebrospinal Fluid Leak after Endoscopic Endonasal Approach for Resection of Pituitary Tumors. Brain Tumor Res Treat. 2019; 7(1):10-15. DOI: 10.14791/btrt.2019.7.e19
5. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006; 116(10):1882-6. DOI: 10.1097/01.mlg.0000234933.37779.e4.
6. Issue Information-Declaration of Helsinki. J Bone Miner Res. 2019; 34(3): BMi-BMii. DOI: 10.1002/jbmr.3492
7. Ein L, Sargi Z, Nicolli EA. Update on anterior skull base reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2019; 27(5):426-430. DOI: 10.1097/MOO.0000000000000572
8. Ringel B, Abergel A, Horowitz G, Safadi A, Zaretski A, Yanko R, et al. Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience. J Neurol Surg B Skull Base. 2021; 82(Suppl 3):e217-e223. DOI: 10.1055/s-0039-3402013
9. Namvar M, Iranmehr A, Fathi MR, Sadrhosseini SM, Tabari A, Shirzad N, et al. Complications in Endoscopic Endonasal Pituitary Adenoma Surgery: An Institution Experience in 310 Patients. J Neurol Surg B Skull Base. 2022; 84(3):255-265. DOI: 10.1055/a-1838-5897
10. Abhinav K, Tyler M, Dale OT, Mohyeldin A, Fernandez-Miranda JC, Katznelson L. Managing complications of endoscopic transsphenoidal surgery in pituitary adenomas. Expert Rev Endocrinol Metab. 2020;15(5):311-319. DOI: 10.1080/17446651.2020.1800452
11. Silveira-Bertazzo G, Manjila S, Carrau RL, Prevedello DM. Expanded endoscopic endonasal approach for extending suprasellar and third ventricular lesions. Acta Neurochir (Wien). 2020; 162(10):2403-2408. DOI: 10.1007/s00701-020-04368-9
12. Khalil W, Salle L, Bresson D, Salle H. Extended endoscopic transsphenoidal approach for suprasellar craniopharyngiomas. Acta Neurochir (Wien). 2023 ;165(3):677-683. DOI: 10.1007/s00701-022-05423-3
13. Bernat AL, Priola SM, Elsawy A, Farrash F, Pasarikovski CR, Almeida JP, et al. Recurrence of Anterior Skull Base Meningiomas After Endoscopic Endonasal Resection: 10 Years' Experience in a Series of 52 Endoscopic and Transcranial Cases. World Neurosurg. 2018; 120:e107-e113. DOI: 10.1016/j.wneu.2018.07.210
14. Nakao N. Endoscopic endonasal extended transsphenoidal approach for parasellar tumors. No Shinkei Geka. 2015; 43(4):297-307. Neurological surgery. DOI: 10.11477/mf.1436203011
15. Yang K, Ellenbogen Y, Dong S, Kim J, Larrazabal R, Rodriguez AR, et al. The expanded endoscopic endonasal approach for suprasellar meningiomas: long-term outcomes in a single-center series of 27 patients. Acta Neurochir (Wien). 2020; 162(3):623-629. DOI: 10.1007/s00701-019-04113-x
16. Solari D, D'Avella E, Bove I, Cappabianca P, Cavallo LM. Extended endonasal approaches for pituitary adenomas. J Neurosurg Sci. 2021; 65(2):160-168. DOI: 10.23736/S0390-5616.20.05120-6
17. Chibbaro S, Signorelli F, Milani D, Cebula H, Scibilia A, Bozzi MT, et al. Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience. Cancers (Basel). 2021 ;13(14):3603. DOI: 10.3390/cancers13143603
18. Özer MI, Kutlay AM, Durmaz MO, Kirik A, Yasar S, Tehli Ö, et al. Extended endonasal endoscopic approach for anterior midline skull base lesions. Clin Neurol Neurosurg. 2020; 196:106024. DOI: 10.1016/j.clineuro.2020.106024
19. Fallah N, Taghvaei M, Sadaghiani S, Sadrhosseini SM, Esfahanian F, Zeinalizadeh M. Surgical Outcome of Endoscopic Endonasal Surgery of Large and Giant Pituitary Adenomas: An Institutional Experience from the Middle East. World Neurosurg. 2019; 132:e802-e811. DOI: 10.1016/j.wneu.2019.08.004
20. Pezzutti DL, Magill ST, Albonette-Felicio T, Hardesty DA, Carrau RL, Otto BA, et al. Endoscopic Endonasal Transtubercular Approach for Resection of Giant Pituitary Adenomas With Subarachnoid Extension: The "Second Floor" Strategy to Avoid Postoperative Apoplexy. World Neurosurg. 2021; 153:e464-e472. DOI: 10.1016/j.wneu.2021.06.142
21. Kutlay M, Durmaz A, Özer I, Kural C, Temiz Ç, Kaya S, et al. Extended endoscopic endonasal approach to the ventral skull base lesions. Clin Neurol Neurosurg. 2018; 167:129-140. DOI: 10.1016/j.clineuro.2018.02.032.
22. Tosaka M, Prevedello DM, Yamaguchi R, Fukuhara N, Miyagishima T, Tanaka Y, et al. Single-Layer Fascia Patchwork Closure for the Extended Endoscopic Transsphenoidal Transtuberculum Transplanum Approach: Deep Suturing Technique and Preliminary Results. World Neurosurg. 2021; 155:e271-e284. DOI10.1016/j.wneu.2021.08.051.
23. Chabot JD, Patel CR, Hughes MA, Wang EW, Snyderman CH, Gardner PA, et al. Nasoseptal flap necrosis: a rare complication of endoscopic endonasal surgery. J Neurosurg. 2018; 128(5):1463-1472. DOI: 10.3171/2017.2.JNS161582
24. Park W, Nam DH, Kong DS, Lee KE, Park SI, Kim HY, et al. Learning curve and technical nuances of endoscopic skull base reconstruction with nasoseptal flap to control high-flow cerebrospinal fluid leakage: reconstruction after endoscopic skull base surgery other than pituitary surgery. Eur Arch Otorhinolaryngol. 2022; 279(3):1335-1340. DOI: 10.1007/s00405-021-06877-4
25. Constanzo F, Pinto J, Ledermann C, Schmidt T. Leukocyte-Rich and Platelet-Rich Fibrin for Skull Base Reconstruction After Endoscopic Endonasal Skull Base Surgery. Neurosurgery. 2023; 92(4):787-794. DOI: 10.1227/neu.0000000000002270
26. Rasmussen J, Ruggeri C, Ciraolo C, Baccanelli M, Yampolsky C, Ajler P. Application of Fibrin Rich in Leukocytes and Platelets in the Reconstruction of Endoscopic Approaches to the Skull Base. World Neurosurg. 2018; 118:32-41. DOI: 10.1016/j.wneu.2018.06.180
2. Mårtensson A, Cervin-Hoberg C, Huygens F, Lindstedt M, Sakellariou C, Greiff L, et al. Upper airway microbiome transplantation for patients with chronic rhinosinusitis. Int Forum Allergy Rhinol. 2023;13(6):979-988. DOI: 10.1002/alr.23122
3. Hannan CJ, Kelleher E, Javadpour M. Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review. Front Oncol. 2020; 10:1614. DOI: 10.3389/fonc.2020.01614
4. Kessler RA, Garzon-Muvdi T, Kim E, Ramanathan M, Lim M. Utilization of the Nasoseptal Flap for Repair of Cerebrospinal Fluid Leak after Endoscopic Endonasal Approach for Resection of Pituitary Tumors. Brain Tumor Res Treat. 2019; 7(1):10-15. DOI: 10.14791/btrt.2019.7.e19
5. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006; 116(10):1882-6. DOI: 10.1097/01.mlg.0000234933.37779.e4.
6. Issue Information-Declaration of Helsinki. J Bone Miner Res. 2019; 34(3): BMi-BMii. DOI: 10.1002/jbmr.3492
7. Ein L, Sargi Z, Nicolli EA. Update on anterior skull base reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2019; 27(5):426-430. DOI: 10.1097/MOO.0000000000000572
8. Ringel B, Abergel A, Horowitz G, Safadi A, Zaretski A, Yanko R, et al. Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience. J Neurol Surg B Skull Base. 2021; 82(Suppl 3):e217-e223. DOI: 10.1055/s-0039-3402013
9. Namvar M, Iranmehr A, Fathi MR, Sadrhosseini SM, Tabari A, Shirzad N, et al. Complications in Endoscopic Endonasal Pituitary Adenoma Surgery: An Institution Experience in 310 Patients. J Neurol Surg B Skull Base. 2022; 84(3):255-265. DOI: 10.1055/a-1838-5897
10. Abhinav K, Tyler M, Dale OT, Mohyeldin A, Fernandez-Miranda JC, Katznelson L. Managing complications of endoscopic transsphenoidal surgery in pituitary adenomas. Expert Rev Endocrinol Metab. 2020;15(5):311-319. DOI: 10.1080/17446651.2020.1800452
11. Silveira-Bertazzo G, Manjila S, Carrau RL, Prevedello DM. Expanded endoscopic endonasal approach for extending suprasellar and third ventricular lesions. Acta Neurochir (Wien). 2020; 162(10):2403-2408. DOI: 10.1007/s00701-020-04368-9
12. Khalil W, Salle L, Bresson D, Salle H. Extended endoscopic transsphenoidal approach for suprasellar craniopharyngiomas. Acta Neurochir (Wien). 2023 ;165(3):677-683. DOI: 10.1007/s00701-022-05423-3
13. Bernat AL, Priola SM, Elsawy A, Farrash F, Pasarikovski CR, Almeida JP, et al. Recurrence of Anterior Skull Base Meningiomas After Endoscopic Endonasal Resection: 10 Years' Experience in a Series of 52 Endoscopic and Transcranial Cases. World Neurosurg. 2018; 120:e107-e113. DOI: 10.1016/j.wneu.2018.07.210
14. Nakao N. Endoscopic endonasal extended transsphenoidal approach for parasellar tumors. No Shinkei Geka. 2015; 43(4):297-307. Neurological surgery. DOI: 10.11477/mf.1436203011
15. Yang K, Ellenbogen Y, Dong S, Kim J, Larrazabal R, Rodriguez AR, et al. The expanded endoscopic endonasal approach for suprasellar meningiomas: long-term outcomes in a single-center series of 27 patients. Acta Neurochir (Wien). 2020; 162(3):623-629. DOI: 10.1007/s00701-019-04113-x
16. Solari D, D'Avella E, Bove I, Cappabianca P, Cavallo LM. Extended endonasal approaches for pituitary adenomas. J Neurosurg Sci. 2021; 65(2):160-168. DOI: 10.23736/S0390-5616.20.05120-6
17. Chibbaro S, Signorelli F, Milani D, Cebula H, Scibilia A, Bozzi MT, et al. Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience. Cancers (Basel). 2021 ;13(14):3603. DOI: 10.3390/cancers13143603
18. Özer MI, Kutlay AM, Durmaz MO, Kirik A, Yasar S, Tehli Ö, et al. Extended endonasal endoscopic approach for anterior midline skull base lesions. Clin Neurol Neurosurg. 2020; 196:106024. DOI: 10.1016/j.clineuro.2020.106024
19. Fallah N, Taghvaei M, Sadaghiani S, Sadrhosseini SM, Esfahanian F, Zeinalizadeh M. Surgical Outcome of Endoscopic Endonasal Surgery of Large and Giant Pituitary Adenomas: An Institutional Experience from the Middle East. World Neurosurg. 2019; 132:e802-e811. DOI: 10.1016/j.wneu.2019.08.004
20. Pezzutti DL, Magill ST, Albonette-Felicio T, Hardesty DA, Carrau RL, Otto BA, et al. Endoscopic Endonasal Transtubercular Approach for Resection of Giant Pituitary Adenomas With Subarachnoid Extension: The "Second Floor" Strategy to Avoid Postoperative Apoplexy. World Neurosurg. 2021; 153:e464-e472. DOI: 10.1016/j.wneu.2021.06.142
21. Kutlay M, Durmaz A, Özer I, Kural C, Temiz Ç, Kaya S, et al. Extended endoscopic endonasal approach to the ventral skull base lesions. Clin Neurol Neurosurg. 2018; 167:129-140. DOI: 10.1016/j.clineuro.2018.02.032.
22. Tosaka M, Prevedello DM, Yamaguchi R, Fukuhara N, Miyagishima T, Tanaka Y, et al. Single-Layer Fascia Patchwork Closure for the Extended Endoscopic Transsphenoidal Transtuberculum Transplanum Approach: Deep Suturing Technique and Preliminary Results. World Neurosurg. 2021; 155:e271-e284. DOI10.1016/j.wneu.2021.08.051.
23. Chabot JD, Patel CR, Hughes MA, Wang EW, Snyderman CH, Gardner PA, et al. Nasoseptal flap necrosis: a rare complication of endoscopic endonasal surgery. J Neurosurg. 2018; 128(5):1463-1472. DOI: 10.3171/2017.2.JNS161582
24. Park W, Nam DH, Kong DS, Lee KE, Park SI, Kim HY, et al. Learning curve and technical nuances of endoscopic skull base reconstruction with nasoseptal flap to control high-flow cerebrospinal fluid leakage: reconstruction after endoscopic skull base surgery other than pituitary surgery. Eur Arch Otorhinolaryngol. 2022; 279(3):1335-1340. DOI: 10.1007/s00405-021-06877-4
25. Constanzo F, Pinto J, Ledermann C, Schmidt T. Leukocyte-Rich and Platelet-Rich Fibrin for Skull Base Reconstruction After Endoscopic Endonasal Skull Base Surgery. Neurosurgery. 2023; 92(4):787-794. DOI: 10.1227/neu.0000000000002270
26. Rasmussen J, Ruggeri C, Ciraolo C, Baccanelli M, Yampolsky C, Ajler P. Application of Fibrin Rich in Leukocytes and Platelets in the Reconstruction of Endoscopic Approaches to the Skull Base. World Neurosurg. 2018; 118:32-41. DOI: 10.1016/j.wneu.2018.06.180
Published
2023-11-09
How to Cite
1.
Vargas Gálvez CR, López Arbolay O, Ortiz Machín MM. Skull base reconstruction barrier in endoscopic endonasal approaches. Rev Cubana Med Milit [Internet]. 2023 Nov. 9 [cited 2025 Apr. 6];52(4):e023014321. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/14321
Issue
Section
Research Article
License
Authors who have publications with this Journal accept the following terms:
- The authors will retain their copyright and guarantee the Journal the right of first publication of their work, which will simultaneously be subject to the Creative Commons Attribution License. The content presented here can be shared, copied and redistributed in any medium or format; Can be adapted, remixed, transformed or created from the material, using the following terms: Attribution (giving appropriate credit to the work, providing a link to the license, and indicating if changes have been made); non-commercial (you cannot use the material for commercial purposes) and share-alike (if you remix, transform or create new material from this work, you can distribute your contribution as long as you use the same license as the original work).
- The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (for example: depositing it in an institutional electronic archive or publishing it in a monographic volume) as long as the initial publication in this Journal is indicated.
- Authors are allowed and recommended to disseminate their work through the Internet (e.g., in institutional electronic archives or on their website) before and during the submission process, which can produce interesting exchanges and increase citations. of the published work.
