Skull base reconstruction strategy in endoscopic endonasal approaches
Keywords:
fibrin rich in platelets and leukocytes, loss of cerebrospinal fluid, skull base, neuroendoscopy.Abstract
Introduction: Endoscopic endonasal procedures allow surgical removal of complex tumors at the cranial base. However, the cranial base repair phase is challenging.
Objectives: To evaluate the effectiveness of a cranial base repair strategy in endoscopic endonasal procedures.
Method: A descriptive, longitudinal, prospective investigation was carried out that included 190 adult patients at the "Hermanos Ameijeiras" Hospital with a diagnosis of benign tumors of the cranial base who underwent surgery using endoscopic endonasal procedures for which a repair strategy was designed. The following variables were evaluated: effectiveness of the repair barrier and the repair strategy, as well as complications, especially cerebrospinal fluid fistula. For data analysis, absolute and relative frequencies were used as summary measures.
Results: Effectiveness of the cranial base repair strategy was evident in 97.4 % of patients. The incidence of cerebrospinal fluid fistula was only 2.6 %.
Conclusions: The cranial base repair strategy for cranial base tumors by endoscopic endonasal approach is safe and effective, with low incidence of complications.
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References
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15. Fraser S, Gardner PA, Koutourousiou M, Kubik M, Fernandez-Miranda JC, Snyderman CH, et al. Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery. J Neurosurg. 2018; 128(4):1066-1071. DOI: 10.3171/2016.12.JNS1694
16. Alshareef M, Alroqi A, Albaharna H, Alsayed A, Alromaih S, Alrasheed AS, et al. Nasoseptal flap and rigid reconstruction in endoscopic endonasal skull base surgeries: The longitudinal experience of a single center. Ear Nose Throat J. 2022: 1455613221099483. DOI: 10.1177/01455613221099483
17. Soliman MAR, Eaton S, Quint E, Alkhamees AF, Shahab S, O'Connor A, et al. Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital. World Neurosurg. 2020; 138:e940-e954. DOI: 10.1016/j.wneu.2020.04.028
18. Kim BK, Kong DS, Nam DH, Hong SD. Comparison of Graft Materials in Multilayer Reconstruction with Nasoseptal Flap for High-Flow CSF Leak during Endoscopic Skull Base Surgery. J Clin Med. 2022; 11(22):6711. DOI: 10.3390/jcm11226711
19. 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
2.Martinez-Perez R, Requena LC, Carrau RL, Prevedello DM. Modern endoscopic skull base neurosurgery. J Neurooncol. 2021;151(3):461-475. DOI: 10.1007/s11060-020-03610-9
3. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus. 2005 [acceso: 18/05/2023]; 19(1):E3. Disponible en: https://pubmed.ncbi.nlm.nih.gov/16078817/
4. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus. 2005[acceso: 18/05/2023]; 19(1):E4. Disponible en: https://pubmed.ncbi.nlm.nih.gov/16078818/
5. Agam MS, Wedemeyer MA, Wrobel B, Weiss MH, Carmichael JD, Zada G. Complications associated with microscopic and endoscopic transsphenoidal pituitary surgery: experience of 1153 consecutive cases treated at a single tertiary care pituitary center. J Neurosurg. 2018:1-8. DOI: 10.3171/2017.12. JNS172318
6. Ozawa H, Sekimizu M, Saito S, Nakamura S, Mikoshiba T, Watanabe Y, et al. Risk factor for cerebrospinal fluid leak after endoscopic endonasal skull base surgery: a single-center experience. Acta Otolaryngol. 2021; 141(6):621-625. DOI: 10.1080/00016489.2021.1900600
7. Iranmehr A, Zeinalizadeh M, Namvar M, Fathi A, Azimi H, Tabari A, et al. Endoscopic endonasal management of skull base defects in pediatric patients. Int J Pediatr Otorhinolaryngol. 2021; 150:110902. DOI: 10.1016/j.ijporl.2021.110902
8. Heng L, Zhang S, Qu Y. Cross-reinforcing suturing and intranasal knotting for dural defect reconstruction during endoscopic endonasal skull base surgery. Acta Neurochir (Wien). 2020; 162(10):2409-2412. DOI: 10.1007/s00701-020-04367-w
9. 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
10. Ortiz-Machín M, López-Arbolay O, Vargas-Gálvez C, Ottenwalder-Díaz A. Surgical Cavity in Extended Endoscopic Endonasal Approach to the Skull Base and their Relationship with Cerebrospinal luid Leak. GJMR. 2023 [acceso: 19/05/2023]; 23(A1):1-4. Disponible en: https://medicalresearchjournal.org/index.php/GJMR/article/view/102278
11. Carrau RL, Jho HD, Ko Y. Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope. 1996; 106(7):914-8. DOI: 10.1097/00005537-199607000-00025
12. Lai LT, Trooboff S, Morgan MK, Harvey RJ. The risk of meningitis following expanded endoscopic endonasal skull base surgery: a systematic review. J Neurol Surg B Skull Base. 2014; 75(1):18-26. DOI: 10.1055/s-0033-1353365
13. López-García R, Abarca-Olivas J, Monjas-Cánovas I, Picó Alfonso A, Moreno-López P, Gras-Albert JR. Endonasal endoscopic surgery in pituitary adenomas: Surgical results in a series of 86 consecutive patients. Neurocirugia (Astur : Engl Ed). 2018; 29(4):161-169. DOI: 10.1016/j.neucir.2018.02.002
14. Alsaleh S, Albakr A, Alromaih S, Alatar A, Alroqi AS, Ajlan A. Expanded transnasal approaches to the skull base in the Middle East: Where do we stand? Ann Saudi Med. 2020; 40(2):94-104. DOI: 10.5144/0256-4947.2020.94
15. Fraser S, Gardner PA, Koutourousiou M, Kubik M, Fernandez-Miranda JC, Snyderman CH, et al. Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery. J Neurosurg. 2018; 128(4):1066-1071. DOI: 10.3171/2016.12.JNS1694
16. Alshareef M, Alroqi A, Albaharna H, Alsayed A, Alromaih S, Alrasheed AS, et al. Nasoseptal flap and rigid reconstruction in endoscopic endonasal skull base surgeries: The longitudinal experience of a single center. Ear Nose Throat J. 2022: 1455613221099483. DOI: 10.1177/01455613221099483
17. Soliman MAR, Eaton S, Quint E, Alkhamees AF, Shahab S, O'Connor A, et al. Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital. World Neurosurg. 2020; 138:e940-e954. DOI: 10.1016/j.wneu.2020.04.028
18. Kim BK, Kong DS, Nam DH, Hong SD. Comparison of Graft Materials in Multilayer Reconstruction with Nasoseptal Flap for High-Flow CSF Leak during Endoscopic Skull Base Surgery. J Clin Med. 2022; 11(22):6711. DOI: 10.3390/jcm11226711
19. 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
Published
2024-04-01
How to Cite
1.
Vargas Gálvez CR, López Arbolay O, Ortiz Machín MM. Skull base reconstruction strategy in endoscopic endonasal approaches. Rev Cubana Med Milit [Internet]. 2024 Apr. 1 [cited 2025 Apr. 3];53(2):e024014406. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/14406
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