Abstract
Objective The purpose of this study is to report the technical procedure and our experience
using a polydioxanone suture (PDS) plate with dural substitute as part of a fully
resorbable gasket seal technique to repair anterior skull base defects.
Methods A series of patients undergoing anterior skull base reconstruction utilizing our
resorbable gasket seal technique from January 2014 to July 2022 was reviewed.
Results A total of 155 patients were included. Nine (5.8%) of the included patients developed
postoperative cerebrospinal fluid (CSF) leaks requiring reoperation. There were no
cases of intraoperative cranial nerve injury or internal carotid artery injury. A
total of 103 (66.5%) patients were observed to have an intraoperative CSF leak, including
57 low-flow leaks and 46 high-flow leaks; 1 of 57 (1.8%) patients with low-flow leaks
and 8 of 46 (17.4%) patients with high-flow leaks developed a postoperative CSF leak.
During the first 3 years that this technique was utilized at our center for the management
of high-flow intraoperative CSF leaks, postoperative CSF leaks were documented in
4 of 12 (33.3%) patients, in comparison to 4 of 34 (11.8%) in the following years.
Conclusion PDS plate reconstruction confers several advantages and can be used in a diverse
set of operative scenarios in conjunction with other reconstruction options. There
appeared to be an associated learning curve as surgeons at our center gained experience
with this new technique. Our findings show that the PDS plate reconstruction is safe
and effective in repairing the skull base.
Keywords
anterior skull base reconstruction - endoscopic skull base - polydioxanone plate -
gasket seal
