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DOI: 10.1055/s-0033-1336349
Reconstruction of Skull Base Defects Following Endonasal Transsphenoidal Approaches to the Sellar Region
Objective: Water-tide closure of the bone and dura defects, prevention of CSF leak after endonasal transsphenoidal approaches to the sellar region, anterior and mid-clival skull base, especially extended approaches to the large pituitary tumors and craniopharingiomas with extrasellar extension is a real challenge for neurosurgeons.
Methods: Between 2007 and 2012, 250 patients were operated on via a transnasal transsphenoidal approach—203 (81.2%) with pituitary tumor, 15 (6%) with craniopharingiomas, 2 (0.8%) with Rathke’s cleft cysts, 6 (2.4%) with different skull base tumors, and 24 (9.6%) with CSF leak of different origin. Four different methods of skull base reconstruction and CSF leak prevention during endonasal approaches to the skull base were used: (1) sella turcica tamponation with spongostan, dura reconstruction with Vicryl patch and fibrin glue after tumor resection; (2) sella turcica tamponation with fat graft, dura reconstruction with a piece of fascia lata and fibrin glue; (3) skull base reconstruction with vascular pedicle mucosal flap of the nasal septum (Hadad-Bassagasteguy [HB] flap); and (4) skull base ventral surface reconstruction with vascular pedicle pericranial flap.
Reconstruction with artificial materials was performed in 162 (64.8%) patients; reconstruction with fat graft and fascia lata was made in 18 (7.2%) patients; skull base reconstruction with vascular pedicle mucosal flap of the nasal septum (HB flap) was applied in 69 (27.6%) patients, and in 3 of these 69 cases it was used iteratively; 1 (0.4%) patient had endonasal endoscopic reconstruction of skull base with vascular pedicle pericranial flap.
Conclusion: Use of different methods for skull base reconstruction in endonasal surgery reduces risks of CSF leak postoperatively. Vascular pedicle flaps give more effective water-tide closure, especially in cases of extended approaches to the sellar region and skull base; they heal more quickly and could be used iteratively.