J Neurol Surg B Skull Base 2013; 74 - A226
DOI: 10.1055/s-0033-1336349

Reconstruction of Skull Base Defects Following Endonasal Transsphenoidal Approaches to the Sellar Region

Bakhtiyar Pashaev 1(presenter), Dmitry Bochkarev 1, Valery Danilov 1, Andrey Alekseev 1, Gulnar Vagapova 1, Vladimir Krasnazhen 1
  • 1Kazan, Russia

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.