Closure of skull base defects after endonasal endoscopic resection of planum sphenoidale and tuberculum sellae meningiomas

Ricardo Dolci; Williams Encinas; Amanda Monteiro; Jeniffer Kozechen Rickli; Jamile de Souza; Alexandre Todeschini; Igor Padilha; Henrique Zuppani; Américo Leite dos Santos; Paulo Lazarini

doi:10.4103/ajns.AJNS_62_20

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 653-659
DOI: 10.4103/ajns.AJNS_62_20

Original Article

Closure of skull base defects after endonasal endoscopic resection of planum sphenoidale and tuberculum sellae meningiomas

Ricardo Dolci

¹Department of Otolaryngology, Irmandade of Santa Casa de Misericórdia of São Paulo

²Faculty of Medical Sciences of Santa Casa of São Paulo, SP

,

Williams Encinas

²Faculty of Medical Sciences of Santa Casa of São Paulo, SP

³Discipline of Neurosurgery, Department of Surgery, Irmandade of Santa Casa of Misericórdia of São Paulo, SP

,

Amanda Monteiro

¹Department of Otolaryngology, Irmandade of Santa Casa de Misericórdia of São Paulo

²Faculty of Medical Sciences of Santa Casa of São Paulo, SP

,

Jeniffer Kozechen Rickli

¹Department of Otolaryngology, Irmandade of Santa Casa de Misericórdia of São Paulo

²Faculty of Medical Sciences of Santa Casa of São Paulo, SP

,

Jamile de Souza

¹Department of Otolaryngology, Irmandade of Santa Casa de Misericórdia of São Paulo

²Faculty of Medical Sciences of Santa Casa of São Paulo, SP

,

Alexandre Todeschini

²Faculty of Medical Sciences of Santa Casa of São Paulo, SP

³Discipline of Neurosurgery, Department of Surgery, Irmandade of Santa Casa of Misericórdia of São Paulo, SP

,

Igor Padilha

²Faculty of Medical Sciences of Santa Casa of São Paulo, SP

⁴Departament of de Radiology, Irmanadade of Santa Casa of Misericórdia of São Paulo, SP

,

Henrique Zuppani

²Faculty of Medical Sciences of Santa Casa of São Paulo, SP

⁴Departament of de Radiology, Irmanadade of Santa Casa of Misericórdia of São Paulo, SP

,

Américo Leite dos Santos

²Faculty of Medical Sciences of Santa Casa of São Paulo, SP

³Discipline of Neurosurgery, Department of Surgery, Irmandade of Santa Casa of Misericórdia of São Paulo, SP

,

Paulo Lazarini

¹Department of Otolaryngology, Irmandade of Santa Casa de Misericórdia of São Paulo

²Faculty of Medical Sciences of Santa Casa of São Paulo, SP

› Institutsangaben

Abstract

Background: The expanded endoscopic endonasal transplanum transtuberculum approach allows tumor removal by minimally invasive procedures. A large dural and bone defect is created during the surgical procedure, increasing the risk of postoperative cerebrospinal fluid (CSF) leakage. Objective: The aim of this study is to describe a surgical technique and complications observed in patients undergoing endonasal resection of planum sphenoidale and/or tuberculum sellae meningiomas. Methods: A retrospective analysis was performed of patients with planum sphenoidale and/or tuberculum sellae meningiomas after expanded endoscopic endonasal resection between June 2013 and August 2018, in which autologous grafts, fascia lata inlay, and nasoseptal flap onlay were used for closure of skull base defects. Results: Ten patients were included in the analysis. No cases of postoperative CSF leakages or meningitis were reported, whereas two patients evolved with postoperative infectious complications (fungal ball in right frontal sinus and brain abscess). The skull base defect created for resection measured, on average, 3.58 cm². Conclusion: Our experience suggests that closure of skull base defects using combined fascia lata inlay and nasoseptal flap onlay is effective for preventing postoperative CSF leakage in resection of planum sphenoidale and/or tuberculum sellae meningiomas, and offers high reproducibility due to its low cost.

Key-words:

Cerebrospinal fluid leak - meningioma - skull base - surgical flaps

Volltext

Referenzen

References
1 Cappabianca P, Alfieri A, de Divitiis E. Endoscopic endonasal transsphenoidal approach to the sella: Towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg 1998;41:66-73.
2 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;19:E3.
3 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;19:E4.
4 Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R. Expanded endonasal approach: Fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 2005;19:E6.
5 Stamm AM. Transnasal endoscopy-assisted skull base surgery. Ann Otol Rhinol Laryngol Suppl 2006;196:45-53.
6 Todeschini AB, Otto BA, Carrau RL, Prevedello DM. Endoscopic endonasal approaches for the management of skull base meningiomas: Selection criteria and clinical outcomes. J Neurosurg Sci 2018;62:617-26.
7 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;116:1882-6.
8 Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008;63:ONS44-52.
9 Esposito F, Dusick JR, Fatemi N, Kelly DF. Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Oper Neurosurg (Hagerstown) 2007;60:295-303.
10 Liu JK, Schmidt RF, Choudhry OJ, Shukla PA, Eloy JA. Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgery. Neurosurg Focus 2012;32:E7.
11 Pinheiro-Neto CD, Snyderman CH. Nasoseptal flap. Adv Otorhinolaryngol 2013;74:42-55.
12 Eloy JA, Shukla PA, Choudhry OJ, Singh R, Liu JK. Challenges and surgical nuances in reconstruction of large planum sphenoidale tuberculum sellae defects after endoscopic endonasal resection of parasellar skull base tumors. Laryngoscope 2013;123:1353-60.
13 Li Z, Ji T, Huang GD, Guo J, Yang JH, Li WP. A stratified algorithm for skull base reconstruction with endoscopic endonasal approach. J Craniofac Surg 2018;29:193-8.
14 Dolci RL, Miyake MM, Tateno DA, Cançado NA, Campos CA, Dos Santos AR, et al. Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base. Braz J Otorhinolaryngol 2017;83:349-55.
15 Caicedo-Granados E, Carrau R, Snyderman CH, Prevedello D, Fernandez-Miranda J, Gardner P, et al. Reverse rotation flap for reconstruction of donor site after vascular pedicled nasoseptal flap in skull base surgery. Laryngoscope 2010;120:1550-2.
16 Ditzel Filho LF, Prevedello DM, Jamshidi AO, Dolci RL, Kerr EE, Campbell R, et al. Endoscopic endonasal approach for removal of tuberculum sellae meningiomas. Neurosurg Clin N Am 2015;26:349-61.
17 Ferrareze Nunes C, Beer-Furlan A, Doglietto F, Carrau RL, Prevedello DM. The McConnell's capsular arteries and their relevance in endoscopic endonasal approach to the sellar region. Oper Neurosurg (Hagerstown) 2018;14:171-7.
18 Todeschini AB, Shahein M, Montaser AS, Hardesty D, Otto BA, Carrau RL, et al. Giant olfactory groove meningioma-2-staged approach: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 2019;16:115-6.
19 Amir A, Gatot A, Zucker G, Sagi A, Fliss DM. Harvesting large fascia lata sheaths: A rational approach. Skull Base Surg 2000;10:29-34.
20 Amir A, Gur E, Gatot A, Zucker G, Cohen JT, Fliss DM. Fascia lata sheaths harvest revisited. Oper Tech Otolayngol Head Neck Surg 2000;11:304-6.
21 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;128:1463-72.
22 Campbell RG, Otto BA, Prevedello DM, Carrau RL. How I do it: Modification of the posterior pedicled nasoseptal flap for clival and nasopharyngeal surgery. Aust J Otolaryngol 2018;1:13.
23 Gardner PA, Kassam AB, Thomas A, Snyderman CH, Carrau RL, Mintz AH, et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 2008;63:36-52.
24 Zanation AM, Carrau RL, Snyderman CH, Germanwala AV, Gardner PA, Prevedello DM, et al. Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy 2009;23:518-21.
25 Pant H, Bhatki AM, Snyderman CH, Vescan AD, Carrau RL, Gardner P, et al. Quality of life following endonasal skull base surgery. Skull Base 2010;20:35-40.
26 Harvey RJ, Parmar P, Sacks R, Zanation AM. Endoscopic skull base reconstruction of large dural defects: A systematic review of published evidence. Laryngoscope 2012;122:452-9.
27 Tang IP, Carrau RL, Otto BA, Prevedello DM, Kasemsiri P, Ditzel L, et al. Technical nuances of commonly used vascularised flaps for skull base reconstruction. J Laryngol Otol 2015;129:752-61.
28 Karligkiotis A, Meloni F, Herman P, Castelnuovo P. How to avoid mucocele formation under pedicled nasoseptal flap. Am J Otolaryngol 2014;35:546-7.
29 Vaezeafshar R, Hwang PH, Harsh G, Turner JH. Mucocele formation under pedicled nasoseptal flap. Am J Otolaryngol 2012;33:634-6.
30 Vaezeafshar R, Hwang PH, Turner JH. Commentary on “How to avoid mucocele formation under pedicled nasoseptal flap”. Am J Otolaryngol 2014;35:547.
31 Cavallo LM, Messina A, Esposito F, de Divitiis O, Dal Fabbro M, de Divitiis E, et al. Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions. J Neurosurg 2007;107:713-20.
32 Eloy JA, Choudhry OJ, Friedel ME, Kuperan AB, Liu JK. Endoscopic nasoseptal flap repair of skull base defects: Is addition of a dural sealant necessary? Otolaryngol Head Neck Surg 2012;147:161-6.
33 Eloy JA, Kuperan AB, Choudhry OJ, Harirchian S, Liu JK. Efficacy of the pedicled nasoseptal flap without cerebrospinal fluid (CSF) diversion for repair of skull base defects: Incidence of postoperative CSF leaks. Int Forum Allergy Rhinol 2012;2:397-401.
34 Tabaee A, Anand VK, Brown SM, Lin JW, Schwartz TH. Algorithm for reconstruction after endoscopic pituitary and skull base surgery. Laryngoscope 2007;117:1133-7.
35 Parizek J, Mericka P, Husek Z, Suba P, Spacek J, Nemecek S, et al. Detailed evaluation of 2959 allogeneic and xenogeneic dense connective tissue grafts (fascia lata, pericardium, and dura mater) used in the course of 20 years for duraplasty in neurosurgery. Acta Neurochir (Wien) 1997;139:827-38.
36 Thammavaram KV, Benzel EC, Kesterson L. Fascia lata graft as a dural substitute in neurosurgery. South Med J 1990;83:634-6.
37 Taha AN, Almefty R, Pravdenkova S, Al-Mefty O. Sequelae of autologous fat graft used for reconstruction in skull base surgery. World Neurosurg 2011;75:692-5.
38 Ricaurte JC, Murali R, Mandell W. Uncomplicated postoperative lipoid meningitis secondary to autologous fat graft necrosis. Clin Infect Dis 2000;30:613-5.
39 Ray J, D'Souza AR, Chavda SV, Walsh AR, Irving RM. Dissemination of fat in CSF: A common finding following translabyrinthine acoustic neuroma surgery. Clin Otolaryngol 2005;30:405-8.
40 McAllister JD, Scotti LN, Bookwalter JW. Postoperative dissemination of fat particles in the subarachnoid pathways. Am J Neuroradiol 1992;13:1265-7.
41 Hwang PH, Jackler RK. Lipoid meningitis due to aseptic necrosis of a free fat graft placed during neurotologic surgery. Laryngoscope 1996;106:1482-6.