Reconstruction of dural defects in endoscopic transnasal approaches for intradural lesions using multi-layered fascia with a pressure-control spinal drainage system.

Reconstruction of dural defects in endoscopic transnasal approaches for intradural lesions using multi-layered fascia with a pressure-control spinal drainage system.

World Neurosurg. 2018 Apr 06;:

Authors: Hasegawa H, Shin M, Kondo K, Saito N

Abstract
OBJECTIVE: Nasoseptal flap reconstruction is a widely accepted method for reducing cerebrospinal fluid (CSF) leakage following endoscopic transnasal surgeries (ETSs). However, this method is associated with nasal complications and has difficulty in repeatedly applying for recurrent cases. Therefore, alternative methods are needed.
METHODS: Layers of autologous fascia lata were placed on the inside and outside of the dural defect to sufficiently cover it, and the grafts were compressed with an inflated balloon. A lumbar drainage system with a pressure-control valve was used for 72 hours postoperatively. We retrospectively analyzed data on patients with skull base lesions showing intracranial extensions that required wide opening of the ventral dura in ETS. Fifty cases (47 skull base tumors and 3 others) were included, in which 28 were recurrent cases.
RESULTS: In 21 cases (42%), the nasal septum was not intact because of the previous ETS. Seventeen patients (34%) had a history of radiotherapy and 9 (18%) had undergone multi-session radiotherapies. None of the 50 patients required additional surgery for postoperative CSF rhinorrhea, while 2 had intermittent CSF leakage that resolved with prolonged lumbar drainage placement for a week. Prior multi-session radiotherapy was the only significant risk factor for the need of prolonged drainage (p = 0.029).
CONCLUSIONS: The multi-layer closure method with pressure control spinal drainage system is a simple, safe, and effective method for preventing postoperative CSF leakage, which can be readily applied for the dural defects in any parts of the skull base regions and for patients with various conditions.

PMID: 29631081 [PubMed - as supplied by publisher]

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