Principles in Skull Base Reconstruction following Expanded Endoscopic Approaches

Abstract

Objectives This study aims to describe the types of anterior skull base defects following expanded endoscopic approaches (EEA) and to outline the techniques involved in the repair of these defects.

Design We retrospectively analyzed 63 cases of endoscopic skull base reconstruction (ESBR) following tumor excision, done from September 2011 to January 2015. These tumors consisted of 14 pituitary adenomas, 20 craniopharyngiomas, and 29 other miscellaneous tumors. The classification of skull base defects by Tabaee et al and the classification of cerebrospinal fluid (CSF) leaks by Esposito et al were considered during the ESBR. Recurrence of CSF leak was considered as failure of reconstruction.

Results The 63 skull base defects included in this study occurred following EEA for tumor excision. Failure of reconstruction occurred in 6 six patients. All were successfully repaired, however, three patients in this series died due to tumor-related complications.

Conclusion The adherence to the general principles of reconstruction, appreciating the subtle differences in the nature of the various defects and the ability to adopt different strategies are the prerequisites for the successful closure of skull base defects.

Keywords

CSF leak - skull base - fovea ethmoidalis - cribriform plate - sphenopalatine artery

Note

The authors have no financial disclosures or conflict of interest to declare in submitting this article. This study has been cleared by the institutional review board.

The skull base reconstruction of the initial group of patients in this study was presented in the World Congress of Skull Base Surgery at Brighton, United Kingdom, May 2012. The abstract of the presentation was published in this journal—Successful dural repair following the endoscopic extended transsphenoidal approach for suprasellar meningiomas, Journal of Neurological Surgery—Skull Base, Supplement Number S 2, Volume 73, June 2012, page 120–121.

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