Download PDF
J Neurol Surg B Skull Base 2022; 83(S 02): e291-e297
DOI: 10.1055/s-0041-1726128
Original Article

Clinical Efficacy of the Multilayered Skull Base Reconstruction Using In Situ Bone Flap in Endoscopic Endonasal Approach for Craniopharyngioma

Yuefei Zhou‡   *
1   Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
,
Yue Hei‡   *
1   Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
,
Jose M. Soto
2   Department of Neurosurgery, Baylor Scott and White Medical Center, Texas A&M University, College of Medicine, Temple, Texas, United States
,
Tao Jin
3   Department of Neurosurgery, The Center Hospital of Ankang City, Ankang, Shaanxi, China
,
Xiaofan Jiang
1   Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
,
Dongxia Feng
2   Department of Neurosurgery, Baylor Scott and White Medical Center, Texas A&M University, College of Medicine, Temple, Texas, United States
,
Weiping Liu
1   Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
,
Dakuan Gao
1   Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
› Author Affiliations Funding This research was supported by Natural Science Foundation of China (No. 81627806).
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective The aim of the study is to summarize and analyze the efficacy of the multilayered skull base reconstruction using in situ bone flap in endoscopic endonasal approach (EEA) for craniopharyngiomas.

Methods A retrospective review of 65 patients who underwent resection of their histopathology confirmed craniopharyngiomas performed at a single institution. Based on the team's understanding and mastery of skull base reconstruction techniques, patients were divided into two groups according to the methods of reconstruction in two periods. First (March 2015 through August 2016), osseous reconstruction was not adopted and served as the control group (34 cases). Second (September 2016 through July 2019), in situ bone flap repair of the skull base (complete osseous reconstruction) served as observation group (31 cases). The length of hospitalization and nasal exudation, bed rest time of hospital discharge, the incidence of cerebrospinal fluid leaks, lumbar drainage, and intracranial/pulmonary infections were collected and compared.

Results Compared with the control group, patients in the observation group had obviously less lumbar drainage and CSF leakage (p < 0.05), but had no significant difference in cases of re-operation, meningitis, and pulmonary infection. At the meantime, cases of nasal exudation, bed rest, and hospitalization of the observation group were significantly reduced (p < 0.05) in the observation group.

Conclusion The multilayered reconstruction technique (especially using in situ bone flap, combined with vascularized pedicled nasoseptal flap) is a safe and effective method in achieving watertight closure after EEEA, and can significantly reduce the incidence of cerebrospinal fluid leaks, and facilitate rehabilitation in skull base reconstruction of craniopharyngiomas.

Keywords

extended endoscopic endonasal approach - craniopharyngioma - skull base reconstruction - multilayer - CSF leak

Authors' Contributions

D.G. contributed toward conception, design, and surgical operation. Y.Z., Y.H., and T.J. contributed toward data collection and analysis. Y.Z. and Y.H. drafted the article. J.X., D.G., and W.L. revised the article. D.G. approved the final version on behalf of all the authors. J.M.S. and D.F. contributed to language polishing. W.L. provided technical support and other help.


* These authors contributed equally to this work.




Publication History

Received: 21 April 2020

Accepted: 29 January 2021

Article published online:
31 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Zhang S, Fang Y, Cai BW, Xu JG, You C. Intracystic bleomycin for cystic craniopharyngiomas in children. Cochrane Database Syst Rev 2016; 7: CD008890
    PubMedGoogle Scholar
  • 2 Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas. World Neurosurg 2012; 77 (02) 329-341
    CrossrefPubMedGoogle Scholar
  • 3 Castelnuovo P, Dallan I, Battaglia P, Bignami M. Endoscopic endonasal skull base surgery: past, present and future. Eur Arch Otorhinolaryngol 2010; 267 (05) 649-663
    CrossrefPubMedGoogle Scholar
  • 4 Elliott RE, Jane Jr JA, Wisoff JH. Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches. Neurosurgery 2011; 69 (03) 630-643 , discussion 643
    CrossrefPubMedGoogle Scholar
  • 5 Garcia-Navarro V, Anand VK, Schwartz TH. Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series. World Neurosurg 2013; 80 (05) 563-568
    CrossrefPubMedGoogle Scholar
  • 6 Cavallo LM, Frank G, Cappabianca P. et al. The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. J Neurosurg 2014; 121 (01) 100-113
    CrossrefPubMedGoogle Scholar
  • 7 Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler-Kabara EC, Wang EW, Snyderman CH. Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients. J Neurosurg 2013; 119 (05) 1194-1207
    CrossrefPubMedGoogle Scholar
  • 8 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 (04, Suppl 2): discussion 303–304 295-303
    CrossrefPubMedGoogle Scholar
  • 9 Hara T, Akutsu H, Yamamoto T. et al. Cranial base repair using suturing technique combined with a mucosal flap for cerebrospinal fluid leakage during endoscopic endonasal surgery. World Neurosurg 2015; 84 (06) 1887-1893
    CrossrefPubMedGoogle Scholar
  • 10 Silveira-Bertazzo G, Manjila S, Carrau R. et al. Expanded endoscopic endonasal approach for extending suprasellar and third ventricular lesions. Acta Neurochir (Wien) 2020; 162 (10) 2403-2408
    CrossrefPubMedGoogle Scholar
  • 11 Wang AJ, Zaidi HA, Laws Jr ED. History of endonasal skull base surgery. J Neurosurg Sci 2016; 60 (04) 441-453
    PubMedGoogle Scholar
  • 12 Cavallo LM, Solari D, Somma T, Cappabianca P. The 3F (fat, flap, and flash) technique for skull base reconstruction after endoscopic endonasal suprasellar approach. World Neurosurg 2019; 126: 439-446
    CrossrefPubMedGoogle Scholar
  • 13 Steno J, Malácek M, Bízik I. Tumor-third ventricular relationships in supradiaphragmatic craniopharyngiomas: correlation of morphological, magnetic resonance imaging, and operative findings. Neurosurgery 2004; 54 (05) 1051-1058 , discussion 1058–1060
    CrossrefPubMedGoogle Scholar
  • 14 Conger A, Zhao F, Wang X. et al. Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients. J Neurosurg 2018; 130 (03) 861-875
    Google Scholar
  • 15 Ivan ME, Iorgulescu JB, El-Sayed I. et al. Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery. J Clin Neurosci 2015; 22 (01) 48-54
    CrossrefPubMedGoogle Scholar
  • 16 Wang EW, Gardner PA, Zanation AM. International consensus statement on endoscopic skull-base surgery: executive summary. Int Forum Allergy Rhinol 2019; 9 (S3) S127-S144
    PubMedGoogle Scholar
  • 17 Hertel V, Schick B. Diagnosis and treatment of frontobasal cerebrospinal fluid fistulas. Laryngorhinootologie 2012; 91 (09) 585-597
    PubMedGoogle Scholar
  • 18 Kim BY, Shin JH, Kim SW. et al. Risk factors predicting nasoseptal flap failure in the endoscopic endonasal transsphenoidal approach. J Craniofac Surg 2016
    PubMedGoogle Scholar
  • 19 Korshunov A, Jakobiec FA, Eberhart CG. et al. Comparative integrated molecular analysis of intraocular medulloepitheliomas and central nervous system embryonal tumors with multilayered rosettes confirms that they are distinct nosologic entities. Neuropathology 2015; 35 (06) 538-544
    CrossrefPubMedGoogle Scholar
  • 20 El-Banhawy OA, Halaka AN, Altuwaijri MA, Ayad H, El-Sharnoby MM. Long-term outcome of endonasal endoscopic skull base reconstruction with nasal turbinate graft. Skull Base 2008; 18 (05) 297-308
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Xie T, Zhang XB, Yun H, Hu F, Yu Y, Gu Y. 3D-FIESTA MR images are useful in the evaluation of the endoscopic expanded endonasal approach for midline skull-base lesions. Acta Neurochir (Wien) 2011; 153 (01) 12-18
    CrossrefPubMedGoogle Scholar