Primary Dural Repair Using Titanium Microclips Following Lateral Skull Base Surgery

Abstract

Objective Standard techniques for primary dural repair following lateral skull base surgery are both technically challenging and time consuming without the potential for primary dural repair. Inadequate closure may result in postoperative cerebrospinal fluid (CSF) leak infectious sequalae. Traditional methods of dural repair rely on secondary obliteration of the CSF fistula. We hypothesized that the use of nonpenetrating titanium microclips may serve as a useful adjunct in primary dural repair or the establishment of an immobile repair layer following lateral skull base surgery.

Methods Here, we report a novel technique for primary dural repair using nonpenetrating titanium microclips as an adjunct to standard techniques in a series of six patients with lateral skull base pathologies.

Results A total of six consecutive lateral skull base tumor patients with titanium microclip dural reconstruction were included in our case series. Lateral skull base pathologies represented in this group included two jugular foramen schwannomas, one vestibular schwannoma, one petroclival meningioma, one glomus jugulare paraganglioma, and one jugular foramen chordoid meningioma.

Conclusion To our knowledge, this is the first report on the use of microclips in repairing dural defects following lateral skull base surgery. Surgical outcomes for this small case series suggest that dural repair of the later skull base with nonpenetrating titanium microclips is a useful adjunct in dural repair following lateral skull base surgery.

Keywords

lateral skull base - dural closure - titanium microclip - tumor

Note

This work has been previously presented as an abstract/poster at the 2020 North American Skull Base Society Meeting. No other disclosures.

Publikationsverlauf

Eingereicht: 10. Juni 2020

Angenommen: 24. Februar 2021

Artikel online veröffentlicht:
03. Juni 2021

• References

• 1 Xu J, Yi H, Li X, Chen W, Xu J. Surgical treatment of lateral skull base lesions and reconstruction of the skull base: a report of 20 cases. Acta Otolaryngol 2017; 137 (02) 131-135
• 2 Marzo SJ, Benscoter B, Leonetti JP. Contemporary options for lateral skull base reconstruction following tumor extirpation. Curr Opin Otolaryngol Head Neck Surg 2011; 19 (05) 330-334
• 3 Leverstein-van Hall MA, Hopmans TE, van der Sprenkel JW. et al. A bundle approach to reduce the incidence of external ventricular and lumbar drain-related infections. J Neurosurg 2010; 112 (02) 345-353
• 4 Glenn CA, Baker CM, Burks JD, Conner AK, Smitherman AD, Sughrue ME. Dural closure in confined spaces of the skull base with nonpenetrating titanium clips. Oper Neurosurg (Hagerstown) 2018; 14 (04) 375-385
• 5 Allen KP, Isaacson B, Purcell P, Kutz Jr JW, Roland PS. Lumbar subarachnoid drainage in cerebrospinal fluid leaks after lateral skull base surgery. Otol Neurotol 2011; 32 (09) 1522-1524
• 6 Indorewala S, Nemade G, Indorewala A, Mahajan G. Repair of bony lateral skull base defects equal to or larger than 10 mm by extracorporeally sewed unit-sandwich graft. Eur Arch Otorhinolaryngol 2018; 275 (08) 2177-2186
• 7 Schwam ZG, Michaelides E, Kuo P, Hajek MA, Judson BL, Schutt C. Thirty-day morbidity and mortality following otologic/neurotologic surgery: analysis of the national surgical quality improvement program. Laryngoscope 2018; 128 (06) 1431-1437
• 8 Thompson NJ, Roche JP, Schularick NM, Chang KE, Hansen MR. Reconstruction outcomes following lateral skull base resection. Otol Neurotol 2017; 38 (02) 264-271
• 9 Ransom ER, Palmer JN, Kennedy DW, Chiu AG. Assessing risk/benefit of lumbar drain use for endoscopic skull-base surgery. Int Forum Allergy Rhinol 2011; 1 (03) 173-177
• 10 McRackan TR, Brackmann DE. Historical perspective on evolution in management of lateral skull base tumors. Otolaryngol Clin North Am 2015; 48 (03) 397-405
• 11 Zanoletti E, Mazzoni A, Martini A. et al. Surgery of the lateral skull base: a 50-year endeavour. Acta Otorhinolaryngol Ital 2019; 39 (Suppl. 01) S1-S146
• 12 Zanoletti E, Martini A, Emanuelli E, Mazzoni A. Lateral approaches to the skull base. Acta Otorhinolaryngol Ital 2012; 32 (05) 281-287
• 13 House JW, Cullen RD. Chapter 15: Complications of Neurotologic Surgery. In: Friedman RA. ed. Lateral Skull Base Surgery: the House Clinic Atlas. 1st ed.. New York, NY: Thieme; 2012: 165-172
• 14 Narotam PK, Reddy K, Fewer D, Qiao F, Nathoo N. Collagen matrix duraplasty for cranial and spinal surgery: a clinical and imaging study. J Neurosurg 2007; 106 (01) 45-51
• 15 Marzo SJ, Leonetti JP, Petruzzelli GJ, Vandevender D. Closure of complex lateral skull base defects. Otol Neurotol 2005; 26 (03) 522-524
• 16 Maier W. Biomaterials in skull base surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg 2009; 8: Doc07
• 17 Patel NS, Modest MC, Brobst TD. et al. Surgical management of lateral skull base defects. Laryngoscope 2016; 126 (08) 1911-1917
• 18 Schick B, Dlugaiczyk J. Surgery of the ear and the lateral skull base: pitfalls and complications. GMS Curr Top Otorhinolaryngol Head Neck Surg 2013; 12: Doc05
• 19 Schick B, Ibing R, Brors D, Draf W. Long-term study of endonasal duraplasty and review of the literature. Ann Otol Rhinol Laryngol 2001; 110 (02) 142-147
• 20 Gray ST, Wu AW. Pathophysiology of iatrogenic and traumatic skull base injury. Adv Otorhinolaryngol 2013; 74: 12-23
• 21 Copeland WR, Mallory GW, Neff BA, Driscoll CLW, Link MJ. Are there modifiable risk factors to prevent a cerebrospinal fluid leak following vestibular schwannoma surgery?. J Neurosurg 2015; 122 (02) 312-316
• 22 Selesnick SH, Liu JC, Jen A, Newman J. The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol 2004; 25 (03) 387-393