Closure of Dural Defects after Anterior Clinoid and Optic Canal Roof Removal: Technical Note

ABSTRACT

A technique using vascularized pericranium to close dural defects after anterior clinoid and/or optic canal roof removal is described. This approach is simple, inexpensive, and uses autologous tissue. This method has provided satisfactory dural closure and has avoided cerebrospinal fluid leaks or extradural accumulation of cerebrospinal fluid.

KEYWORDS

CSF leak - dural reconstruction - pericranial graft

REFERENCES

• 1 Pritz M B. Lateral orbital rim osteotomy in the treatment of certain skull base lesions.  Skull Base. 2002;  12 1-8
• 2 Freije J E, Gluckman J L, van Loveren H, McDonough J J, Shumrick K A. Reconstruction of the anterior skull base after craniofacial resection.  Skull Base Surg. 1992;  2 17-21
• 3 Al-Mefty O. Clinoidal meningiomas.  J Neurosurg. 1990;  73 840-849
• 4 Risi P, Uske A, de Triboulet N. Meningiomas involving the anterior clinoid process.  Br J Neurosurg. 1994;  8 295-305
• 5 Al-Mefty O. Clinoidal meningiomas. In: Al-Mefty O Meningiomas New York, NY; Raven Press 1991: 427-443

The author has reported an interesting and useful technique. In my practice, dural reconstruction is unnecessary after resection of the anterior clinoid process or decompression of the optic nerve unless an opening has been created into the sphenoid sinus. Collections of subgaleal fluid are infrequent and almost always transient. The following question remains: When such a long flap is used to repair a small dural defect at such depth, to what extent does the tip of the flap remain vascularized? Nevertheless, this is a good technique to have in one's armamentarium to prevent cerebrospinal fluid leaks.