Reconstruction of dural defects in endoscopic transnasal approaches for intradural lesions utilizing multi-layered fascia with a pressure-control spinal drainage system.
World Neurosurg. 2018 Apr 06;:
Authors: Hasegawa H, Shin M, Kondo Ok, Saito N
OBJECTIVE: Nasoseptal flap reconstruction is a broadly accepted methodology for lowering cerebrospinal fluid (CSF) leakage following endoscopic transnasal surgical procedures (ETSs). Nonetheless, this methodology is related to nasal issues and has issue in repeatedly making use of for recurrent instances. Subsequently, various strategies are wanted.
METHODS: Layers of autologous fascia lata had been positioned on the within and outdoors of the dural defect to sufficiently cowl it, and the grafts had been compressed with an inflated balloon. A lumbar drainage system with a pressure-control valve was used for 72 hours postoperatively. We retrospectively analyzed knowledge on sufferers with cranium base lesions exhibiting intracranial extensions that required broad opening of the ventral dura in ETS. Fifty instances (47 cranium base tumors and three others) had been included, through which 28 had been recurrent instances.
RESULTS: In 21 instances (42%), the nasal septum was not intact due to the earlier ETS. Seventeen sufferers (34%) had a historical past of radiotherapy and 9 (18%) had undergone multi-session radiotherapies. Not one of the 50 sufferers required extra surgical procedure for postoperative CSF rhinorrhea, whereas 2 had intermittent CSF leakage that resolved with extended lumbar drainage placement for every week. Prior multi-session radiotherapy was the one important threat issue for the necessity of extended drainage (p = zero.029).
CONCLUSIONS: The multi-layer closure methodology with stress management spinal drainage system is a straightforward, protected, and efficient methodology for stopping postoperative CSF leakage, which might be readily utilized for the dural defects in any elements of the cranium base areas and for sufferers with varied situations.
PMID: 29631081 [PubMed – as supplied by publisher]