Circumferential watertight dural repair using nitinol U-clips in expanded endonasal and sublabial approaches to the cranial base

Francesco Acerbi, Eric Genden, Joshua Bederson

Research output: Contribution to journalArticle

Abstract

BACKGROUND: In recent years, significant advances have been made in the field of expanded endonasal approaches that permit treatment of different cranial base intradural lesions. OBJECTIVE: To report our technique of cranial base dural repair by the application of nitinol U-Clips in endoscope-assisted extended endonasal or sublabial approaches. Closure techniques and postoperative cerebrospinal (CSF) leaks are reported. METHODS: We reviewed 11 patients with different kinds of cranial base tumors or vascular diseases (2 tuberculum sellae meningiomas, 1 planum sphenoidale meningioma, 4 craniopharyngiomas, 1 recurrent clival chordoma, 1 esthesioneuroblastoma, 1 ethmoidal melanoma metastasis, 1 basilar trunk aneurysm) who underwent an endoscope-assisted extended endonasal or sublabial approach. Dural repair was performed using nitinol U-Clips to circumferentially suture AlloDerm or fascia lata directly to the existing dural borders. Lumbar drainage was not used in 9 patients and was used in 2 patients for 5 days. Patients were evaluated for the appearance of CSF leaks. RESULTS: Postoperative CSF leak was observed in 1 patient (9%). This required a second transnasal repair. CONCLUSION: Circumferential dural closure with U-Clips is a useful adjunct to prevent CSF leaks after expanded endonasal or sublabial approaches to the cranial base for treatment of intracranial pathology.

Original languageEnglish
JournalNeurosurgery
Volume67
Issue numberSUPPL. 2
DOIs
Publication statusPublished - Dec 2010

Keywords

  • Cerebrospinal fluid leak repair
  • Endoscopy
  • Expanded endonasal approach
  • Expanded sublabial approach
  • U-Clip

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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