TY - JOUR
T1 - Circumferential watertight dural repair using nitinol U-clips in expanded endonasal and sublabial approaches to the cranial base
AU - Acerbi, Francesco
AU - Genden, Eric
AU - Bederson, Joshua
PY - 2010/12
Y1 - 2010/12
N2 - 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.
AB - 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.
KW - Cerebrospinal fluid leak repair
KW - Endoscopy
KW - Expanded endonasal approach
KW - Expanded sublabial approach
KW - U-Clip
UR - http://www.scopus.com/inward/record.url?scp=78650618893&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78650618893&partnerID=8YFLogxK
U2 - 10.1227/NEU.0b013e3181faaa86
DO - 10.1227/NEU.0b013e3181faaa86
M3 - Article
C2 - 21099571
AN - SCOPUS:78650618893
VL - 67
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - SUPPL. 2
ER -