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Circumferential Watertight Dural Repair Using Nitinol U-Clips in Expanded Endonasal and Sublabial Approaches to the Cranial Base

Acerbi, Francesco MD1; Genden, Eric MD2; Bederson, Joshua MD3

Neurosurgery:
doi: 10.1227/NEU.0b013e3181faaa86
Operative Technique: Editor's Choice
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.

Author Information

1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; and Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York

2Department of Otolaryngology–Head and Neck Surgery, Endoscopic Skull Base Surgery Center, Mount Sinai School of Medicine, New York, New York

3Department of Neurosurgery, Endoscopic Skull Base Surgery Center, Mount Sinai School of Medicine, New York, New York

Received, January 28, 2010.

Accepted, July 23, 2010.

Reprint requests: Joshua Bederson, MD, Department of Neurosurgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY 10029. E-mail: joshua.bederson@mountsinai.org

Copyright © by the Congress of Neurological Surgeons