Journal Article

GASKET-SEAL WATERTIGHT CLOSURE IN MINIMAL-ACCESS ENDOSCOPIC CRANIAL BASE SURGERY

SCHWARTZ, Theodore H, LENG, Lewis Z, ANAND, Vijay K, BROWN, Seth

2008

Overview

Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented. To achieve watertight closure of the anterior cranial base, autologous fascia lata was used to create a \"gasket seal\" around a bone buttress, followed by application of a tissue sealant such as DuraSeal (Confluent Surgical, Inc., Waltham, MA). The gasket-seal closure was used to seal the anterior cranial base in a series of 10 patients with intradural surgery for suprasellar craniopharyngiomas (n = 5), planum meningiomas (n = 3), clival chordoma (n = 1), and recurrent iatrogenic cerebrospinal fluid leak (n = 1). Lumbar drains were placed intraoperatively in five patients and remained in place for 3 days postoperatively. After a mean follow-up period of 12 months, there were no cerebrospinal fluid leaks. The gasket-seal closure is an effective method for achieving watertight closure of the anterior cranial base after endoscopic intradural surgery.

• Publisher: Lippincott Williams & Wilkins
• Subject: Biological and medical sciences / Brain Neoplasms - surgery / Craniotomy - methods / Humans / Medical sciences / Minimally Invasive Surgical Procedures - methods / Neuroendoscopy - methods / Neurosurgery / Skull Base - surgery / Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases / Tissue Adhesives - administration & dosage / Treatment Outcome / Water