Closure of Skull Base Defects after Endonasal Endoscopic Resection of Planum Sphenoidale and Tuberculum Sellae Meningiomas

经鼻内镜蝶窦平台及鞍结节脑膜瘤切除术后颅底缺损缝合

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作者:Ricardo Landini Lutaif Dolci, Williams Escalante Encinas, Amanda André Monteiro, Jeniffer Cristina Kozechen Rickli, Jamile Lopes de Souza, Alexandre Bossi Todeschini, Igor Gomes Padilha, Henrique Bortot Zuppani, Américo Rubens Leite Dos Santos, Paulo Roberto Lazarini

Background

The expanded endoscopic endonasal transplanum transtuberculum approach allows tumor removal by minimally invasive procedures. A large dural and bone defect is created during the surgical procedure, increasing the risk of postoperative cerebrospinal fluid (CSF) leakage.

Conclusion

Our experience suggests that closure of skull base defects using combined fascia lata inlay and nasoseptal flap onlay is effective for preventing postoperative CSF leakage in resection of planum sphenoidale and/or tuberculum sellae meningiomas, and offers high reproducibility due to its low cost.

Methods

A retrospective analysis was performed of patients with planum sphenoidale and/or tuberculum sellae meningiomas after expanded endoscopic endonasal resection between June 2013 and August 2018, in which autologous grafts, fascia lata inlay, and nasoseptal flap onlay were used for closure of skull base defects.

Objective

The aim of this study is to describe a surgical technique and complications observed in patients undergoing endonasal resection of planum sphenoidale and/or tuberculum sellae meningiomas.

Results

Ten patients were included in the analysis. No cases of postoperative CSF leakages or meningitis were reported, whereas two patients evolved with postoperative infectious complications (fungal ball in right frontal sinus and brain abscess). The skull base defect created for resection measured, on average, 3.58 cm2.

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