Triple-layer reconstruction technique for large cribriform defects after endoscopic endonasal resection of anterior skull base tumors

Authors

  • Jean Anderson Eloy MD, FACS,

    Corresponding author
    1. Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
    2. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
    • Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
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  • Smruti K. Patel BA,

    1. Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
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  • Pratik A. Shukla BA,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
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  • Mickey L. Smith MBS,

    1. Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
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  • Osamah J. Choudhry BA,

    1. Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
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  • James K. Liu MD

    1. Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
    2. Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
    3. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
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  • Potential conflict of interest: None provided.

  • Presented at the 22nd North American Skull Base Society Meeting, Las Vegas, NV, February 17–19, 2012.

Correspondence to: Jean Anderson Eloy, MD, FACS, Vice Chairman, Director of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, UMDNJ-New Jersey Medical School, 90 Bergen St., Suite 8100, Newark, NJ 07103; e-mail: jean.anderson.eloy@gmail.com

Abstract

Background

Endoscopic endonasal transcribriform (EET) resection of anterior skull base (ASB) tumors results in large defects that may extend the entirety of the cribriform plate. Endoscopic repair of these cribriform defects can often be challenging. We describe our reconstruction technique for large ASB defects after EET resection of ASB tumors. This triple-layer technique is comprised of autologous fascia lata, acellular dermal allograft, and a vascularized pedicled nasoseptal flap (PNSF). The technique is described and postoperative cerebrospinal fluid (CSF) leak rate is evaluated.

Methods

Retrospective review over a 2-year period identified 10 patients who underwent a purely EET approach for resection of ASB tumors. Patients who underwent combined cranionasal approaches and those treated for ASB encephaloceles were excluded from this study. After tumor resection, patients underwent triple-layer reconstruction using autologous fascia lata inlay, acellular dermal allograft inlay/overlay, followed by a PNSF to reconstruct the cribriform defect. No postoperative lumbar drainage was used.

Results

The average cribriform defect size was 9.1 (range, 5.0–13.8) cm2. All 10 patients underwent successful reconstruction with a postoperative CSF leak rate of 0% without the use of postoperative lumbar drainage. The mean follow-up period was 7.4 (range, 2–17) months. The mean age was 45.8 (range, 15–81) years with 30% of the patients being females.

Conclusion

The triple-layer reconstruction technique is effective in reconstructing large ASB defects after endoscopic resection of the cribriform plate. We feel that the use of postoperative lumbar drainage is not necessary when using this repair technique.

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