Endoscopic Skull Base Reconstruction: An Evolution of Materials and Methods

Aaron C Sigler; Brian D'Anza; Brian C Lobo; Troy D Woodard; Pablo F Recinos; Raj Sindwani

doi:10.1016/j.otc.2017.01.015

Endoscopic Skull Base Reconstruction: An Evolution of Materials and Methods

Otolaryngol Clin North Am. 2017 Jun;50(3):643-653. doi: 10.1016/j.otc.2017.01.015. Epub 2017 Mar 31.

Authors

Aaron C Sigler¹, Brian D'Anza², Brian C Lobo³, Troy D Woodard⁴, Pablo F Recinos⁵, Raj Sindwani⁶

Affiliations

¹ Tulane Center for Clinical Neurosciences, Department of Neurosurgery, 131 S. Robertson St., Ste 1300, New Orleans, LA 70112, USA.
² Section of Rhinology, Sinus and Skull Base Surgery, University Hospitals - Case Western Reserve University, 11000 Euclid Avenue, Cleveland, OH 44106, USA.
³ Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA.
⁴ Minimally Invasive Cranial Base and Pituitary Surgery Program, Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Rosa Ella Burkhardt Brain Tumor Center, Cleveland Clinic, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA.
⁵ Minimally Invasive Cranial Base and Pituitary Surgery Program, Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Rosa Ella Burkhardt Brain Tumor Center, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195, USA.
⁶ Minimally Invasive Cranial Base and Pituitary Surgery Program, Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Rosa Ella Burkhardt Brain Tumor Center, Cleveland Clinic, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA. Electronic address: sindwar@ccf.org.

PMID: 28372814
DOI: 10.1016/j.otc.2017.01.015

Abstract

Endoscopic skull base surgery has developed rapidly over the last decade, in large part because of the expanding armamentarium of endoscopic repair techniques. This article reviews the available technologies and techniques, including vascularized and nonvascularized flaps, synthetic grafts, sealants and glues, and multilayer reconstruction. Understanding which of these repair methods is appropriate and under what circumstances is paramount to achieving success in this challenging but rewarding field. A graduated approach to skull base reconstruction is presented to provide a systematic framework to guide selection of repair technique to ensure a successful outcome while minimizing morbidity for the patient.

Keywords: CSF leak repair; Endoscopic endonasal approach; Graduated approach to reconstruction; Nasoseptal flap; Pericranial flap; Skull base defect repair.

Publication types

Review

MeSH terms

Cerebrospinal Fluid Leak / surgery*
Endoscopy
Humans
Magnetic Resonance Imaging
Plastic Surgery Procedures / methods*
Skull Base / diagnostic imaging
Skull Base / surgery*
Surgical Flaps / surgery*