Cross-reinforcing suturing and intranasal knotting for dural defect reconstruction during endoscopic endonasal skull bas
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HOW I DO IT - PITUITARIES
Cross-reinforcing suturing and intranasal knotting for dural defect reconstruction during endoscopic endonasal skull base surgery Lijun Heng 1 & Shuo Zhang 1 & Yan Qu 1 Received: 20 February 2020 / Accepted: 21 April 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background With technical improvement, accumulating lesions could be resected using endoscopic endonasal surgery. However, cerebrospinal fluid leakage is still a concern. Intraoperative dural defect reconstruction is critical. Method We developed a new knotting technique for dural closure during endoscopic skull base surgery. We presented a step-bystep description of the fascia lata inlay and autologous dural patch intermittent suturing method following cross-reinforcing principles and emphasized the key points of the novel intranasal knotting technique. Conclusion The new intranasal knotting and suturing technique is a feasible method to close the dura and to prevent cerebrospinal fluid leakage. Keywords Cerebrospinal fluid leakage . Dura closure . Suturing . Skull base . Pituitary
Relevant surgical anatomy Endoscopic endonasal surgery is widely used in managing lesions, such as craniopharyngiomas, pituitary adenomas, meningiomas, and chordomas. Traditional closure method, like fat packing, multi-layer reconstruction with fascia lata, artificial or allograft dura mater, and nasal septal flap, has been attempted [1]. These techniques are effective to some extent, but are hard to resume the integrity of dura and to give the materials adequate anti-pressure and counter-shift capability in a short time after surgery. Suturing technique is developed at this background, but intranasal knotting is still hard and rarely reported due to the complexity for working in the deep and narrow surgical corridor. Take craniopharyngioma resection as an example, transplanum transtuberculum approach is preferred. Limbus ligament is a landmark for the pre-chiasmatic sulcus. The front edge of dura opening This article is part of the Topical Collection on Pituitaries Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04367-w) contains supplementary material, which is available to authorized users. * Yan Qu [email protected] 1
Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Xi’an 710038, Shaanxi, China
is usually posterior to it for removing retrochiasmatic craniopharyngiomas. During skull base reconstruction, dural suturing is a useful method to prevent cerebrospinal fluid (CSF) leakage [2, 3]. The dural edges are usually close to the anterior communicating artery complex anteriorly, the optic nerves, paraclinoidal internal carotid artery (ICA), and cavernous sinus laterally and the pituitary gland posteriorly. If pituitary transposition is used, the cavernous sinus might be opened and the posterior edge of dural opening could be extended to upper clivus. The intracavernous and paraclival ICA, basilar artery, and brain ste
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