Watertight Closure after Extended Endoscopic Transnasal Approaches for Skull Base Pathologies

Objective: The extended endoscopic transnasal approaches became an option for skull base pathologies, which are difficult to reach with microsurgical techniques. Intradural exploration through the nasal cavity requires proper watertight closure. Standard guidelines and repeatable solutions are still under investigation. In this contribution we present methods of dural repair in different clinical situations during extended endoscopic endonasal procedures.

Methods: Endoscopic transnasal duraplasty to prevent cerebrospinal fluid leakage after extended approaches was performed in 42 cases in the Department of Neurosurgery of the Medical University of Bialystok (Poland) in years 2009 to 2015. Various types of dural closure were used with multilayer reconstruction using artificial and auto grafts.

Results: Low flow minor defects were successfully closed with artificial grafts only what minimize operative trauma. High flow defects were closed with mixed techniques using collagen matrix intraduraly and autograft extraduraly. In 7 out of 42 cases early repeatable operation was necessary. There was no need of conversion to craniotomy.

Conclusion: The ability to perform watertight closure after transnasal exploration of the cranium is necessary to perform endoscopic skull base procedures. The rate of unsuccessful closure at first stage reduces with learning curve.