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One-piece modified gasket seal technique.

Aaron Wessell1, Ameet Singh2, Zachary Litvack3

  • 1School of Medicine, George Washington University Medical Center, Washington, District of Columbia, USA.

Journal of Neurological Surgery. Part B, Skull Base
|January 18, 2014
PubMed
Summary

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This study found that a modified gasket seal technique effectively closes anterior skull base defects after endoscopic surgery, preventing cerebrospinal fluid leaks without significant donor site issues.

Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Skull Base Surgery

Background:

  • Endoscopic skull base surgery necessitates robust methods for reconstructing anterior cranial base defects.
  • Traditional multilayered closure techniques can be complex and time-consuming.

Purpose of the Study:

  • To evaluate the efficacy of a modified gasket seal technique for primary closure of anterior skull base defects.
  • To assess the technique's impact on cerebrospinal fluid (CSF) leaks and donor site morbidity.
  • To determine if rectus sheath fascia is a suitable dural substitute without fat grafting.

Main Methods:

  • Retrospective review of five patients undergoing expanded endoscopic endonasal surgery.
  • Utilized a one-piece modified gasket seal technique with a porous high-density polyethylene plate/rectus sheath fascia construct.
Keywords:
CSF leakendoscopicgasket sealskull base

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  • Monitored for postoperative CSF leaks and donor site complications.

    • Main Results:

    • No postoperative CSF leaks were observed in any patients.
    • Two patients developed aseptic meningitis, managed with steroids.
    • Two patients experienced new chronic/recurrent sinusitis, treated with antibiotics and nasal therapy.
    • No donor site morbidity, including infection, hematoma, or hernias, was reported.

    Conclusions:

    • The one-piece modified gasket-seal closure is a safe and effective reconstructive method for anterior skull base defects.
    • Rectus sheath fascia serves as an appropriate dural substitute with minimal donor site morbidity.
    • This technique simplifies closure, reducing operative time and the learning curve.