Principles in Skull Base Reconstruction following Expanded Endoscopic Approaches

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Expanded endoscopic approaches (EEA) are increasingly used for skull base tumor resection.
• These approaches can lead to anterior skull base defects requiring reconstruction.
• Cerebrospinal fluid (CSF) leaks are a common complication following such procedures.

Purpose of the Study:

• To classify anterior skull base defects resulting from EEA.
• To describe the surgical techniques used for endoscopic skull base reconstruction (ESBR).
• To evaluate the success rates and complications of ESBR.

Main Methods:

• Retrospective analysis of 63 ESBR cases performed between September 2011 and January 2015.
• Tumor types included pituitary adenomas, craniopharyngiomas, and miscellaneous tumors.
• Defect and CSF leak classifications by Tabaee et al. and Esposito et al. were utilized.

Main Results:

• Sixty-three skull base defects were analyzed following EEA for tumor excision.
• Reconstruction failed in 6 patients, but all were successfully repaired upon revision.
• Three patients experienced tumor-related mortality.

Conclusions:

• Successful skull base defect closure relies on adhering to general reconstruction principles.
• Appreciating subtle differences in defect nature is crucial for selecting appropriate repair strategies.
• Adaptability in employing diverse surgical techniques ensures successful outcomes in ESBR.