Watertight Robust Osteoconductive Barrier for Complex Skull Base Reconstruction: An Expanded-endoscopic Endonasal...

Area of Science:

• Neurosurgery
• Otolaryngology
• Biomaterials Engineering

Background:

• Endoscopic skull base reconstruction (ESBR) following expanded-endoscopic endonasal approaches (EEA) presents significant challenges, particularly for high-risk patients.
• Existing reconstructive techniques often fall short, necessitating innovative solutions for durable and reliable skull base repair.

Purpose of the Study:

• To address the reconstructive knowledge gap in expanded-EEA procedures.
• To introduce and evaluate the watertight robust osteoconductive (WRO)-barrier as a durable reconstructive option.
• To assess the WRO-barrier's performance under various challenging conditions, including high pressure and simulated redo procedures.

Main Methods:

• Development of a 3D skull base-water system model to simulate realistic ESBR conditions.
• Creation of a large, irregular skull base defect (31 × 89 mm) from crista galli to mid-clivus.
• Fashioning and rigorous testing of the WRO-barrier, including high-pressure tolerance (55 cmH2O), radiological assessment, simulated removal for redo-EEA, and 18-month long-term tolerance evaluation.

Main Results:

• The WRO-barrier was successfully fashioned to conform to the defect's geometry under realistic EEA conditions.
• The barrier demonstrated exceptional tolerance to high and sudden-elevated pressures without leakage, maintaining a watertight seal.
• Radiological assessment confirmed the long-term watertight seal (18 months), and the barrier proved easily removable and reconstructible for potential redo-EEA.

Conclusions:

• The WRO-barrier is an effective osteoconductive and watertight robust design for cranial base reconstruction.
• Its distinct qualities offer potential benefits for patients undergoing complex skull base tumor surgeries.
• The WRO-barrier represents a promising advancement in addressing challenging ESBR scenarios.