Suture Repair in Endoscopic Surgery for Craniovertebral Junction

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Craniovertebral Junction (CVJ) Pathologies

Background:

• Endoscopic approaches to the craniovertebral junction (CVJ) are established surgical treatments.
• Cerebrospinal fluid (CSF) leakage is a significant complication following these procedures.
• Effective management of durotomy and associated CSF leaks is critical.

Purpose of the Study:

• To investigate the efficacy and feasibility of suture closure of the nasopharyngeal mucosa.
• To evaluate the impact of this technique on preventing postoperative CSF leakage after endoscopic CVJ surgery.
• To compare outcomes between suture-repaired and non-suture repaired durotomies.

Main Methods:

• Retrospective review of 22 patients undergoing endoscopic CVJ approaches over 13 years.
• Analysis of pathologies, surgical corridors, outcomes, and complications.
• Description and comparison of different repair strategies for intraoperative CSF leakage, including suture closure.

Main Results:

• 8 patients (36.4%) experienced intraoperative CSF leakage.
• The suture-repaired (SR) group had only 1 minor CSF rhinorrhea, which healed spontaneously.
• The non-suture (NS) group had 3 (75%) persistent CSF leakages, leading to 1 mortality.

Conclusions:

• Suture closure of the nasopharyngeal mucosa following durotomy is technically challenging but significantly reduces postoperative CSF leakage.
• This technique is effective in lowering the risks of serious complications related to CSF leakage after endoscopic CVJ surgery.
• Nasopharyngeal mucosal incisions without durotomy generally heal rapidly with few complications.