[Points and Pitfalls of Deep Dural Suture]

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Infection, particularly meningitis, is a significant historical complication of transsphenoidal surgery (TSS) for sella turcica tumors.
• The evolution of TSS is closely linked to the efforts to combat meningitis.
• Introduction of endoscopy around 1990 expanded TSS applications to extended skull base surgeries, increasing the incidence of large dural defects.

Purpose of the Study:

• To describe the historical transition and current methodologies of skull base reconstruction in transsphenoidal surgery.
• To detail the deep dural suture method (DDSM) as a technique to prevent cerebrospinal fluid leakage.
• To provide a comprehensive overview of evolving TSS techniques for complex skull base defects.

Main Methods:

• Review of historical literature on transsphenoidal surgery and infection prevention.
• Detailed description of the deep dural suture method (DDSM) for skull base reconstruction.
• Inclusion of institutional videos demonstrating current skull base reconstruction techniques in TSS.

Main Results:

• Significant improvements in transsphenoidal surgery techniques have been driven by the need to prevent meningitis.
• The deep dural suture method (DDSM) has emerged as a key technique for managing large dural defects in extended TSS.
• Current methods focus on robust skull base reconstruction to minimize cerebrospinal fluid leakage and infection.

Conclusions:

• Skull base reconstruction techniques in TSS have evolved considerably to address complications like meningitis.
• The deep dural suture method (DDSM) represents a significant advancement in managing dural defects during extended transsphenoidal surgery.
• Continued refinement of surgical methods is crucial for improving outcomes in complex skull base tumor resections via TSS.