Anterior skull base reconstruction with polydioxanone (PDS) framework: effectiveness across aetiologies and radiotherapy.

BACKGROUND

Anterior skull base defects arise from diverse aetiologies and may cause serious complications. Endoscopic multilayer reconstruction is standard, but evidence supporting absorbable polydioxanone (PDS) plates remains limited.

OBJECTIVES

To assess clinical outcomes and safety of PDS plates in endoscopic anterior skull base repair across different aetiologies, including patients receiving postoperative radiotherapy.

MATERIALS AND

METHODS

Retrospective review of patients undergoing endoscopic anterior skull base repair using PDS plates (January 2020 to October 2025). Data included demographics, comorbidities, defect characteristics, reconstructive technique, postoperative complications, and cerebrospinal fluid (CSF) leak closure.

RESULTS

Sixteen patients (eight female; median age 60 years) were included. The main aetiologies were idiopathic CSF leaks (n = 7) and postoperative defects after tumour resection (n = 7). Defects most frequently involved the ethmoidal roof and olfactory cleft (n = 7 each). Reconstruction commonly included dural substitute (81.3%) and a vascularised nasoseptal flap (62.5%). Primary closure was achieved in 15/16 patients (93.8%); one recurrence was attributed to defect underestimation. No major complications were observed. Two patients received postoperative radiotherapy without recurrence during follow-up.

CONCLUSIONS AND SIGNIFICANCE: PDS plates appear to be a safe and effective structural adjunct in multilayer endoscopic anterior skull base reconstruction, with durable closure including after adjuvant radiotherapy.