Soft Gasket Seal Reconstruction After Endoscopic Endonasal Transtuberculum Resection of Craniopharyngiomas.

BACKGROUND

The expanded endoscopic endonasal approach (EEA) is currently well accepted for a variety of ventral skull base tumors. Such an approach often results in a transdural defect and intraoperative cerebrospinal fluid (CSF) leak, and adequate reconstruction is necessary to prevent postoperative CSF leak and its complications. Reconstruction is usually performed using a variety of materials along with the nasoseptal flap.

OBJECTIVE

This work's aim is to describe a new reconstructive technique called the "soft gasket seal" (SGS) in detail and compare it with the standard reconstructive technique at our institution for craniopharyngiomas operated via transtuberculum EEA.

METHODS

A retrospective chart review was achieved to identify patients who underwent transtubercular EEA for craniopharyngioma between 2010 and 2018, by the same neurosurgical and otolaryngology team using either the SGS or standard reconstructive technique.

RESULTS

Of 36 patients who met criteria and were considered for analysis, 15 of them underwent SGS reconstruction and 21 had standard reconstruction. There were 16 female (44%) and 20 male (56%) patients. The median age was 42.2 ± 20.9 years. The rate of postoperative CSF leak in the group of patients treated with the standard technique was 14.2% and 6.6% in the SGS group (odds ratio 0.43 [confidence interval 95% 0.007-6.15], P = 0.62).

CONCLUSIONS

The SGS technique provides a simple reconstructive technique in conjunction with the nasoseptal flap, showing a tendency of lower complications when compared with our standard technique while avoiding donor site morbidity. Such results are encouraging, but further studies are necessary to confirm these findings.