“GASKET-SEAL” WATERTIGHT CLOSURE IN MINIMAL-ACCESS ENDOSCOPIC CRANIAL BASE SURGERY

TLDR

Transnasal endoscopic cranial base surgery is a novel minimal‑access method for reaching the midline cranial base, yet postoperative cerebrospinal fluid leak remains a persistent challenge. The study presents a new method for watertight closure of the anterior cranial base. Autologous fascia lata was fashioned into a gasket seal around a bone buttress and reinforced with DuraSeal, applied in 10 patients undergoing endoscopic intradural surgery for various skull‑base tumors, with lumbar drains used in half the cases for 3 days. At a mean 12‑month follow‑up, no cerebrospinal fluid leaks occurred, demonstrating the gasket‑seal closure’s effectiveness.

Abstract

OBJECTIVE Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented. METHODS To achieve watertight closure of the anterior cranial base, autologous fascia lata was used to create a "gasket seal" around a bone buttress, followed by application of a tissue sealant such as DuraSeal (Confluent Surgical, Inc., Waltham, MA). The gasket-seal closure was used to seal the anterior cranial base in a series of 10 patients with intradural surgery for suprasellar craniopharyngiomas (n = 5), planum meningiomas (n = 3), clival chordoma (n = 1), and recurrent iatrogenic cerebrospinal fluid leak (n = 1). Lumbar drains were placed intraoperatively in five patients and remained in place for 3 days postoperatively. RESULTS After a mean follow-up period of 12 months, there were no cerebrospinal fluid leaks. CONCLUSION The gasket-seal closure is an effective method for achieving watertight closure of the anterior cranial base after endoscopic intradural surgery.