Circumferential Watertight Dural Repair Using Nitinol U-Clips in Expanded Endonasal and Sublabial Approaches to the Cranial Base

Abstract

In recent years, significant advances have been made in the field of expanded endonasal approaches that permit treatment of different cranial base intradural lesions. To report our technique of cranial base dural repair by the application of nitinol U-Clips in endoscope-assisted extended endonasal or sublabial approaches. Closure techniques and postoperative cerebrospinal (CSF) leaks are reported. We reviewed 11 patients with different kinds of cranial base tumors or vascular diseases (2 tuberculum sellae meningiomas, 1 planum sphenoidale meningioma, 4 craniopharyngiomas, 1 recurrent clival chordoma, 1 esthesioneuroblastoma, 1 ethmoidal melanoma metastasis, 1 basilar trunk aneurysm) who underwent an endoscope-assisted extended endonasal or sublabial approach. Dural repair was performed using nitinol U-Clips to circumferentially suture AlloDerm or fascia lata directly to the existing dural borders. Lumbar drainage was not used in 9 patients and was used in 2 patients for 5 days. Patients were evaluated for the appearance of CSF leaks. Postoperative CSF leak was observed in 1 patient (9%). This required a second transnasal repair. Circumferential dural closure with U-Clips is a useful adjunct to prevent CSF leaks after expanded endonasal or sublabial approaches to the cranial base for treatment of intracranial pathology.