Clinical application of in situ bone flap in skull base reconstruction in endoscopic endonasal surgery for craniopharyngioma

Abstract

Objectives To compare different methods of the skull base reconstruction in craniopharyngioma surgery via extended endoscopic endonasal approach (EEEA) and to investigate the advantage and feasibility of in situ bone flap in skull base reconstruction. Methods Twenty-six cases with craniopharyngiomas who underwent complete osseous skull base reconstruction using in situ bone flap in skull base reconstruction and repair in EEEA were enrolled retrospectively into the experimental group at Department of Neurosurgery, Xijing Hospital, Air Force Medical University from July 2016 to December 2017. Thirty-one cases with craniopharyngiomas who underwent partial osseous skull base reconstruction using fashioned piece of nasoseptal bone or artificial bone matrix from March 2015 to June 2016 were enrolled into the control group. The rates of intracranial infection and lumbar cisterna drainage, time from surgery to out-of-bed activity and hospitalization length were compared between the 2 groups. Results Intracranial infection occurred in 2 cases in the control group, whereas no intracranial infection was reported in experimental group. There was no statistically significant difference between the 2 groups (P=0.291). Lumbar cisterna drainage rate in the control group (29.0%, 9/31)was significantly higher than that in the experimental group (3.8%, 1/26, P=0.013). Compared with those in control group, patients in the experimental group were able to get off bed earlier (7.5±1.1 d vs. 12.1±2.4 d, P<0.001). The hospitalization length in the control group was also longer than that in the experimental group (13.5±1.8 d vs. 8.2±0.9 d, P<0.001). There was no delayed cerebrospinal fluid leak or brain hernia during the follow-up period lasting for 3-32 months. Conclusions The multilayer repair using duramax, in situ bone flap and vascularized pedicled nasoseptal flap could significantly reduce the incidence of cerebrospinal fluid rhinorrhea and shorten hospitalization length. Skull base reconstruction using in situ bone flap seems to be an effective procedure for EEEA. The clinical efficacy of using the method in EEEA for craniopharyngioma is valid with bright prospects and deserves clinical promotion. Key words: Craniopharyngioma; Natural orifice endoscopic surgery; Extended endonasal approach; Skull base reconstruction; In situ bone flap