Abstract
Following the introduction of fully endoscopic techniques for the resection of pituitary tumors, there was a rapid expansion of the indications for endonasal endoscopic surgery to include extrasellar tumors of the skull base. These techniques offer significant advantages over traditional open surgical approaches to the skull base, including improved tumor resection, and better post-operative neurological outcomes. Following their introduction, however, the initial rate of post-operative CSF leak was unacceptably high. Post-operative CSF leak following skull base surgery is a major source of morbidity, and can lead to the development of life-threatening intracranial infection. The use of vascularized naso-septal flaps transformed the management of these patients, significantly reducing the rate of post-operative CSF leak and increasing the number of patients that could benefit from this less invasive treatment modality. Adequate repair of iatrogenic defects in the skull base is of crucial importance for patients with skull base tumors, as the development of a post-operative CSF leak, and the associated complications can significantly delay the administration of the adjunctive oncological therapies these patients require. In this review, we provide an overview of the latest evidence regarding skull base reconstruction following endoscopic skull base surgery, and describe the skull base repair technique in use at our institution.
Highlights
The endoscopic endonasal approach to the skull base was initially introduced as an adjunct to the microscope in the resection of pituitary tumors in 1979, with fully endoscopic approaches described in the early 1990s [1,2,3]
The 3F Technique Cavallo et al recently published a modification to their skull base reconstruction technique following extended endonasal approaches (EEA), having previously employed a modification of the gasket seal technique combined with a naso-septal flap (NSF) [10]
Using autologous iliotibial tract and fat tissue in a three-layer reconstruction protocol, the authors reported a post-operative CSF leak rate of 5.8% [47]. These studies do suggest that acceptable results can be obtained with the use of free graft techniques, in the absence of a trial comparing both techniques, the weight of the evidence suggests that lower rates of CSF leak are obtained with the use of local vascularized flaps, and this view is supported by the results of a systematic review comparing the efficacy of skull base reconstruction methods following EEA [48]
Summary
The endoscopic endonasal approach to the skull base was initially introduced as an adjunct to the microscope in the resection of pituitary tumors in 1979, with fully endoscopic approaches described in the early 1990s [1,2,3]. Following the adoption of this technique for the resection of pituitary tumors, it was adapted for resection of extrasellar skull base lesions [6,7,8,9]. Endoscopic approaches are in widespread use in the management of malignancies of the ventral skull base, including esthesioneuroblastoma, chordoma, and chondrosarcoma, as well as aggressive, locally invasive pathologies such as meningiomas, and craniopharyngiomas [10,11,12,13,14]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
