Novel concepts and strategies in skull base reconstruction after endoscopic endonasal surgery

Domenico Solari,Ida Papallo,Massimo Martorelli,Antonio Gloria,Ilaria Onofrio,Paolo Cappabianca,Luigi M Cavallo,Teresa Russo,Arturo Brunetti,Renato Cuocolo,Lorenzo Ugga,Giovanni Improta

doi:10.21014/acta_imeko.v9i4.745

Abstract

<p align="left">Recently, a variety of craniofacial approaches has been adopted to enter the skull base, among those, the endonasal endoscopic technique. An effective watertight thereafter: the reconstruction can be performed using different materials, both autologous and non-autologous, individually or combined in a multilayer fashion. The current study was focused on the development of new advanced devices and techniques, aiding in reducing postoperative CSF leak rate. Additive manufacturing allows the design of devices with tailored structural and functional features and, as well, injectable semi-IPNs and composites; therefore specific mechanical/rheological and injectability studies are valuable. Accordingly, we propose new additive-manufactured and injectable devices.</p>

Highlights

The skull base is located between the brain and the extracranial compartment and consists of several anatomical structures.From an anatomical and surgical point of view, the skull base represents one of the most complex areas of the human body.It is reported that a broad variety of lesions, either neoplastic or not, may arise primarily from this area or, subsequently, involve it
The selection of the system components was made with the aim of promoting a clinical translation of the injectable devices as dura mater substitutes and sealant systems able to reduce the risk of cerebrospinal fluid (CSF) leakage
Starting from some basic concepts and principles, novel strategies may be proposed towards the design of injectable systems and additively manufactured devices for skull base reconstruction after endoscopic endonasal surgery

Summary

Introduction

The skull base is located between the brain and the extracranial compartment and consists of several anatomical structures.From an anatomical and surgical point of view, the skull base represents one of the most complex areas of the human body.It is reported that a broad variety of lesions, either neoplastic or not, may arise primarily from this area or, subsequently, involve it. The skull base is located between the brain and the extracranial compartment and consists of several anatomical structures. From an anatomical and surgical point of view, the skull base represents one of the most complex areas of the human body. The surgical management of these lesions can be extremely difficult, especially of deep-seated lesions, despite a variety of innovative craniofacial approaches that have been adopted to access the entire skull base in recent decades 0-[9]. It should be underlined that tissue disruption and neurovascular manipulation often characterise the access routes to the skull base, increasing perioperative morbidity and/or mortality rates. The surgical advances and technological innovations, together with the progress in diagnostic imaging techniques and the intraoperative neuronavigational systems, have progressively reduced the surgical invasiveness of the skull base approaches

Methods

Results

Conclusion