Skull Base Dural Repair Using Autologous Fat as a Dural Substitute: An Efficient Technique

Abstract

Dural repair during skull base approaches remains challenging, especially in the presence of significant defects. The autologous fat has become an alternative to various substitute materials being used previously. We report here our experience and technique for the repair of notable skull base dural defects using autologous fat as a dural substitute. Over a period of 5 years, 71 consecutive patients operated on for skull base pathologies with an important intraoperative dural defect repaired using autologous fat tissue as replacement material were reviewed. The graft, withdrawn from the abdomen or thigh, was flattened and applied to the defect. The clinical findings and outcomes were assessed. Main pathologies included schwannomas (45%) and meningiomas (35.21%), with no side predilection. Surgical approaches such as transcondylar fossa, suboccipital, and frontotemporal approaches were used. Dural defects were mainly located in the posterior (73.2%) and middle cranial fossae (25.4%). No harvesting site-related complication occurred. In 7 cases, transitory subcutaneous fluid collection spontaneously resorbing after 8 days to 2 months was observed. No external cerebrospinal fluid leakage, infection, or other complication was noted during the following period. Dural repair can be effectively and durably achieved using autologous fat graft as a dural substitute during skull base approaches, even in cases of extended defects. The observed characteristics of the fat graft along with the achieved outcome make it an ideal dural substitute.