Trans-Defect Underlay Watertight Duraplasty for Traumatic Anterior Skull Base Dural Defect: Technical Report

Abstract

BackgroundWatertight duraplasty is essential for surgical management of traumatic anterior skull base (ASB) dural defect but challenging in the deep and narrow operative corridor. Here, the authors report the trans-defect underlay watertight duraplasty (TDUWD) technique for traumatic ASB dural defect. MethodsTDUWD was performed by inserting a free pericranium graft under the dural defect. The diameter of the pericranium graft was larger than the dural defect. The pericranium graft was sutured to the dural defect watertightly in an “inside-to-outside” direction, with the needle not penetrating the inner layer of pericranium graft. The pedicled pericranium flap was used as a second layer of reconstruction. The characteristics, complications and outcomes of patients who received TDUWD are reported. ResultsA total of 29 patients received TDUWD. Immediate postoperative cessation of cerebrospinal fluid (CSF) leak occurred in 28 patients. The other one patient recovered after lumber drainage. No patient needed a second operation or reported delayed recurrence of CSF leak. No complication related to the surgical technique was observed. ConclusionUse of TDUWD for traumatic ASB dural defect results in an immediate, one-stage and definitive correction of CSF leak and seems to be simple, safe, and reliable for large and deep located dural defects.