Use of Cortoss for reconstruction of anterior cranial base: a preliminary clinical experience

Abstract

Management of cerebrospinal fluid (CSF) leak due to a variety of clinical conditions is a challenging problem for the neurosurgeon, and life-threatening complications can arise unless the CSF leak is handled appropriately. Numerous methods have been described and used for prevention of CSF rhinorrhea, including vascularized pedicle flaps, free vascularized flaps, grafts, and alloplastic materials. The primary objective of this study is to evaluate the role of Cortoss, which provides three-dimensional reconstruction with watertight and weight-bearing support in the treatment of anterior cranial base bony defects. Ten consecutive patients with anterior skull base defects including frontal bone, frontal sinus, cribriform plate, orbital roof, ethmoid sinus, planum sphenoidale, sphenoid sinus, secondary to tumor invasion or traumatic injury were included in this study. The surgical technique is simple and effective, and consists of filling the bony defect with Cortoss. Surgical glue was required for dural repair only. Lumbar CSF drainage in the postoperative period was performed in two patients. These patients had fractures in the lateral walls of their sphenoid sinuses, which were managed via intracranial route. At a mean postoperative follow-up time of 8.9 months, none of the patients had developed complications including infections, meningocele, or recurrent CSF fistula. The use of Cortoss in the case of anterior skull base defects seems to be safe, effective, quick, and a feasible method for reconstruction. This technique may eliminate the use of adjunct materials including fat, muscle, fascia, and bone.