ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

How To: ‘Parachute’ Technique for Reconstruction of Small Skull Base Defects of the Ventral Skull Base

by Valentin Favier, MD; Johnny Youssef, MD; Romain Kania, MD, PhD; Benjamin Vérillaud, MD, PhD; and Philippe Herman, MD, PhD • December 14, 2020

  • Tweet
  • Email
Print-Friendly Version

TRIO How I Do It articles are reviews from The Laryngoscope designed to provide guidance on clinical and surgical techniques and practice issues from experts in the field.

You Might Also Like

  • Endoscopic Sandwich Technique for Moderate Nasal Septal Perforations
  • Ethmoidal Arteries with Pedicled Septal Floor Rotational Flaps Are Ideal for Endoscopic Skull Base Reconstruction
  • Stereotactic Radiotherapy Treats Skull Base Tumors: Part 2 of
  • Endoscopic Skull Base Surgery Indications Continue to Expand
Explore This Issue
December 2020

Introduction

Cerebrospinal fluid (CSF) rhinorrhea is a consequence of a breakdown of the layers of the arachnoid membrane, dura matter, the bony skull base and periosteum, and the nasalmucosa (Neurosurgery. 2006;58:246–257). In the past few years, several endoscopic techniques have been described to close ventral skull base CSF leaks. These include local pedicled flaps (e.g., nasoseptal flap [Laryngoscope. 2006;116:1882–1886], turbinates [Laryngoscope. 2009;119:2094–2098]), regional pedicled flaps (e.g., pericranium [Laryngoscope. 2016;126:1736–1738], fascia temporalis [J Neurosurg. 2016;125:419–430]), free grafts (e.g., abdominal fat [Otolaryngol Head Neck Surg. 2016;154:540–546], fascia lata [Otolaryngol Clin North Am. 1984;17:591–599]), microanastomosed free flaps (Am J Rhinol Allergy. 2017;31:122–126), as well as synthetic grafts (ibid). Nowadays, most authors use multiple-layer reconstruction by combining these techniques to improve the success rate of endoscopic skull base reconstruction.

The choice of skull base reconstruction technique depends on the location and the size of the defect, as well as intracranial pressure. The graft can be placed in the extracranial or extradural spaces that are often used, or in the intradural space, which is technically more demanding.

In cases of small-size CSF leaks, we propose a new surgical technique with a good success rate that allows centering the intradural graft adequately on the defect. This “parachute” placement can be used with both autologous free grafts and synthetic materials.

Method

A retrospective chart review was performed to identify patients who had undergone endoscopic-guided transnasal duraplasty for small low-flow CSF leaks (<2 cm) of the ventral skull base at the Lariboisière University Hospital in Paris, France. Leaks that were reconstructed with other techniques were excluded. We report on the surgical technique, graft materials, and outcomes. All patients were imaged preoperatively with skull base computed tomography and magnetic resonance imaging.

The procedure is done under general anesthesia. The patient is positioned supine, with the patient’s head in a neutral position. An anterior and posterior ethmoidectomy is performed, associated most often with a middle turbinate removal. Then, the CSF leak site is identified endoscopically and measured. Site preparation begins by removal of the overlying mucosa. Abrasion of the adjacent and involved bone is generally advocated to stimulate osteoneogenesis. If needed, the bone defect is enlarged to see the limits of the dura defect. Then, an intradural and extradural circular dissection is performed with angled elevators to allow an underlay and overlay placement of the graft.

Pages: 1 2 3 | Single Page

Filed Under: How I Do It Tagged With: clinical careIssue: December 2020

You Might Also Like:

  • Endoscopic Sandwich Technique for Moderate Nasal Septal Perforations
  • Ethmoidal Arteries with Pedicled Septal Floor Rotational Flaps Are Ideal for Endoscopic Skull Base Reconstruction
  • Stereotactic Radiotherapy Treats Skull Base Tumors: Part 2 of
  • Endoscopic Skull Base Surgery Indications Continue to Expand

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Experts Delve into Treatment Options for Laryngopharyngeal Reflux
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Weaning Patients Off of PPIs
    • Vertigo in the Elderly: What Does It Mean?
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Podcasts Becoming More Popular Method of Education for Otolaryngologists
    • How to Embrace Optimism in the Midst of the COVID-19 Pandemic
    • Tips on How to Approach Conversations with Patients about the COVID-19 Vaccine
    • Steps You Should Take to Protect Your Voice and Hearing During Telemedicine Sessions
    • Routine Postoperative Adjunct Treatments Unnecessary for Idiopathic Cerebrospinal Fluid Leaks

Polls

Have you spoken with your patients about receiving the COVID-19 vaccine?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2021 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.