Novel Bioabsorbable Plate Associated with Lower Leak Risk in Patients Receiving Endoscopic Skull Base Repair

by Linda Kossoff •

What are the comparative outcomes of different techniques used in endoscopic repair of skull base defects following resection of intracranial pathology via the endoscopic endonasal approach (EEA)?

BOTTOM LINE

Reconstructive technique, extent of resection (EOR), and patient body mass index (BMI) significantly contribute to cerebrospinal fluid (CSF) leak rate.

BACKGROUND: Advances in endoscopic neurosurgery have rendered transnasal resection of anterior skull base lesions a safe, effective option for surgical pathologies, with lower complication rates and shorter recovery times compared with traditional transcranial approaches. The required endoscopic repair of skull base defects is challenging, however, and choosing between closure techniques remains controversial.

STUDY DESIGN: Retrospective study.

SETTING: Department of Otolaryngology, University of Iowa, Iowa City, Iowa.

SYNOPSIS: Researchers reviewed 508 patients receiving a total of 560 EEA procedures at a single institution from 2005 to 2019. Skull base defects in patients were repaired using established techniques: polylactic acid bioabsorbable Resorb-X Sellar Wall Plate (RXP) (47.1%); fat graft with or without DuraGen or Gelfoam (37%); DuraGen/Gelfoam combinations (12%); and nasoseptal flap (3.9%). Routine RXP use began in 2013; thus, a similar number of procedures before and after this adoption enabled rigid vs. nonrigid technique comparison. Although the overall CSF leak rate was 5.0%, this varied among closure techniques, with an 8.5% rate pre-RXP use and 1.7% in procedures employing the technique. Patient BMI was significantly associated with leak risk. Gross total resection correlated with increased leak rate, whereas the RXP was comparatively protective. Factors such as Knosp grade, tumor dimension, tumor volume, or suprasellar extension demonstrated no influence. Authors conclude that it is reasonable to consider using the RXP in most procedures requiring reconstruction of the anterior skull base, especially if BMI > 30 or intraoperative CSF leak is anticipated or encountered. Study limitations included its retrospective, observational format.

CITATION: Piscopo AJ, Dougherty MC, Woodiwiss TR, et al. Endoscopic reconstruction of the anterior skull base following tumor resection: application of a novel bioabsorbable plate. Laryngoscope. 2023;133:1092–1098.