Endoscopic Reconstruction of the Anterior Skull Base Following Tumor Resection: Application of a Novel Bioabsorbable Plate

• Published in: The Laryngoscope Vol. 133; no. 5; pp. 1092 - 1098
• Main Authors: Piscopo, Anthony J., Dougherty, Mark C., Woodiwiss, Timothy R., Ankrah, Nii‐Kwanchie, Hughes, Tyler, Seaman, Scott C., Walsh, Jarrett E., Graham, Scott M., Greenlee, Jeremy D. W.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.05.2023
• Subjects: Absorbable Implants; Cerebrospinal Fluid Leak - etiology; Cerebrospinal Fluid Leak - surgery; CSF leak; endonasal; Endoscopy - methods; Humans; pituitary; Plastic Surgery Procedures; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Retrospective Studies; rigid repair; septal flap; Skull Base - pathology; Skull Base - surgery; Skull Base Neoplasms - pathology; Surgical Flaps - surgery; pituitary; CSF leak; endonasal; rigid repair; septal flap
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.30501

Objective Endoscopic repair of skull base defects is required following resection of intracranial pathology via the endoscopic endonasal approach (EEA). Many closure techniques have been described, but choosing between techniques remains controversial. We report outcomes of 560 EEA procedures of skull base reconstruction performed on 508 patients over a 15‐year‐period. Halfway through this period, we adopted the use of a rigid, bioabsorbable extrasellar plate for reconstruction, enabling a comparison between this technique and those used previously. Methods All patients undergoing EEA from 2005 to 2019 at our institution were retrospectively reviewed. Demographic information, surgical pathology, tumor dimensions and radiographic features, reconstructive technique, and patient‐related outcomes were collected and analyzed with univariate and multivariate statistical modeling. Results Five‐hundred sixty procedures were performed on 508 patients. The series complication rate was 8.2%. Overall, cerebrospinal fluid (CSF) leak rate was 5.0% but varied significantly across closure techniques (p < 0.001). Critically, the CSF leak rate in the 272 cases prior to our 2013 adoption of the Resorb‐X Plate (RXP) was 8.5%, whereas leak rate in the subsequent 288 cases was 1.7%. RXP was protective against CSF leak (p = 0.001), whereas gross total resection (GTR) correlated with increased leak rate (p = 0.001). Patient BMI was significantly associated with risk of leak (p = 0.047). Other variables did not impact leak risk. Conclusion Reconstructive technique, extent of resection, and patient BMI significantly contributed to CSF leak rate. GTR was associated with increased leak risk while the RXP was protective. The bioabsorbable RXP is an effective option for rigid skull base repair with comparatively few complications. Level of Evidence 3 Laryngoscope, 133:1092–1098, 2023 Endoscopic repair of skull base defects is required following resection of intracranial pathology via the endoscopic endonasal approach. We report outcomes of 560 EEA procedures of skull base reconstruction performed on 508 patients over a 15‐year period. Halfway through this period, we adopted the use of a rigid, bioabsorbable extrasellar plate for reconstruction, enabling a comparison between this technique and those used previously. CSF leak rate decreased from 8.5% in the 272 cases prior to incorporation of the bioabsorbable Resorb‐X plate to 1.7% following its implementation.