Hydroset-Based Closure Is a Safe and Efficacious Adjuvant for Skull Base Reconstruction following Endoscopic Resection of Suprasellar Tumors

Le résumé fourni par la source

Purpose: Cerebrospinal fluid leak after endonasal endoscopic skull base surgery, while significantly diminished with the use of the nasoseptal flap, remains a complication that could be further improved upon. Recently, a few investigators have suggested the use of Hydroset cranioplasty as a possible method to further reduce leak rates. We investigated our early experience with the use of Hydroset, limited to two pathologies for histologic and approach homogeneity, as part of a multilayer closure and compared our CSF leak rates with case–control historic controls. Methods: We queried a prospective database of consecutive patients undergoing endoscopic, endonasal surgical resection of anterior skull lesions from 2015 to 2023 ( n = 905 cases). We selected only first time transplanum, transtuberculum approaches for the removal of suprasellar meningiomas or craniopharyngiomas. Of these, cases closed with Hydroset were compared with historic series of controls. The Hydroset group closure consisted of a gasket seal with Allomax and Medpor, covered with Hydroset and a nasoseptal flap. The control cases were closed with a gasket seal covered with a nasoseptal flap. Comparison was made between demographics (age, gender, tobacco use, tumor volume), technical considerations (use of CSF diversion, duration of postoperative CSF diversion), and postoperative outcomes (CSF leak, sinonasal symptoms as measured by SNOT22 questionnaire). Results: Seventy patients met inclusion criteria (meningioma n = 37; craniopharyngioma n = 33). Twenty patients (meningioma n = 12; craniopharyngioma n = 8) were closed with Hydroset (mean age: 51.25 years, BMI: 28.1, tumor volume: 6.4 cm 3 ) and 50 control patients (meningioma n = 25; craniopharyngioma n = 25) were closed without Hydroset (mean age: 51.4 years, BMI: 28.03, tumor volume: 5.65 cm 3 ). CSF diversion was used in 75% (15/20) of the Hydroset group (average of 2.67 days) compared with 94% (47/50) the control group (average of 2.21 days). CSF leak occurred 5% (1/20) in the Hydroset group compared with 12% (6/50) in the control group ( p = 0.19). Subgroup analyses by pathology did not demonstrate significant difference in CSF leak rates. One patient closed with hydroxyapatite required delayed debridement for infection, though there was no significant difference in sinonasal complaints between groups. Conclusions: While the use of a nasoseptal flap in the context of a multilayer closure has significantly reduced CSF leak rates, we demonstrate reconstruction with hydroxyapatite trends toward further improved rates of CSF leak control without significant associated morbidity. Publication History Article published online: 05 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.