ORIGINAL ARTICLE   

Otorinolaringologia 2018 September;68(3):89-95

DOI: 10.23736/S0392-6621.18.02157-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Skull base reconstruction in endoscopic endonasal surgery using a novel nanofibrous synthetic dural patch

Paolo PACCA ¹ ✉, Valentina TARDIVO ¹, Luca SALVATI ¹, Matteo MONTICELLI ¹, Federica PENNER ¹, Roberto ALTIERI ¹, Diego GARBOSSA ¹, Giancarlo PECORARI ², Francesco ZENGA ¹

¹ Division of Neurosurgery, Department of Neurosciences, University of Turin, Turin, Italy; ² First ENT Division, Department of Surgical Sciences, University of Turin, Turin, Italy

BACKGROUND: Reconstruction of the barriers between the intracranial space and the sinonasal tract continues to be a challenge after endoscopic endonasal skull base surgery. The gold standard is a multilayer closure that reproduces the physiological tissue barrier; a watertight closure is the paramount to prevent cerebrospinal fluid leak and meningitis. An effective dural closure may be achieved with a patch that satisfies the requirement of non-immune, neither inflammatory response or toxicity, improvement of dura regeneration, dura-like elasticity and resistance, easy handling and manageability.
METHODS: In our paper we present and discuss our experience with a novel dural substitute, ReDura (Medprin Biotech, La Mirada, CA, USA), for skull base reconstruction on 22 patients who underwent endoscopic endonasal removal of sellar and suprasellar lesions, with a minimum follow up of 14 months.
RESULTS: All patients underwent endonasal endoscopic ENT evaluation after surgery. The otorinolaryngological assessment ruled out the absence of rhinorrhea and confirmed a physiological healing of the surgical scar.
CONCLUSIONS: Based on our experience, we believe that the use of ReDura PLLA mesh along with a multilayer reconstruction accomplished, when needed, with a mucosal flap, provides an effective combination for endonasal approaches, even extended ones.

KEY WORDS: Cerebrospinal fluid leak - Skull base - Surgery - Treatment outcome