Soft Gasket Seal: Refining the Closure Technique following EEA: Case Series and Review of Literature: A230.

Introduction: Endoscopic endonasal approaches (EEA) have become the standard for various skull base pathologies, but cerebrospinal fluid (CSF) fistula has been a main concern. After the introduction of the nasoseptal flap by Hadad et al in 2006, the rates of CSF fistula have dramatically decreased. Since then, several authors attempted to improve the technique, with some proposing a multilayered closure. In such a closure, a rigid buttress (autologous bone or cartilage or some synthetic absorbable material) is employed in addition to the nasal septal flap to keep the construct in place. Herein, we propose a refinement of this technique, not requiring the use of rigid materials known as “Soft Gasket Seal (SGS).” This is distinct from the already described “Gasket Seal.” In addition, we present a series of craniopharyngioma to illustrate such concept.