Optimal Multiple-Layered Anterior Skull Base Reconstruction Using a 360 degrees Suturing Technique

BACKGROUND:Advances in technique and instrumentation have improved outcomes after resection of anterior skull base tumors. However, cerebrospinal fluid (CSF) leak occurs in 4%-20% of patients. To reduce the risk of CSF leak, we have developed a novel reconstruction technique that consists of a 4-layered graft with patchwork suturing and hard material.OBJECTIVE:To evaluate the effectiveness of this reconstruction technique when used for resection of anterior skull base tumors.METHODS:This case series included 59 patients with anterior skull base tumors in whom the 4-layered closure technique was used. The main outcome measures were complications, including CSF leak, meningitis, postoperative bleeding, and infection.RESULTS:There were no CSF leak cases or serious complications after closure of the anterior skull base using the 4-layered technique.CONCLUSION:Closure of the anterior skull base in 4 layers prevented CSF leak and was not associated with any serious complications. However, further studies in larger numbers of patients are needed to confirm our outcomes using this closure method.