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@AMSAli93
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16. A recent RCT by Zwagerman et al has demonstrated that its use perioperatively in the context of vascularized nasoseptal flap closure significantly reduced the rate of postoperative CSF leaks.
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17. Although there is a lack of high level evidence for a number of the repair methods utilised, several other repair options have been shown to be effective in high grade ioCSFL including the button technique, gasket seal and pedicled nasoseptal flap.
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18. The button technique can be used to augment dural reconstruction and involves suturing a larger barrier graft to a smaller graft in stacked fashion.
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19. The use of the pedicled vascular flap (nasal and extra-nasal) was reported in 169 papers. Across a number of protocols the nasoseptal flap was the first line for vascularised repairs of the anterior, middle, clival, sellar & lateral/parasellar defects.
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20. The gasket seal was reported in 20 papers, particularly for large & high flow defects. This has been shown to be effective for achieving watertight closure & may prevent the need for use of lumbar drains, nasal packing or vascularised repair.
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21. Although several of these techniques are available for skull base repair, each have their own limitations.
Below is a summary of some of the advantages and disadvantages of the repair techniques at each of the anatomical levels.
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22. What’s the study shown?
✅It’s provided a taxonomy highlighting the principles of barrier restoration, pressure relief & use of staged approaches to prevent CSFR.
✅It’s shown the wide scope of repair techniques following endonasal pituitary & skull base tumour resection
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23. At present, limited evidence currently exists to help guide the optimal repair technique. As such, larger, multi-centre studies are required to help guide practice.
One such ongoing study is the CRANIAL study
@cranial_study
@NANSIG1
@BNTRC
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24. This study aims to establish the scope of skull base repair methods used and their corresponding rates of post-operative CSFR in both TSA and EEA to help establish a standard for skull base repair methods & assist in guiding current neurosurgical practice
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25. ICYMI here is our recent
#BNES
#tweetorial
on Part 1 of the CRANIAL study discussing the study protocol and the findings so far. ⬇️
6. Hence, the CRANIAL study aims to establish the types of skull base repair methods used & determine their corresponding rates of postoperative CSF rhinorrhoea.
#BNES
#tweetorial
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