%0 Journal Article
%T The Suture-Pull as a Refinement of the Gasket Implant Technique for Reconstruction after Endoscopic Skull Base Surgery
%A Karim Elayoubi
%A Alexander G. Weil
%A Ioannis Nikolaidis
%A Robert Moumdjian
%A Martin Desrosiers
%J International Journal of Otolaryngology and Head & Neck Surgery
%P 88-92
%@ 2168-5460
%D 2012
%I Scientific Research Publishing
%R 10.4236/ijohns.2012.13018
%X <b>Introduction:</b> Adequate reconstruction of the skull base is the key to avoiding cerebrospinal fluid (CSF) leak following endonasal skull base surgery. The use of an endocranial ˇ°gasketˇ± plug has been reported for this and is used in our institution. We present a simple refinement of the ˇ°gasketˇ± technique using commonly available materials that helps ensure proper size and positioning of the gasket by applying stress on a suture attached on the center of the gasket implant. <b>Materials and Methods:</b> We report a case of massive CSF leak following endonasal transsphenoidal surgery for pitui- tary macroadenoma. The skull base was reconstructed in a multi-layered fashion with fascia lata and bony buttress reinforced with a vascularized nasoseptal flap. In order to avoid implant slippage from too-small size or malpositioning, we performed a ˇ°stress testˇ± using traction applied to a suture attached to the center of the implant (Medpor®), which allowed us to confirm intraoperatively that the buttress was positioned securely. <b>Results:</b> The patient did well without recurrence of CSF leak. At two-year follow-up, there has been no recurrence of CSF leak or occurrence local complica- tions. We have not verified whether bony regrowth into the implant has occurred. <b>Conclusion:</b> The suture-pull refinement of the gasket implant technique is a simple, inexpensive and low risk method to assure secure endocranial positioning over the skull base defect, and may prevent CSF leak resulting from too-small sizing or buttress malpositioning.
%K CSF Leak
%K Nasoseptal Flap
%K Skull Base Closure
%K Transsphenoidal Surgery
%U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=24813