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Acellular dermal matrix as an alternative to autologous fascia lata for skull base repair following extended endoscopic endonasal approaches.

TitleAcellular dermal matrix as an alternative to autologous fascia lata for skull base repair following extended endoscopic endonasal approaches.
Publication TypeJournal Article
Year of Publication2020
AuthorsYoungerman BE, Kosty JA, Gerges MM, Tabaee A, Kacker A, Anand VK, Schwartz TH
JournalActa Neurochir (Wien)
Volume162
Issue4
Pagination863-873
Date Published2020 04
ISSN0942-0940
KeywordsAcellular Dermis, Adult, Aged, Craniopharyngioma, Drainage, Fascia Lata, Female, Humans, Male, Meningeal Neoplasms, Meningioma, Middle Aged, Nose, Pituitary Neoplasms, Reconstructive Surgical Procedures, Retrospective Studies, Skull Base, Surgical Flaps, Treatment Outcome
Abstract

BACKGROUND: Skull base reconstruction after extended endoscopic endonasal approaches (EEAs) can be challenging. In addition to the nasoseptal flap, which has been adopted by most centers, autologous fascia lata is also often utilized. Harvesting of fascia lata requires a separate thigh incision, may prolong recovery, and results in a visible scar. In principal, the use of non-autologous materials would be preferable to avoid a second incision and maintain the minimally invasive nature of the approach, assuming the CSF leak rate is not compromised.

OBJECTIVE: To assess the efficacy of acellular dermal matrix (ADM) as a non-autologous alternative to autologous fascia lata graft for watertight closure of the cranial base following EEAs.

METHODS: A retrospective chart review of extended EEAs performed before and after the transition from fascia lata to ADM was performed. Cases were frequency matched for approach, pathology, BMI, use of lumbar drainage, and tumor volume. Power analysis was performed to estimate the sample size needed to demonstrate non-inferiority.

RESULTS: ADM was used for watertight closure of the cranial base in 19 consecutive extended endoscopic endonasal approaches (16 gasket-seals and 3 buttons) with 1 postoperative CSF leak at the last follow-up (median 5.3, range 1.0-12.6 months). All patients had high-flow intraoperative leaks. The cohort included 8 meningiomas, 8 craniopharyngiomas, 2 chordomas, and 1 pituicytoma ranging in size from 0.2 to 37.2cm (median 5.5, IQR 2.8-13.3 cm). In 19 historical controls who received fascia lata, there were 2 postoperative CSF leaks.

CONCLUSIONS: Preliminary results suggest that ADM provides a non-inferior non-autologous alternative to fascia lata for watertight gasket-seal and button closures following extended EEAs, potentially reducing or eliminating the need to harvest autologous tissue.

DOI10.1007/s00701-019-04200-z
Alternate JournalActa Neurochir (Wien)
PubMed ID32048039