title: Endoscopic endonasal suturing of dural reconstruction grafts: a novel application of the U-Clip technology. Technical note.
abstract: Cerebrospinal fluid (CSF) leakage following endoscopic endonasal skull base resection can be a significant problem. A method for securing tissue grafts is needed. In this paper the authors used an endonasal suturing device to secure the graft reconstruction following endonasal tumor resection. The U-Clip anastomotic device (Medtronic), developed for cardiovascular anastomoses, was used to secure the tissue graft to native dura. A specialized needle driver and hemoclip applier were used for the application and deployment of this device. No suture tying was necessary, facilitating its endonasal application. The graft was successfully secured in its desired position to native dura by using the U-Clip anastomotic device. The patient did not suffer a postoperative CSF leak, and postoperative imaging and endoscopy revealed that the graft was in a good position. There was no complication from the use of the device. The U-Clip anastomotic device can be used as a suture device during endonasal surgery. It may prevent tissue graft migration and help prevent CSF leakage.
authors.affiliation: Department of Neurosurgery, Minimally Invasive endoNeurosurgery Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Gardner
authors.forename: Amin
authors.initials: A
authors.lastname: Kassam
authors.forename: Carl
authors.initials: C
authors.lastname: Snyderman
authors.forename: Arlan
authors.initials: A
authors.lastname: Mintz
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carrau
authors.forename: John J
authors.initials: JJ
authors.lastname: Moossy
mesh_terms: D001672:Biocompatible Materials; D002559:Cerebrospinal Fluid Rhinorrhea / Q000517:prevention & control; D003094:Collagen; D004388:Dura Mater / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D009666:Nose; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures / Q000145:classification*
chemical_list: D001672:Biocompatible Materials; D003094:Collagen