"Gasket-seal" watertight closure in minimal-access endoscopic cranial base surgery.
OBJECTIVE
Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented.


METHODS
To achieve watertight closure of the anterior cranial base, autologous fascia lata was used to create a "gasket seal" around a bone buttress, followed by application of a tissue sealant such as DuraSeal (Confluent Surgical, Inc., Waltham, MA). The gasket-seal closure was used to seal the anterior cranial base in a series of 10 patients with intradural surgery for suprasellar craniopharyngiomas (n = 5), planum meningiomas (n = 3), clival chordoma (n = 1), and recurrent iatrogenic cerebrospinal fluid leak (n = 1). Lumbar drains were placed intraoperatively in five patients and remained in place for 3 days postoperatively.


RESULTS
After a mean follow-up period of 12 months, there were no cerebrospinal fluid leaks.


CONCLUSIONS
The gasket-seal closure is an effective method for achieving watertight closure of the anterior cranial base after endoscopic intradural surgery.
Leng
Lewis Z
LZ
Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
Brown
Seth
S
Anand
Vijay K
VK
Schwartz
Theodore H
TH
D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D044583:Neuroendoscopy / Q000379:methods*; D019291:Skull Base / Q000601:surgery*; D014014:Tissue Adhesives / Q000008:administration & dosage*; D016896:Treatment Outcome; D014867:Water
D014014:Tissue Adhesives; D014867:Water