title: Closure of large skull base defects after endoscopic transnasal craniotomy. Clinical article.
abstract: OBJECTIVE
  The authors describe the utility of and outcomes after endoscopic transnasal craniotomy and skull reconstruction in the management of skull base pathologies.
  
  
  METHODS
  The authors conducted a observational study of patients undergoing totally endoscopic, transnasal, transdural surgery. The patients included in the study underwent treatment over a 12-month period at 2 tertiary medical centers. The pathological entity, region of the ventral skull base resected, and size of the dural defect were recorded. Approach-related complications were documented, as well as CSF leaks, infections, bleeding-related complications, and any minor complications.
  
  
  RESULTS
  Thirty consecutive patients were assessed during the study period. The patients had a mean age of 45.5 +/- 20.2 years and a mean follow-up period of 182.4 +/- 97.5 days. The dural defects reconstructed were as large as 5.5 cm (mean 2.49 +/- 1.36 cm). One patient (3.3%) had a CSF leak that was managed endoscopically. Two patients had epistaxis that required further care, but there were no complications related to intracranial infections or bleeding. Some minor sinonasal complications occurred.
  
  
  CONCLUSIONS
  Skull base endoscopic reconstructive techniques have significantly advanced in the past decade. The use of pedicled mucosal flaps in the reconstruction of large dural defects resulting from an endoscopic transnasal craniotomy permits a robust repair. The CSF leak rate in this study is comparable to that achieved in open approaches. The ability to manage the skull base defects successfully with this approach greatly increases the utility of transnasal endoscopic surgery.
authors.affiliation: Department of Otolaryngology, Skull Base Surgery, Hospital Prof. Edmundo Vasconcelos, Sao Paulo, Brazil. richard@richardharvey.com.au
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Harvey
authors.forename: João F
authors.initials: JF
authors.lastname: Nogueira
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Schlosser
authors.forename: Sunil J
authors.initials: SJ
authors.lastname: Patel
authors.forename: Eduardo
authors.initials: E
authors.lastname: Vellutini
authors.forename: Aldo C
authors.initials: AC
authors.lastname: Stamm
mesh_terms: D003399:Craniotomy / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps