title: Endoscopic repair of high-flow cranial base defects using a bilayer button.
abstract: OBJECTIVE
  Repair of the skull base still begins with a direct repair of the dural defect. We present a new button closure for primary repair of the dura for high flow defects.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  We reviewed our 20 cases of primary button grafts and compared the results to the previous 20 high-flow open-cistern cerebrospinal fluid (CSF) cases. Subjects were excluded if they had no violation of the arachnoid space or potential for low-flow CSF leak. The button is constructed so that the inlay portion is at least 25% larger than the dural defect, and the onlay portion is just large enough to cover the dural defect. The two grafts are sutured together using two 4-0 Neurolon sutures and placed with the inlay portion intradurally and the onlay portion extradurally.
  
  
  RESULTS
  The button graft repair of open-cisternal defects had a drop in CSF leak complications to 10% (2/20), and these two leaks were repaired with the button technique as the salvage surgery. This is a significant improvement over the 45% leak rate in the prebutton graft group (P < .03). In our button graft group we used nasoseptal flaps on 16/20 repairs, and 1/2 repairs that leaked in the button group did not have a nasoseptal flap. Lumbar drains were used in approximately 38% in both groups (P = .83).
  
  
  CONCLUSIONS
  The button graft can be used in conjunction with the nasal septal flap or as a stand-alone repair with good results reducing the postoperative leak rate to 10% for high-flow CSF repairs. Laryngoscope, 2010.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Luginbuhl
authors.forename: Peter G
authors.initials: PG
authors.lastname: Campbell
authors.forename: James
authors.initials: J
authors.lastname: Evans
authors.forename: Marc
authors.initials: M
authors.lastname: Rosen
mesh_terms: D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D003131:Combined Modality Therapy; D003397:Craniopharyngioma / Q000601:surgery; D004388:Dura Mater / Q000601:surgery; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D005206:Fascia Lata / Q000637:transplantation; D006801:Humans; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery; D013524:Surgical Flaps; D013536:Suture Techniques; D020858:Tissue and Organ Harvesting / Q000379:methods