title: Circumferential watertight dural repair using nitinol U-clips in expanded endonasal and sublabial approaches to the cranial base.
abstract: BACKGROUND
  In recent years, significant advances have been made in the field of expanded endonasal approaches that permit treatment of different cranial base intradural lesions.
  
  
  OBJECTIVE
  To report our technique of cranial base dural repair by the application of nitinol U-Clips in endoscope-assisted extended endonasal or sublabial approaches. Closure techniques and postoperative cerebrospinal (CSF) leaks are reported.
  
  
  METHODS
  We reviewed 11 patients with different kinds of cranial base tumors or vascular diseases (2 tuberculum sellae meningiomas, 1 planum sphenoidale meningioma, 4 craniopharyngiomas, 1 recurrent clival chordoma, 1 esthesioneuroblastoma, 1 ethmoidal melanoma metastasis, 1 basilar trunk aneurysm) who underwent an endoscope-assisted extended endonasal or sublabial approach. Dural repair was performed using nitinol U-Clips to circumferentially suture AlloDerm or fascia lata directly to the existing dural borders. Lumbar drainage was not used in 9 patients and was used in 2 patients for 5 days. Patients were evaluated for the appearance of CSF leaks.
  
  
  RESULTS
  Postoperative CSF leak was observed in 1 patient (9%). This required a second transnasal repair.
  
  
  CONCLUSIONS
  Circumferential dural closure with U-Clips is a useful adjunct to prevent CSF leaks after expanded endonasal or sublabial approaches to the cranial base for treatment of intracranial pathology.
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Acerbi
authors.forename: Eric
authors.initials: E
authors.lastname: Genden
authors.forename: Joshua
authors.initials: J
authors.lastname: Bederson
mesh_terms: D000328:Adult; D000368:Aged; D000497:Alloys / Q000627:therapeutic use; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery*; D005260:Female; D006801:Humans; D008046:Lip / Q000033:anatomy & histology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery*; D013525:Surgical Instruments / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D000497:Alloys; C013616:nitinol