New Model of Bone Reconstruction Specially Designed for Skull Base Surgery

Objective: The direct endonasal or transoral transclival approaches to the skull base permit effective minimally invasive surgery along the clivus region. Developing consistently effective techniques to prevent cerebrospinal fluid (CSF) leaks and their consequences (infections and healing processes with long and complicated recoveries), remains a major challenge. In this study we tested a method of bone reconstruction newly developed by us, which makes use of a specially designed silicone plug. It can be used for bone replacement after minimally invasive skull base surgery with nearly no risks of postoperative CSF leaks.

Methods: German landrace pigs were used to test the plugging efficiency of the new technique. With a subtemporal approach 6 craniotomies were made and the dura opened. The craniotomy defects were occluded with the silicon ball, which has a near spherical shape and conforms elastically to fill the bone defect. Each pig received an intracranial pressure (ICP) catheter and a subdural catheter for later fluorescein injection. Then we increased ICP by infusion of artificial CSF and detected fluorescein leaks from the craniotomy using ultraviolet illumination and a photomacroscope equipped with appropriate filters and a CCD camera.

Results: In all pigs we increased ICP to 70-75 mmHg by infusing 25–30 ml saline containing 0.05% sodium fluorescein. All craniotomies were 100% tight without CSF leak. The application of the silicone plugs, which are made of a cost-effective and biocompatible material, is easy and fast—making use of a specially developed toolkit.

Conclusion: This novel medical device allows a leak-proof closure of bone defects after minimally invasive craniotomies; no additional surgery or other therapies are necessary.

The Glomus Vagale Tumor-Diagnostic and Therapeutic Procedure on the Example of an Extensive Tumor