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Acellular dermal matrix as an alternative to autologous fascia lata for skull base repair following extended endoscopic endonasal approaches

  • Original Article - Neurosurgical technique evaluation
  • Published:
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Abstract

Background

Skull base reconstruction after extended endoscopic endonasal approaches (EEAs) can be challenging. In addition to the nasoseptal flap, which has been adopted by most centers, autologous fascia lata is also often utilized. Harvesting of fascia lata requires a separate thigh incision, may prolong recovery, and results in a visible scar. In principal, the use of non-autologous materials would be preferable to avoid a second incision and maintain the minimally invasive nature of the approach, assuming the CSF leak rate is not compromised.

Objective

To assess the efficacy of acellular dermal matrix (ADM) as a non-autologous alternative to autologous fascia lata graft for watertight closure of the cranial base following EEAs.

Methods

A retrospective chart review of extended EEAs performed before and after the transition from fascia lata to ADM was performed. Cases were frequency matched for approach, pathology, BMI, use of lumbar drainage, and tumor volume. Power analysis was performed to estimate the sample size needed to demonstrate non-inferiority.

Results

ADM was used for watertight closure of the cranial base in 19 consecutive extended endoscopic endonasal approaches (16 gasket-seals and 3 buttons) with 1 postoperative CSF leak at the last follow-up (median 5.3, range 1.0–12.6 months). All patients had high-flow intraoperative leaks. The cohort included 8 meningiomas, 8 craniopharyngiomas, 2 chordomas, and 1 pituicytoma ranging in size from 0.2 to 37.2cm3 (median 5.5, IQR 2.8–13.3 cm3). In 19 historical controls who received fascia lata, there were 2 postoperative CSF leaks.

Conclusions

Preliminary results suggest that ADM provides a non-inferior non-autologous alternative to fascia lata for watertight gasket-seal and button closures following extended EEAs, potentially reducing or eliminating the need to harvest autologous tissue.

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Authors and Affiliations

  1. Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA

    Brett E. Youngerman, Mina M. Gerges & Theodore H. Schwartz

  2. Department of Neurosurgery, Ochsner Louisiana State University Shreveport, Shreveport, LA, USA

    Jennifer A. Kosty

  3. Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Mina M. Gerges

  4. Department of Otolaryngology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA

    Abtin Tabaee, Ashutosh Kacker, Vijay K. Anand & Theodore H. Schwartz

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  1. Brett E. Youngerman
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Youngerman, B.E., Kosty, J.A., Gerges, M.M. et al. Acellular dermal matrix as an alternative to autologous fascia lata for skull base repair following extended endoscopic endonasal approaches. Acta Neurochir 162, 863–873 (2020). https://doi.org/10.1007/s00701-019-04200-z

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