Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal Surgery
Extended endonasal transsphenoidal surgery (eTSS) offers a wide surgical field for various parasellar lesions; however, intraoperative high-flow cerebrospinal fluid (CSF) leakage is inevitable. Therefore, secure sellar reconstruction methods are essential to prevent postoperative CSF leakage. Althou...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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The Japan Neurosurgical Society
2022-04-01
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| Series: | Neurologia Medico-Chirurgica |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/nmc/62/4/62_2021-0355/_pdf/-char/en |
| _version_ | 1811340156856172544 |
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| author | Yuichi NAGATA Kazuhito TAKEUCHI Hiroo SASAKI Akihiro MIZUNO Hideyuki HARADA Kuniaki TANAHASHI Yoshio ARAKI Ryuta SAITO |
| author_facet | Yuichi NAGATA Kazuhito TAKEUCHI Hiroo SASAKI Akihiro MIZUNO Hideyuki HARADA Kuniaki TANAHASHI Yoshio ARAKI Ryuta SAITO |
| author_sort | Yuichi NAGATA |
| collection | DOAJ |
| description | Extended endonasal transsphenoidal surgery (eTSS) offers a wide surgical field for various parasellar lesions; however, intraoperative high-flow cerebrospinal fluid (CSF) leakage is inevitable. Therefore, secure sellar reconstruction methods are essential to prevent postoperative CSF leakage. Although collagen matrix has been applied for dural reconstruction in neurosurgery, its suitability for application in extended eTSS remains unclear. Eighteen patients underwent modified shoelace dural closure using collagen matrix after lesionectomy via extended eTSS. In this technique, a collagen matrix, which was placed subdurally (inlay graft), was continuously sutured with both open dural edges like a shoelace. Then, another collagen matrix was placed epidurally (onlay graft), and rigid reconstruction was performed using the septal bone and a resorbable fixation mesh. Postoperative CSF leakage did not occur in 17 patients but did occur in 1 patient with tuberculum sellae meningioma. In this case, the CSF leakage point was detected just around the area between the coagulated dura and the adjacent collagen matrix. The collagen matrix harvested from this area was pathologically examined; neovascularization and fibroblastic infiltration into the collagen matrix were not detected. On the other hand, neovascularization and fibroblast infiltration into the collagen matrix were apparent on the surface of the collagen matrix harvested from the non-CSF leakage area. Our novel dural closure technique using collagen matrix could be an effective option for sellar reconstruction in extended eTSS; however, it should be applied in patients in whom normal dural edges are preserved. |
| first_indexed | 2024-04-13T18:36:58Z |
| format | Article |
| id | doaj.art-5e2ce36c3e334900a9c76814933cf88b |
| institution | Directory Open Access Journal |
| issn | 1349-8029 |
| language | English |
| last_indexed | 2024-04-13T18:36:58Z |
| publishDate | 2022-04-01 |
| publisher | The Japan Neurosurgical Society |
| record_format | Article |
| series | Neurologia Medico-Chirurgica |
| spelling | doaj.art-5e2ce36c3e334900a9c76814933cf88b2022-12-22T02:34:50ZengThe Japan Neurosurgical SocietyNeurologia Medico-Chirurgica1349-80292022-04-0162420320810.2176/jns-nmc.2021-03552021-0355Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal SurgeryYuichi NAGATA0Kazuhito TAKEUCHI1Hiroo SASAKI2Akihiro MIZUNO3Hideyuki HARADA4Kuniaki TANAHASHI5Yoshio ARAKI6Ryuta SAITO7Department of Neurosurgery, Nagoya University Graduate School of MedicineDepartment of Neurosurgery, Nagoya University Graduate School of MedicineDepartment of Neurosurgery, Nagoya University Graduate School of MedicineDepartment of Neurosurgery, Nagoya University Graduate School of MedicineDepartment of Neurosurgery, Nagoya University Graduate School of MedicineDepartment of Neurosurgery, Nagoya University Graduate School of MedicineDepartment of Neurosurgery, Nagoya University Graduate School of MedicineDepartment of Neurosurgery, Nagoya University Graduate School of MedicineExtended endonasal transsphenoidal surgery (eTSS) offers a wide surgical field for various parasellar lesions; however, intraoperative high-flow cerebrospinal fluid (CSF) leakage is inevitable. Therefore, secure sellar reconstruction methods are essential to prevent postoperative CSF leakage. Although collagen matrix has been applied for dural reconstruction in neurosurgery, its suitability for application in extended eTSS remains unclear. Eighteen patients underwent modified shoelace dural closure using collagen matrix after lesionectomy via extended eTSS. In this technique, a collagen matrix, which was placed subdurally (inlay graft), was continuously sutured with both open dural edges like a shoelace. Then, another collagen matrix was placed epidurally (onlay graft), and rigid reconstruction was performed using the septal bone and a resorbable fixation mesh. Postoperative CSF leakage did not occur in 17 patients but did occur in 1 patient with tuberculum sellae meningioma. In this case, the CSF leakage point was detected just around the area between the coagulated dura and the adjacent collagen matrix. The collagen matrix harvested from this area was pathologically examined; neovascularization and fibroblastic infiltration into the collagen matrix were not detected. On the other hand, neovascularization and fibroblast infiltration into the collagen matrix were apparent on the surface of the collagen matrix harvested from the non-CSF leakage area. Our novel dural closure technique using collagen matrix could be an effective option for sellar reconstruction in extended eTSS; however, it should be applied in patients in whom normal dural edges are preserved.https://www.jstage.jst.go.jp/article/nmc/62/4/62_2021-0355/_pdf/-char/endural closuresellar reconstructionshoelace closurecollagen matrixduragen |
| spellingShingle | Yuichi NAGATA Kazuhito TAKEUCHI Hiroo SASAKI Akihiro MIZUNO Hideyuki HARADA Kuniaki TANAHASHI Yoshio ARAKI Ryuta SAITO Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal Surgery Neurologia Medico-Chirurgica dural closure sellar reconstruction shoelace closure collagen matrix duragen |
| title | Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal Surgery |
| title_full | Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal Surgery |
| title_fullStr | Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal Surgery |
| title_full_unstemmed | Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal Surgery |
| title_short | Modified Shoelace Dural Closure with Collagen Matrix in Extended Transsphenoidal Surgery |
| title_sort | modified shoelace dural closure with collagen matrix in extended transsphenoidal surgery |
| topic | dural closure sellar reconstruction shoelace closure collagen matrix duragen |
| url | https://www.jstage.jst.go.jp/article/nmc/62/4/62_2021-0355/_pdf/-char/en |
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