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Complete closure of the skull base with suturing in endoscopic endonasal surgery.
1108 16:55-17:05
Skull Base/304A
Background / introduction Endoscopic endonasal surgery for skull base lesions is now being performed at many institutions. Advances in endoscopic and surgical techniques have made it possible to remove a variety of skull base lesions safely and reliably, but problems remain in the closure of the skull base. There are various methods of closure, the vascularized nasoseptal mucosal flap has drastically changed the concept of closure. It reduces the incidence of CSF leakage to 5-10%. To further reduce the occurrence rate of CSF leakage, we introduced a closure technique using fascia-lata with suturing. Methods By the end of 2023, there were 200 endoscopic endonasal skull base surgeries in which obvious intra-operative CSF leakage was observed. After removing the tumor, the dura was closed using following technique. A fascia-lata, larger than the dural defect, was laid in the subdural space and patch-sutured with dura until the CFS leakage was stopped. Next, another fascia was placed over the dura and fixed with bone fragment. Finally, a nasoseptal mucosal flap or a local mucosal flap was applied. The time spent closing the skull base ranged from 20 to 40 minutes. Postoperative bed rest was limited to the day of surgery, and lumbar drainage was not performed. Result There was no postoperative CSF leakage in these 200 cases. There were no infections such as meningitis that would suggest late-onset CFS leak. The reason why no CSF leakage occurred is that CSF flow was completely stopped on the layer of the dura. Conclusions The use of a mucosal flap is effective in promoting wound healing and preventing infection by supplementing blood flow, and the complete dural closure with suturing is needed to prevent CSF leakage in the early postoperative stage.

Secure and safe resection of pituitary and parasellar tumors in endoscopic endonasal surgery.
1108 16:15-16:25
Skull Base/304A
Endoscopic endonasal transsphenoidal surgery has been the mainstream of removing pituitary and para-sellar tumors. The reason for this includes followings: less invasiveness, wide visibility and ability to reach the tumor origin early. To perform secure and safe resection, tumor-specific resection strategies and anatomical location are necessary. In pituitary tumors, resection strategies should be changed depending on tumor shape. In brief, round shape tumors are removed using extra-capsular techniques, and lobular shape tumors are removed by sub-capsular techniques. Supra-sellar meningiomas and craniopharyngiomas are safely removed by following the anatomical landmarks and peeling from surrounding structures. In orbital tumors, schwannomas are removed by sub-capsular techniques, and cavernous hemangiomas are removed in “en bloc” with shrinkage by coagulation. It is also important to choose the optimal route and get the wide surgical field. To achieve this, team surgery with ENT and Neurosurgery is extremely effective.