Introduction: Dural repair of the anterior skull base has long been tedious and time consuming. However, inadequate closure may result in postoperative CSF leaks with neurologic sequelae. We report patient outcomes after dural closure of the anterior skull base with nonpenetrating titanium microclips.
Methods: We conducted a retrospective review of data obtained on all patients who underwent a bifrontal craniotomy and subsequently needed dural repair of the anterior skull base between 2013 and 2016 at our home institution. Patients were classified based on underlying pathology and posterior extent of dural repair. We describe a technique of dura closure for the anterior skull base and report patient outcomes using this method.
Results: Twenty-four patients underwent a bifrontal craniotomy with subsequent dural repair of the anterior skull base. Patients were classified as those who received the operation for trauma (n=9), tumor resection (n=11), and for neither trauma nor tumor resection (n=4). Of the patients who underwent an operation, 16/24 (67%) had dural repair at or posterior to the planum sphenoidale. There were no permanent complications. A cerebrospinal fluid leak occurred in one of 24 (4%) patients and 3/24 (13%) patients had a surgical site infection. Artifact did not inhibit postoperative imaging.
Conclusions: Our results suggest that dural repair of the anterior skull base with non-penetrating, titanium microclips is a feasible alternative to suturing dura in confined spaces with limited maneuverability. We offer a method for bypassing a technically challenging aspect of these cases.
Patient Care: Utilizing this method for dural closure we have had acceptable postoperative CSF leaks and complications. This method has been easy to implement and in our opinion, reduces operative time when compared to suturing.
Learning Objectives: By the conclusion of this presentation, participants will be able to (1) describe a method of repairing anterior skull base defects using nonpenetrating titanium microclips and (2) learn the postoperative complication and CSF leak rates associated with this method.