With the rapid development of diagnosis and treatment technology, equipment and instruments in the new era of neurosurgery, [1, 2] endoscope-assisted transnasal skull base surgery technology is becoming increasingly mature, surgical indications show an expanding trend, and the types of treated lesions are increasing day by day under the advantages of less trauma, quick recovery, high total resection rate and clear visual field exposure [3-5]. However, cerebrospinal fluid leakage and severe intracranial infection caused by the defect of skull base bone and dura mater have a great adverse impact on the prognosis of patients. Therefore, how to carry out long-lasting and effective skull base reconstruction after successful tumor resection is particularly important to reduce the occurrence of cerebrospinal fluid leakage after operation. Currently, there is no uniform standard for skull base reconstruction methods, which can be roughly divided into soft reconstruction and rigid reconstruction [6, 7]. There is no doubt about the importance of soft reconstruction in tissue water sealing, but rigid reconstruction of skull base is often ignored or even controversial [6]. In this paper, various techniques of skull base rigid reconstruction are reviewed, and the necessity of skull base rigid reconstruction is expounded.

Liu Lili, Lin Dingfa, Yang Gang. Research Progress of Rigid Skull Base Reconstruction after Transnasal Endoscopy. International Journal of Frontiers in Medicine (2023), Vol. 5, Issue 2: 8-12. https://doi.org/10.25236/IJFM.2023.050202.

[1] Abergel A, Cavel O, Margalit N et al. Comparison of quality of life after transnasal endoscopic vs open skull base tumor resection. Arch Otolaryngol Head Neck Surg 2012; 138: 142-147.

[2] Eloy JA, Vivero RJ, Hoang K et al. Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base. Laryngoscope 2009; 119: 834-840.

[3] Esquenazi Y, Essayed WI, Singh H,et al. Endoscopic Endonasal Versus Microscopic Transsphenoidal Surgery for Recurrent and/or Residual Pituitary Adenomas[J]. World Neurosurg, 2017, 101: 186-95.

[4] Ishii Y, Tahara S, Teramoto A, et al. Endoscopic endonasal skull base surgery: advantages, limitations, and our techniques to overcome cerebrospinal fluid leakage: technical note[J]. Neurol Med Chir (Tokyo), 2014, 54(12): 983-90.

[5] Neuroendoscopy Professional Committee of Endoscopy Branch of Chinese Medical Doctor Association, Neurosurgeon Branch of Chinese Medical Doctor Association, Neuroprosthetic Professional Committee of Chinese Medical Doctor Association, etc. Expert Consensus on Skull Base Reconstruction Technology in Neuroendoscopic Transnasal Skull Base Surgery [J]. Chinese Journal of Neurosurgery, 2020, 36 (11): 1081-1087.

[6] Eloy JA, Shukla PA, Choudhry OJ et al. Assessment of frontal lobe sagging after endoscopic endonasal transcribriform resection of anterior skull base tumors: is rigid structural reconstruction of the cranial base defect necessary? Laryngoscope 2012; 122: 2652-2657.

[7] Gao D.Reconstruction of medium-flow cerebrospinal fluid leakage in transsphenoidal pituitary adenoma resection with bone-membrane mosaic technique [D]. Chongqing Medical University, 2022. DOI: 10.27674/D.cnki.gcyku.2022. 001295.

[8] Komotar RJ,Starke RM,Raper DM,et al. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of giant pituitary adenomas[J]. Pituitary, 2012, 15: 150.

[9] Xu YZ, Xue YJ, Lan J, et al. Application of multilayer reconstruction technology in endoscopic skull base surgery [J]. Chinese Journal of Neurosurgery, 2017, 33: 1005.

[10] Schmalbach CE, Webb DE, Weitzel EK. Anterior skull base reconstruction: A review of current techniques[J]. Curr Opin Otolaryngol Head Neck Surg, 2010,18(4): 238-243. doi: 10.1097/MOO. 06013e32833a4706.

[11] Raza S M, Schwartz T H. Multi-layer reconstruction during endoscopic endonasal surgery: how much is necessary?[J]. World Neurosurg, 2015, 83(2):138-9.

[12] Yan ZC, Zhang HZ, Wang XD, et al. Sellar floor reconstruction strategy for neuroendoscopic transsphenoidal pituitary tumor surgery [J] Journal of Clinical Neurosurgery, 2016, 13 (02): 98-101

[13] Park JH, Choi JH, Kim YI et al. Modified graded repair of cerebrospinal fluid leaks in endoscopic endonasal transsphenoidal surgery[J]. J Korean Neurosurg Soc, 2015, 58: 36.

[14] Jin B,Wang XS,Huo G,et al. Reconstruction of skull base bone defects using an in situ bone flap after endoscopic endonasal transplanum-transtuberculum approaches.[J]. Eur Arch Otorhinolaryngol, 2020, 277(7):2071-2080.

[15] Harvey RJ,Parmar P,Sacks R et al. Endoscopic skull base defects: asystematicreview of published evidence [ J ]. Laryngoscope, 2012, 122: 452.

[16] Fomichev D, Kalinin P, Kutin M, et al. Extended Transsphenoidal Endoscopic Endonasal Surgery of Suprasellar Craniopharyngiomas[J]. World Neurosurg, 2016, 94: 181-7

[17] Esposito F, Dusick J R, Fatemi N, et al. Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery[J].Operative neurosurgery (Hagerstown, Md), 2007, 60(4 Suppl 2): 295-303; discussion-4

[18] Hadad G, Bassagasteguy L,Carrau R L,et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap[J]. Laryngoscope, 2006, 116(10): 1882-6.

[19] Patel K S, Komotar R J, Szentirmal O,et al. Case-specific protocol to reduce cerebrospinal fluid leakage after endotransnasal endoscopy[J]. J Neurosurg, 2013, 119(3): 661-8.

[20] Garcia-Navarro V, Anand V K, Schwartz T H. Gasket Seal Closure for Extended Endonasal Endoscopic Skull Base Surgery: Efficacy in a Large Case Series[J]. World Neurosurgery, 2013, 80(5): 563-8.

[21] Xia HL, Jin B, Mou JM, et al. Application of in-situ bone flap reconstruction in neuroendoscopic extended transsellar tuberculum-sphenoid plateau approach [J]. Journal of Clinical Neurosurgery, 2020, 17 (03): 278-282.

[22] Yu JJ, Wang XS, Liu LL, et al. Comparison of in situ bone flap combined with different nasal mucosal flap in skull base reconstruction after neuroendoscopic extended nasal surgery [J]. Chinese Journal of Neurosurgery, 2022, 38 (02): 139-144.

[23] Motiee-Langroudi M, Harirchi I, Amali A, et al. Reconstruction of Midface and Orbital Wall Defects After Maxillectomy and Orbital Content Preservation With Titanium Mesh and Fascia Lata: 3-Year Follow-Up[J]. J Oral Maxillofac Surg, 2015, 73(12): 2447.e1-5.

[24] Khan A, Lapin A, Eisenman D J. Use of titanium mesh for middle cranial fossa skull base reconstruction[J]. J Neurol Surg B Skull Base, 2014, 75(2): 104-9.

[25] He JJ, Gong ZB, Zhang JN, et al. Clinical study on sellar floor reconstruction with medical collagen-hydroxyapatite artificial bone [J]. Journal of Tissue Engineering and Reconstructive Surgery, 2017, 13 (01): 21-4

[26] Badie B, Preston J K, Hartig G K. Use of titanium mesh for reconstruction of large anterior cranial base defects[J]. J Neurosurg, 2000, 93(4): 711-4.

[27] Brandicourt P, Delanoé F, Roux F-E,et al. Reconstruction of Cranial Vault Defect with Polyetheretherketone Implants[J]. World Neurosurgery, 2017,105: 783-9.

[28] Shin J, Forbes J, Lehner K, et al. Skull Base 3D Modeling of Rigid Buttress for Gasket-Seal Closure Using Operative Endoscopic Imaging: Cadaveric Feasibility[J]. J Neurol Surg B Skull Base, 2019, 80(1): 67-71.

[29] Choi J W,Ahn J S.3D Printed Titanium Implant for the Skull Reconstruction:A Preliminary Case Study[J].Journal of International Society for Simulation Surgery,2014,1(2):99-102.

[30] Ammar A. Repair of skull base dural defects: the dura sandwich. Technical note[J]. Acta Neurochir (Wien), 1992, 119(1-4): 174-5.

[31] Leng L Z, Brown S, Anand V K,et al. "Gasket-seal" watertight closure in minimal-access endoscopic cranial base surgery[J]. Neurosurgery, 2008, 62(Suppl 2): ONSE342-3; discussion ONSE3.

[32] Luo CH, Xie SH, Liu XH, etc. Application of nasal septum bone flap combined with pedicled nasal septum mucosal flap in skull base reconstruction through neuroendoscopic transsphenoidal extended approach [J]. Chinese Journal of Neurosurgery, 2021, 37 (11): 6.

[33] Hsu Y W, Ho C Y, Yen Y S. Reconstructed bone chip detachment is a risk factor for sinusitis after transsphenoidal surgery[J]. Laryngoscope, 2014, 124(1): 57-61.

[34] Jin B, Wang XS, Huo G, et al. Application of in situ bone flap combined with free middle turbinate mucosal flap in skull base reconstruction through neuroendoscopic extended nasal approach [J]. Chinese Journal of Neurosurgery, 2020, 36 (06): 597-601.