Endoscopic endonasal repair of skull base defects after tumor resection

Shelesko E.V.; Kapitanov D.N.; Chernikova N.A.; Belov A.I.; Nersesian M.V.; Zinkevich D.N.

doi:https://doi.org/10.17116/endoskop20202602119

Shelesko E.V.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Kapitanov D.N.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

Chernikova N.A.

Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047

Belov A.I.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN

Nersesian M.V.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Zinkevich D.N.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Endoscopic endonasal repair of skull base defects after tumor resection

Authors:

Shelesko E.V., Kapitanov D.N., Chernikova N.A., Belov A.I., Nersesian M.V., Zinkevich D.N.

More about the authors

Journal: Endoscopic Surgery. 2020;26(2): 19‑28

DOI: 10.17116/endoskop20202602119

Read: 2362 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Shelesko EV, Kapitanov DN, Chernikova NA, Belov AI, Nersesian MV, Zinkevich DN. Endoscopic endonasal repair of skull base defects after tumor resection. Endoscopic Surgery. 2020;26(2):19‑28. (In Russ.)
https://doi.org/10.17116/endoskop20202602119

Подписка 2026 Эндоскопическая хирургия (Endoscopic Surgery)

Использование инфографики авторами научных работ

Close metadata

Recommended articles:

Classification of minimally invasive and endoscopic thyroid surgery adapted for training specialists in the system of additional professional education. Endoscopic Surgery. 2025;(5):20-27

Constitutional features of structures of skull base in children aged 8—12 years old in normality and with recurrent subluxation of C1—C2 vertebrae. Russian Journal of Operative Surgery and Clinical Anatomy. 2025;(1):29-35

Perioperative complications in surgery for craniosynostosis in children: a systematic review and meta-analysis. Burdenko's Journal of Neurosurgery. 2025;(3):114-121

Structure and features of damage to the nose and paranasal sinuses in modern armed conflict: an experience of the Otorhinolaryngology clinic of the S.M. Kirov Military Medical Academy. Russian Rhinology. 2025;(2):111-116

The role of minimally invasive transpapillary surgical interventions in emergency abdominal surgery. Russian Journal of Evidence-Based Gastroenterology. 2025;(2):12-18

Basal encephalocele complicated by nasal liquorrhea in patients with craniosynostosis. Burdenko's Journal of Neurosurgery. 2025;(4):61-68

Endoscopic treatment of patients with adenomas of the major duodenal papilla and familial adenomatous polyposis. Pirogov Russian Journal of Surgery. 2025;(9):5-11

Proton therapy of skull base chordoma. P.A. Herzen Journal of Oncology. 2025;(5):64-67

Results of open and endonasal approaches in surgical treatment of the most common malignant tumors of the paranasal sinuses and skull base. P.A. Herzen Journal of Oncology. 2025;(5):83-88

Removal of a foreign body (bullet) from infratemporal fossa through endoscopic endonasal transmaxillary approach. Russian Rhinology. 2025;(4):67-70

Abstract:

Introduction. In connection with the evolvement of expanded endoscopic approaches to remove tumors of the base of the skull, modern literature focuses on the results of radical surgery. There are few works devoted to defects in the base of the skull during removal of the tumor and their plastic closure. The purpose. Analysis of a series of cases of endoscopic endonasal removal of a tumor of the base of the skull with simultaneous plastic surgery, development of a convenient classification of defects with practical recommendations. Material and methods. Retrospective analysis of 50 cases of removal of tumors of the base of the skull with simultaneous plastic surgery of the defect of the base of the skull. The results of plastic surgery after removal of the tumor in the early and late postoperative period were evaluated. A literature review was conducted to compare the data obtained with the results of other studies. Results. After removal of the tumor, all 50 patients underwent simultaneous plastic surgery of the defect. The choice of technique and plastic materials for closing the defect did not depend on the degree of malignancy of the removed formation (p=0.174; criterion χ2). The histological structure of the tumor and subsequent radiation therapy in the case of malignant tumors were did not affect the risk of developing of liquorrhea in the postoperative period (p=0.221; Fisher’s exact test). Based on the results obtained, we developed our own classification of defects in tumors of the base of the skull, taking into account the size, localization and plastic materials used. Conclusions. For intracranial spread of the tumor of the nasal cavity and paranasal sinuses, the removal of the tumor by endoscopic or combined approach with simultaneous plasty of the skull base defect is indicated. The choice of plastic materials and the method of plasty depends on the location, size of the defect, the degree damage to the surrounding tissues and the dura matter by tumor. The effectiveness of the plasty does not depend of the histological structure of the tumor and subsequent chemo- and radiation therapy.

Keywords:

skull base

endoscopic surgery

tumors of the base of the skull

defects of the base of the skull

Authors:

Shelesko E.V.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Kapitanov D.N.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

Chernikova N.A.

Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047

Belov A.I.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN

Nersesian M.V.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Zinkevich D.N.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Close metadata

References:

João Flávio Nogueira, Aldo Stamm, Eduardo Vellutini. Evolution of Endoscopic Skull Base Surgery, Current Concepts, and Future Perspectives. 2010;43(3);639-652.
Snyderman C.H., Pant H., Carrau R.L., Prevedello D., Gardner P., Kassam A.B. What are the limits of endoscopic sinus surgery: the expanded endonasal approach to the skull base. 2009;58(3):152-160.
Harvey R.J., Nogueira J.F., Schlosser R.J., Patel S.J., Vellutini E., Stamm A.C. Closure of large skull base defects after endoscopic transnasal craniotomy. Clinical article. 2009;111(2):371-379.
Aldo C. Stamm, Eduardo Vellutini, Richard John Harvey, João Flávio Nogeira, Diego R. Herman Endoscopic transnasal craniotomy and the resection of craniopharyngioma. 2008;118(7):1142-1148.
Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. 2005;19:E3.
Mattavelli D., Ferrari M., Bolzoni Villaret A., Schreiber A., Rampinelli V., Turri-Zanoni M., Lancini D., Taglietti V., Accorona R., Doglietto F., Battaglia P., Castelnuovo P., Nicolai P. Transnasal endoscopic surgery in selected nasal-ethmoidal cancer with suspected brain invasion: Indications, technique, and outcomes. 2019;41(6):1854-1862.
Abuabara A. Cerebrospinal fluid rhinorrhoea: diagnosis and management. 2007;12:397-400.
Bozkurt G., Leone F., Arosio A.D., Dehgani Mobaraki P., Elhassan H.A., Seyhun N., Turri-Zanoni M., Castelnuovo P., Battaglia P. Septal Flip Flap for Anterior Skull Base Reconstruction After Endoscopic Transnasal Craniectomy: Long-Term Outcomes. 2019;1878-8750(19)31161-1.
Kutin M.A., Kalinin P.L., Fomichev D.V., Shkarubo A.N., Sharipov O.I., Nersesyan M.V., Fomochkina L.A., Kapitanov D.N. Algorithm for choosing the technique of plastics of the skull base in the transsphenoidal endoscopic surgery of the neoplasms of the skull base. 2018;10:142-143.
Daniel M. Prevedello, Juan Barges-Coll, Juan Carlos Fernandez-Miranda, Victor Morera, Deborah Jacobson, Ricky Madhok, Marco C. J. dos Santos, Adam Zanation, Carl H. Snyderman, Paul Gardner, Amin B. Kassam, Ricardo Carrau Middle turbinate flap for skull base reconstruction: cadaveric feasibility study. 2009;119(11):2094-2098.
Bernal-Sprekelsen M., Rioja E., Enseñat J., Enriquez K., Viscovich L., Agredo-Lemos F.E., Alobid I. Management of Anterior Skull Base Defect Depending on Its Size and Location. 2014;1:7.
Kühn U.M., Mann W.J., Amedee R.G. Endonasal Approach for Nasal and Paranasal Sinus Tumor Removal. 2001;63(6):366-371.
Nicolai P., Battaglia P., Bignami M., Villaret A.B., Delù G., Khrais T., Lombardi D, Castelnuovo P. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience. 2008;22:308-316.
Volpi L., Bignami M., Lepera D., Karligkiotis A., Pistochini A., Ottini G., Grigioni E., Lombardi D., Nicolai P., Castelnuovo P. Endoscopic endonasal resection of adenoid cystic carcinoma of the sinonasal tract and skull base. 2019;129(5):1071-1077.
Shin M., Shojima M., Kondo K., Hasegawa H., Hanakita S., Ito A., Kin T., Saito N. Endoscopic Endonasal Craniofacial Surgery for Recurrent Skull Base Meningiomas Involving the Pterygopalatine Fossa, the Infratemporal Fossa, the Orbit, and the Paranasal Sinus. 2018;112:302-312.
Komotar R.J., Starke R.M., Raper D.M., Anand V.K., Schwartz T.H. Endoscopic endonasal versus open repair of anterior skull base CSF leak, meningocele, and encephalocele: a systematic review of outcomes. 2013;74(4):239-250.
Kerr J.T., Chu F.W., Bayles S.W: Cerebrospinal fluid rhinorrhea: diagnosis and management. 2005;38:597-611.
Tomaszewska M., Brożek-Mądry E., Krzeski A. Spontaneous sphenoid sinus cerebrospinal fluid leak and meningoencephalocele — are they due to patent Sternberg’s canal? 2015;10(2):347-358.
Kapitanov D.N., Lopatin A.S., Potapov A.A. M.: Prakticheskaya meditsina; 2015.
Banu MA, Szentirmai O, Mascarenhas L, Salek AlA, Anand VK, Schwartz TH. Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks. 2014;121(4):961-975.
Kuo-Hsing Liao, Jia-Yi Wang, Hui-Wen Lin, Tai-Ngar Lui, Kai-Yun Chen, David Hung Tzang Yen, Mei-Jy Jeng Risk of death in patients with post-traumatic cerebrospinal fluid leakaged Analysis of 1773 case. 2016;79(2):58-64. https://doi.org/10.1016/j.jcma.2015.10.002
Reinard K., Basheer A., Jones L., Standring R., Lee I., Rock J. Surgical technique for repair of complex anterior skull base defects. 2015;6(1):20.
Urken M.L., Catalano P.J., Sen C., Post K., Futran N., Biller H.F. Free tissue transfer for skull base reconstruction analysis of complications and a classification scheme for defining skull base defects. 1993;119(12):1318-1325. https://doi.org/10.1001/archotol.1993.01880240054007
Yamamoto Y., Minakawa H., Kawashima K., Sugihara T., Fukuda S., Sawamura Y., Watanabe A., Nohira K. Experiencewith 24 cases of reconstructive anterior skull base surgery: classification and evaluation of postoperative facial appearance. 2000;10(2):65-70.
Pusic A.L., Chen C.M., Patel S., Cordeiro P.G., Shah J.P. Microvascular reconstruction of the skull base: a clinical approach to surgical defect classification and flap selection. 2007;17(1):5-15.
Yano T., Okazaki M., Tanaka K., Iida H., Aoyagi M., Tsunoda A., Kishimoto S. A New Concept for Classifying Skull Base Defects for Reconstructive Surgery. 2012;73(2):125-131.
Thorp B.D., Sreenath S.B., Ebert C.S., Zanation A.M. Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak. 2014;37(4):E4.
Ivan M.E., Iorgulescu J.B., El-Sayed I., McDermott M.W., Parsa A.T., Pletcher S.D., Jahangiri A., Wagner J., Aghi M.K. Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery. 2015;22(1):48-54.
Shiley S.G., Limonadi F., Delashaw J.B., Barnwell S.L., Andersen P.E., Hwang P.H., Wax M.K. Incidence, Etiology, and Management of Cerebrospinal Fluid Leaks Following Trans-Sphenoidal Surgery. 2003;113(8):1283-1288.
Carrabba G., Dehdashti A.R., Gentili F. Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach. 2008;25(6):E7.
Tabaee A., Anand V.K., Brown S.M., Lin J.W.., Schwartz TH. Algorithm for Reconstruction After Endoscopic Pituitary and Skull Base Surgery. 2007;117(7):1133-1137.
Mortuaire G., Vandeville S., Assaker R., Chevalier D. Endoscopic repair of anterior or middle skull base cerebrospinal fluid leaks after tumour resection. 2012;129(2):77-81.
Qiangyi Zhou, Zhijun Yang, Xingchao Wang, Zhenmin Wang, Chi Zhao, Shun Zhang, Peng Li, Shiwei Li, Pinan Liu. Risk Factors and Management of Intraoperative Cerebrospinal Fluid Leaks in Endoscopic Treatment of Pituitary Adenoma: Analysis of 492 Patients. 2017;101:390-395.
Stapleton A.L., Tyler-Kabara E.C., Gardner P.A., Snyderman C.H. Endoscopic Endonasal Surgery for Benign Fibro-osseous Lesions of the Pediatric Skull Base. 2015;125(9):2199-2203.
Karnezis T.T., Baker A.B., Soler Z.M., Wise S.K., Rereddy S.K., Patel Z.M., Oyesiku N.M., DelGaudio JM.., Hadjipanayis C.G.., Woodworth BA, Riley K.O., Lee J., Cusimano M.D., Govindaraj S., Psaltis A., Wormald P.J., Santoreneos S., Sindwani R., Trosman S., Stokken J.K., Woodard T.D., Recinos P.F., Vandergrift W.A., Schlosser R.J. Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery. 2016;6(11):1117-1125.
Chiman Jeon, Sang Duk Hong, Ho Jun Seol, Jung-Il Lee, Do-Hyun Nam, Yoon Jung Hwang, Doo-Sik Kong Reconstructive outcome of intraoperative cerebrospinal fluid leak after endoscopic endonasal surgery for tumors involving skull base. 2017;45:227-231.
Ari George Chacko, Gandham E. Jonathan, Sauradeep Sarkar, Georgene Singh, Sunithi Mani, Regi Thomas. A randomized controlled trial to determine the role of intraoperative lumbar cerebrospinal fluid drainage in patients undergoing endoscopic transsphenoidal surgery for pituitary adenomas. 2018;66(1):133-138.
Mohamed Hussein, Mostafa Abdellatif. Continuous Lumbar Drainage for the Prevention and Management of Perioperative Cerebrospinal Fluid Leakage. 2019;14(2):473-478.
Tilak A.M., Koehn H., Mattos J., Payne S.C. Preoperative management of spontaneous cerebrospinal fluid rhinorrhea with acetazolamide. 2019;9(3):265-269.
Hegazy H.M., Carrau R.L., Snyderman C.H., Kassam A., Zweig J. Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: A Meta-Analysis. 2000;110(7):1166-1172.