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  • Author or Editor: Arlan Mintz x
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Paul Gardner, Amin Kassam, Carl Snyderman, Arlan Mintz, Ricardo Carrau and John J. Moossy

✓ Cerebrospinal fluid (CSF) leakage following endoscopic endonasal skull base resection can be a significant problem. A method for securing tissue grafts is needed. In this paper the authors used an endonasal suturing device to secure the graft reconstruction following endonasal tumor resection.

The U-Clip anastomotic device (Medtronic), developed for cardiovascular anastomoses, was used to secure the tissue graft to native dura. A specialized needle driver and hemoclip applier were used for the application and deployment of this device. No suture tying was necessary, facilitating its endonasal application.

The graft was successfully secured in its desired position to native dura by using the U-Clip anastomotic device. The patient did not suffer a postoperative CSF leak, and postoperative imaging and endoscopy revealed that the graft was in a good position. There was no complication from the use of the device.

The U-Clip anastomotic device can be used as a suture device during endonasal surgery. It may prevent tissue graft migration and help prevent CSF leakage.

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Amin Kassam, Ajith J. Thomas, Carl Snyderman, Ricardo Carrau, Paul Gardner, Arlan Mintz, Hilal Kanaan, Michael Horowitz and Ian F. Pollack

Object

The authors reviewed their experience with endoscopic approaches to determine their safety and efficacy in the treatment of pediatric patients who harbor skull base lesions. Although they were interested in ascertaining outcomes after surgery as well as validating and defining indications and limitations of these approaches, the authors recognized that the follow-up duration was inadequate to assess long-term outcomes.

Methods

The authors conducted a retrospective review of all endoscopic procedures performed at their institution between January 2000 and September 2005. The procedures were categorized into a series of anatomical modular approaches.

Twenty-five patients 18 years of age or younger were identified. The surgical goals were individualized and included gross-total resection, partial resection, biopsy, decompression of neural structures, and repair of a cerebrospinal fluid (CSF) leak. One patient required an open procedure in addition to the expanded endonasal approach for definitive therapy. No patient suffered a neurological deficit, vascular injury, or central nervous system infection. A CSF leak was the most common complication and occurred in two (8%) of the 25 patients.

Conclusions

In well-selected patients, the expanded endonasal approach represents a safe, effective, and minimally invasive technique for the treatment of skull base lesions in children. Incremental experience is needed for acquiring the skills with endoscopic techniques to progress to the more complex modular approaches.