Document Type

Article

Publication Date

5-1-2010

Comments

This article has been peer reviewed. It is the authors' final version prior to publication in Laryngoscope Volume 120, Issue 5, May 2010, Pages 876-880. The published version is available at DOI: 10.1002/lary.20861. Copyright © Wiley InterScience

Abstract

OBJECTIVES/HYPOTHESIS: Repair of the skull base still begins with a direct repair of the dural defect. We present a new button closure for primary repair of the dura for high flow defects.

STUDY DESIGN: Retrospective review.

METHODS: We reviewed our 20 cases of primary button grafts and compared the results to the previous 20 high-flow open-cistern cerebrospinal fluid (CSF) cases. Subjects were excluded if they had no violation of the arachnoid space or potential for low-flow CSF leak. The button is constructed so that the inlay portion is at least 25% larger than the dural defect, and the onlay portion is just large enough to cover the dural defect. The two grafts are sutured together using two 4-0 Neurolon sutures and placed with the inlay portion intradurally and the onlay portion extradurally.

RESULTS: The button graft repair of open-cisternal defects had a drop in CSF leak complications to 10% (2/20), and these two leaks were repaired with the button technique as the salvage surgery. This is a significant improvement over the 45% leak rate in the prebutton graft group (P < .03). In our button graft group we used nasoseptal flaps on 16/20 repairs, and 1/2 repairs that leaked in the button group did not have a nasoseptal flap. Lumbar drains were used in approximately 38% in both groups (P = .83).

CONCLUSIONS: The button graft can be used in conjunction with the nasal septal flap or as a stand-alone repair with good results reducing the postoperative leak rate to 10% for high-flow CSF repairs.

Luginbuhl_Figure 1.ppt (4422 kB)
Figure 1.

Luginbuhl_Figure 2.ppt (4334 kB)
Figure 2.

Luginbuhl_Figure3.ppt (168 kB)
Figure 3.

Luginbuhl_Tables.doc (39 kB)
Tables

 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.