Clival dural reconstruction via transnasal approaches:fat graft fixation technique

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dc.authorscopusidAbuzer Güngör / 54895233300
dc.authorwosidAbuzer Güngör / F-4189-2019
dc.contributor.authorLuzzi, Sabino
dc.contributor.authorDoğruel, Yücel
dc.contributor.authorGüngör, Abuzer
dc.contributor.authorGürses, Muhammet Enes
dc.contributor.authorRahmanov, Serdar
dc.contributor.authorTüre, Hatice
dc.contributor.authorTüre, Uğur
dc.date.accessioned2025-04-18T08:54:20Z
dc.date.available2025-04-18T08:54:20Z
dc.date.issued2025
dc.departmentİstinye Üniversitesi, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü
dc.description.abstractOBJECTIVE CSF fistulas are the weak spots of transnasal endoscopic and microsurgical skull base approaches. An autologous fat graft is considered the best substrate for clival dural reconstruction via transnasal approaches. However, potential gravitational displacement of the graft may result in CSF leakage. The authors have developed and described herein the fat graft fixation (FGF) technique to secure the fat graft against dislocation after transclival resection of chor- domas invading the dura. METHODS Seventy-five patients with cranial chordomas underwent surgical treatment at the authors’ institution from September 2006 through June 2023. Of these, the authors collected demographic, clinical, radiological, surgical, and outcome data from 34 patients who underwent an endoscope-assisted microsurgical transclival approach via a transna- sal, sublabial, or sublabial transmaxillary extended corridor. The FGF reconstruction technique was progressively imple- mented to improve clival reconstruction, with a focus on the results. With a custom-made 8-mm 3/8 round atraumatic surgical suture needle, a 4/0 Vicryl stitch was placed through the adjacent dural borders. An abdominal autologous fat graft was then placed over the dural defect. One triple knot was tied to secure the graft and prevent its delayed gravita- tional displacement. The primary outcome was to determine if the FGF group had a higher rate of early or late oronasal CSF fistula compared to the unlocked free graft group. Secondary outcomes included tension pneumocephalus, surgical site infection, and meningitis. RESULTS The fat graft was not used in 8 (23.5%) of the 34 patients because the dura was intraoperatively intact. The unlocked free graft and FGF techniques were used in 20 (58.8%) and 6 (17.6%) patients, respectively. Of the 34 patients, no fistulas were observed in the group treated with the FGF technique, while 4 fistulas were found in the unlocked free graft group (p < 0.05), with 2 of these cases involving meningitis. Patients with a CSF fistula underwent a total of 7 surgi- cal procedures: 3 revision surgical procedures, 2 lumboperitoneal shunts, and 2 ventriculoperitoneal shunts. CONCLUSIONS In the authors’ preliminary experience, the FGF technique has shown promise in eliminating the risk of CSF fistula and other related complications after the transclival approach for clival chordomas involving the dura.https://thejns.org/doi/abs/10.3171/2024.11.FOCUS24560 ©AANS 2025, except where prohibited by US copyright law.
dc.identifier.citationLuzzi, S., Doğruel, Y., Güngör, A., Gurses, M. E., Rahmanov, S., Türe, H., & Türe, U. (2025). Clival dural reconstruction via transnasal approaches: fat graft fixation technique. Neurosurgical Focus, 58(2), E4.
dc.identifier.doi10.3171/2024.11.FOCUS24560
dc.identifier.endpageE4
dc.identifier.issn10920684
dc.identifier.issue2
dc.identifier.pmid39891933
dc.identifier.scopus2-s2.0-85217116966
dc.identifier.scopusqualityQ1
dc.identifier.startpageE4
dc.identifier.urihttp://dx.doi.org/10.3171/2024.11.FOCUS24560
dc.identifier.urihttps://hdl.handle.net/20.500.12713/6634
dc.identifier.volume58
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.institutionauthorGüngör, Abuzer
dc.institutionauthoridAbuzer Güngör / 0000-0002-2792-7610
dc.language.isoen
dc.publisherAmerican Association of Neurological Surgeons
dc.relation.ispartofNeurosurgical Focus
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.subjectAutologous Fat Graft
dc.subjectCerebrospinal Fluid Fistula
dc.subjectChordomas
dc.subjectClival Dural Reconstruction
dc.subjectFat Graft Fixation
dc.subjectTransnasal Approach
dc.titleClival dural reconstruction via transnasal approaches:fat graft fixation technique
dc.typeArticle

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