BACKGROUND Skull base reconstruction after extended endoscopic endonasal approaches (EEAs) can be challenging. In addition to the nasoseptal flap, which has been adopted by most centers, autologous fascia lata is also often utilized. Harvesting of fascia lata requires a separate thigh incision, may prolong recovery, and results in a visible scar. In principal, the use of non-autologous materials would be preferable to avoid a second incision and maintain the minimally invasive nature of the approach, assuming the CSF leak rate is not compromised. OBJECTIVE To assess the efficacy of acellular dermal matrix (ADM) as a non-autologous alternative to autologous fascia lata graft for watertight closure of the cranial base following EEAs. METHODS A retrospective chart review of extended EEAs performed before and after the transition from fascia lata to ADM was performed. Cases were frequency matched for approach, pathology, BMI, use of lumbar drainage, and tumor volume. Power analysis was performed to estimate the sample size needed to demonstrate non-inferiority. RESULTS ADM was used for watertight closure of the cranial base in 19 consecutive extended endoscopic endonasal approaches (16 gasket-seals and 3 buttons) with 1 postoperative CSF leak at the last follow-up (median 5.3, range 1.0-12.6 months). All patients had high-flow intraoperative leaks. The cohort included 8 meningiomas, 8 craniopharyngiomas, 2 chordomas, and 1 pituicytoma ranging in size from 0.2 to 37.2cm3 (median 5.5, IQR 2.8-13.3 cm3). In 19 historical controls who received fascia lata, there were 2 postoperative CSF leaks. CONCLUSIONS Preliminary results suggest that ADM provides a non-inferior non-autologous alternative to fascia lata for watertight gasket-seal and button closures following extended EEAs, potentially reducing or eliminating the need to harvest autologous tissue.

中文翻译：

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脱细胞真皮基质作为自体阔筋膜的替代物，用于扩展内窥镜鼻内入路后的颅底修复。

背景技术扩展内窥镜鼻内入路（EEA）后的颅底重建可能具有挑战性。除了大多数中心采用的鼻中隔皮瓣外，还经常使用自体阔筋膜。收割阔筋膜需要单独的大腿切口，可能会延长恢复时间，并导致可见疤痕。原则上，假设 CSF 泄漏率没有受到影响，使用非自体材料将更可取，以避免第二次切口并保持该方法的微创性质。目的 评估脱细胞真皮基质 (ADM) 作为自体阔筋膜移植物的非自体替代物，用于 EEA 后颅底水密闭合的功效。方法 对从阔筋膜过渡到 ADM 之前和之后进行的扩展 EEA 进行了回顾性图表审查。病例在方法、病理、BMI、腰椎引流的使用和肿瘤体积方面进行频率匹配。进行功效分析以估计证明非劣效性所需的样本量。结果 ADM 用于连续 19 次延长的内窥镜鼻内入路（16 个垫圈密封和 3 个按钮）中的颅底水密闭合，在最后一次随访时有 1 次术后脑脊液漏（中位数 5.3，范围 1.0-12.6 个月）。所有患者都有高流量术中漏。该队列包括 8 个脑膜瘤、8 个颅咽管瘤、2 个脊索瘤和 1 个垂体细胞瘤，大小范围为 0.2 至 37.2 cm3（中位数 5.5，IQR 2.8-13.3 cm3）。在接受阔筋膜的 19 位历史对照中，术后有 2 次脑脊液漏。结论 初步结果表明，ADM 提供了一种非劣质非自体筋膜替代品，用于延长 EEA 后的防水垫圈密封和纽扣闭合，可能减少或消除采集自体组织的需要。