Skull Base Dural Repair Using Autologous Fat as a Dural Substitute: An Efficient Technique.

BACKGROUND: Dural repair during skull base approaches remains challenging, especially in the presence of significant defects. The autologous fat has become an alternative to various substitute materials being used previously. We report here our experience and technique for the repair of notable skull base dural defects using autologous fat as a dural substitute. METHODS: Over a period of 5 years, 71 consecutive patients operated on for skull base pathologies with an important intraoperative dural defect repaired using autologous fat tissue as replacement material were reviewed. The graft, withdrawn from the abdomen or thigh, was flattened and applied to the defect. The clinical findings and outcomes were assessed. RESULTS: Main pathologies included schwannomas (45%) and meningiomas (35.21%), with no side predilection. Surgical approaches such as transcondylar fossa, suboccipital, and frontotemporal approaches were used. Dural defects were mainly located in the posterior (73.2%) and middle cranial fossae (25.4%). No harvesting site-related complication occurred. In 7 cases, transitory subcutaneous fluid collection spontaneously resorbing after 8 days to 2 months was observed. No external cerebrospinal fluid leakage, infection, or other complication was noted during the following period. CONCLUSIONS: Dural repair can be effectively and durably achieved using autologous fat graft as a dural substitute during skull base approaches, even in cases of extended defects. The observed characteristics of the fat graft along with the achieved outcome make it an ideal dural substitute.

Safety and accuracy of spinal instrumentation surgery in a hybrid operating room with an intraoperative cone-beam computed tomography.

Although spinal instrumentation technique has undergone revolutionary progress over the past few decades, it may still carry significant surgery-related risks. The purpose of the present study was to assess the radiological accuracy of spinal screw instrumentation using a hybrid operating room (OR) and quantify the related radiation exposure. This retrospective study included 33 cases of complex spine fusion surgeries that were conducted using a hybrid OR with a flat panel detector (FPD) angiography system. Twelve cases (36.4%) were cervical, and 21 (63.6%) were thoracolumbar. The average number of spine fusion levels was 3 and 4.8, respectively, at the cervical and thoracolumbar spine levels. A FPD angiography system was used for intraoperative cone-beam computed tomography (CBCT) to obtain multi-slice spine images. All operations were conducted under optimized radiation shielding. Entrance surface doses (ESDs) and exposure times were recorded in all cases. A total of 313 screws were placed. Satisfactory screw insertion could be achieved in all cases with safe screw placement in 97.4% and acceptable placement in 2.6%. None of the cases showed any significant anatomical violation by the screws. The radiation exposure to the patients was absolutely consistent with the desired ESD value, and that to the surgeons, under the annual dose limit. These results suggest that the hybrid OR with a FPD angiography system is helpful to achieve safe and precise spinal fusion surgery, especially in complex cases.

Usefulness of the anterior transpetrosal approach for pontine cavernous malformations.

Surgical resection of pontine cavernous malformation remains a particularly formidable challenge. We report the surgical outcome of eight cases with pontine cavernous malformations operated using the anterior transpetrosal approach. All cases presented with neurological deficits caused by hemorrhage before surgery. Gross-total removal was achieved in all cases without any postoperative complication such as worsening of facial nerve palsy, ocular movement disorder, or hemiplegia. A small incision of the pons with multidirectional dissection is the most important factor for minimizing postoperative neurological deficits, so resection of a pontine cavernous malformation via this approach can be an alternative better option. The video can be found here: https://youtu.be/2Q2CUhBbo28.