The Use of Dehydrated Amniotic Membrane Allograft for the Augmentation of Dural Repair in Craniotomies

Human Amniotic Membrane for Dural Repair and Duraplasty: A Systematic Review of Safety and Efficacy

The use of human amniotic membrane (HAM) has recently gained attention as a promising alternative option for duraplasty due to its superior tensile strength, elasticity, and anti-inflammatory and anti-fibrotic properties, offering greater durability and reliability compared to autologous grafts like the muscle fascia and pericranium. This systematic review aimed to evaluate the complications associated with duraplasty using HAM. We comprehensively searched the PubMed, Scopus, and Web of Science databases for studies on duraplasty with HAM. The eligibility criteria included studies on patients who underwent dural repair with duraplasty using HAM, with or without a control group. Duraplasty involves opening the dura mater, the protective covering of the brain and spinal cord, and using a graft to enlarge the space around the cerebellum. Dual repair, on the other hand, involves repairing the dura mater without opening it and then using a patch to enlarge the space around the cerebellum. Randomized controlled trials, observational studies, case series, and case reports were included, and quality assessment was conducted. Our search yielded 191 articles. Ten studies were included, with a total of 560 participants. The overall incidence of cerebrospinal fluid (CSF) leakage was three (0.63%) out of 478 in the HAM group and three (4.76%) out of 63 in the other methods group (pericranium, temporalis fascia, and biological dural substitutes). Regarding the incidence of postoperative complications, the overall incidence was eight (1.92%) out of 417 in the HAM group and two (8%) out of 25 in the other methods group. The overall incidence of meningitis was one (0.67%) out of 150 in the HAM group and three (10%) out of 30 in the other methods group. In conclusion, duraplasty using HAM may be a safe and effective alternative to traditional methods, with a low incidence of CSF leakage and postoperative complications.

Conservative Management of Post-Operative Cerebrospinal Fluid Leak following Skull Base Surgery: A Pilot Study

Background/aims: Iatrogenic CSF leaks after endoscopic endonasal transsphenoidal surgery remain a challenging entity to manage, typically treated with CSF diversion via lumbar drainage. Objective: To assess the safety and efficacy of high-volume lumbar puncture (LP) and acetazolamide therapy to manage iatrogenic CSF leaks. Methods: We performed a prospective pilot study of four patients who developed iatrogenic postoperative CSF leaks after transsphenoidal surgery and analyzed their response to treatment with concomitant high-volume lumbar puncture followed by acetazolamide therapy for 10 days. Data collected included demographics, intra-operative findings, including methodology of skull base repair and type of CSF leak, time to presentation with CSF leak, complications associated with high-volume LP and acetazolamide treatment, and length of follow-up. Results: Mean patient age was 44.28 years, with an average BMI of 27.4. Mean time from surgery to onset of CSF leak was 7.71 days. All four patients had resolution of their CSF leak at two- and four-week follow-up. Mean overall follow-up time was 179 days, with a 100% CSF leak cure rate at the last clinic visit. No patient suffered perioperative complications or complications secondary to treatment. Conclusion: Although our pilot case series is small, we demonstrate that a high-volume LP, followed by acetazolamide therapy for 10 days, can be considered in the management of post-operative CSF leaks.

The use of dehydrated amniotic membrane allograft for augmentation of dural repair in transsphenoidal endoscopic endonasal resection of pituitary adenomas

BACKGROUND

In transsphenoidal endoscopic endonasal surgery (TEES), watertight separation of the sinonasal cavity and intracranial compartment is the primary goal of closure. However, even when meticulous closure technique is implemented, cerebrospinal fluid (CSF) leaks, dural scarring, and meningitis may result. Particularly when intraoperative CSF leak occurs, materials that facilitate the creation of a watertight seal that inhibits disease transition and minimizes inflammatory response after durotomy are sought. Dehydrated amniotic membrane (DAM) allograft appears to confer these attributes as studies have shown it augments epithelialization, facilitates wound healing, and minimizes and impedes bacterial growth. We detail the use of DAM allograft to augment sellar closures after TEES.

METHODS

We conducted a feasibility study, retrospectively reviewing our institution's database of TEES for resection of pituitary adenomas in which DAM was utilized to supplement sellar closure.

RESULTS

One hundred twenty transsphenoidal surgery cases with DAM were used during sellar closure, with a 49.2% intraoperative CSF leak rate. Of this cohort, two patients experienced postoperative CSF leak (1.7%), and no patients developed meningitis. CSF leak rate for TEES-naïve patients was 0.9%.

CONCLUSIONS

This feasibility study demonstrates that dehydrated amniotic membrane allograft can be safely utilized as an adjunct during sellar closures for TEES for pituitary adenoma resection with very low rates of CSF leak and meningitis.

Nasoethmoid Schwannoma with Intracranial Extension: A Case Report and Comprehensive Review of the Literature

We describe all cases of nasoethmoid schwannomas with intracranial extension reported in the literature, including an original case report describing the successful gross total resection of a nasoethmoid schwannoma with intracranial extension. Ten cases of nasoethmoid schwannoma with intracranial extension have previously been reported. These lesions most often appear in the second through fourth decades of life and commonly present with anosmia, headache, and visual deficits. Bifrontal craniotomy was the predominantly implemented surgical approach and gross total resection was achieved in all cases, except for one. In conclusion, nasoethmoid schwannoma with intracranial extension is a rare disease entity that is most often benign and is most commonly treated by gross total resection using a bifrontal craniotomy approach.