Guidelines for Complications of Cancer Treatment Vol VIII Part B

Operative Techniques include:1) Endoscopic repair :(extradural repair)It is advised for discrete and definable normal pressureleaks .The key is to identify and seal the leaks with somecombination of dural graft or substitute, bone or bonesubstitute and packing.2) Open repair (Craniotomy) :This is indicated when there is extensive dehiscence ofthe skull base, or a previous endoscopic approach hasfailed.The repair can be an intradural or an extradural repair.The principles are identical to those described in theprevention of leaks.Lumbar drains are used after endoscopic and open extraduralrepairs to allow the leak to heal. They are avoided afterintradural repairs to allow raised CSF pressure to push thegraft onto the dura and promote sealing of the leak.References :1. Origitano TC, Petruzzelli GJ, Leonetti JP, et al.Combined anterior and anterolateral approaches to thecranial base: complication analysis, avoidance, andmanagement. Neurosurgery. 2006 Apr;58(4 Suppl2):ONS-327-36; discussion ONS-336-7.2. Kryzanski JT, Annino DJ Jr, Heilman CB. Complicationavoidance in the treatment of malignant tumors of theskull base. Neurosurg Focus. 2002 May 15;12(5):e11.3. Liu JK, Niazi Z, Couldwell WT. Reconstruction of theskull base after tumor resection: an overview of methods.Neurosurg Focus. 2002 May 15;12(5):4. Trivedi N P, Kuriakose M A, Iyer S. Reconstruction inskull base surgery: Review of current concepts. Ind JPlast Surg 2007; 40(12) : 52-59.250