Closure of small skull base defects with muscle plug napkin ring technique: how I do it

Background Defects through the skull base into the paranasal sinuses can occur during anterior skull base procedures, risking cerebrospinal fluid leak and infection if not repaired. Methods We describe a muscle plug napkin ring technique for closure of small skull base defects, wherein a free muscle...

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Bibliographic Details
Published in:Acta neurochirurgica 2023-08, Vol.165 (8), p.2321-2325
Main Authors: Salah, Walid K., Rennert, Robert C., Mortimer, Vance, Couldwell, William T.
Format: Article
Language:English
Subjects:
Carotid arteries
Cerebrospinal fluid
Cerebrospinal Fluid Leak - diagnostic imaging
Cerebrospinal Fluid Leak - etiology
Cerebrospinal Fluid Leak - surgery
Defects
Edema
Endoscopy - methods
Female
Fibrin
How I Do it
Humans
Infections
Interventional Radiology
Magnetic resonance imaging
Medicine
Medicine & Public Health
Meningeal Neoplasms - diagnostic imaging
Meningeal Neoplasms - surgery
Meningioma
Meningioma - diagnostic imaging
Meningioma - surgery
Middle Aged
Minimally Invasive Surgery
Muscles - surgery
Neurology
Neuroradiology
Neurosurgery
Optic nerve
Paranasal sinus
Plastic Surgery Procedures
Sinuses
Skull
Skull Base - diagnostic imaging
Skull Base - surgery
Surgical Orthopedics
Tomography
Tumor – Meningioma
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Summary:Background Defects through the skull base into the paranasal sinuses can occur during anterior skull base procedures, risking cerebrospinal fluid leak and infection if not repaired. Methods We describe a muscle plug napkin ring technique for closure of small skull base defects, wherein a free muscle graft slightly bigger than the defect is packed tightly in the defect, half extracranially and half intracranially and sealed with fibrin glue. The technique is illustrated in the case of a 58-year-old woman with a large left medial sphenoid wing/clinoidal meningioma. Conclusions The muscle plug napkin ring technique is a simple solution to small skull base defects.
ISSN:0942-0940
0001-6268
0942-0940
DOI:10.1007/s00701-023-05631-5