A Novel Technique for Endoscopic Repair of Large Anterior Skull Base Defects: The PDS Wrap

Background Endoscopic skull base surgery continues to push boundaries with increased complexity of work and subsequently larger defects requiring repair. Robust repair following endoscopic skull base surgery is essential to reduce significant postoperative complications such as cerebrospinal fluid leak, meningitis, and pneumocephalus. Objective To describe and further validate our novel technique of using a polydioxanone plate wrap used in large anterior skull base resections where brain herniation can be of concern. Method After large resections where there is obvious brain herniation, our PDS (polydioxanone) wrap can be deployed to provide rigid support to the brain. The PDS plate is wrapped in a dural graft material and sutured closed in order to allow deployment by releasing the sutures when in position under the bony ridge of the defect. Conclusion Till date we have successfully used this technique in 3 patients following large skull base resections of olfactory meningiomas, where there was herniation of the brain. Postoperatively, there was no evidence of cerebrospinal fluid leak. We therefore recommend the use of the PDS wrap to prevent brain herniation and provide additional support to the repair.