TY - JOUR
T1 - Subgaleal retention sutures
T2 - Internal pressure dressing technique for Dolenc approach
AU - Burrows, Anthony M.
AU - Rayan, Tarek
AU - Van Gompel, Jamie J.
N1 - Publisher Copyright:
© 2017 by the Congress of Neurological Surgeons.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - BACKGROUND: Extradural approach to the cavernous sinus, the "Dolenc"approach recognizing its developing Dr. Vinko Dolenc, is a critically important skull base approach. However, resection of the lateralwall of the cavernous sinus,most commonly for cavernous sinus meningiomas, results commonly in a defect that often cannot be reconstructed in a water-tight fashion. This may result in troublesome pseudomeningocele postoperatively. OBJECTIVE: To describe a technique designed to mitigate the development of pseudomeningocele. METHODS: We found the Dolenc approach critical for resection of cavernous lesions. However, a number of pseudomeningoceles were managed with prolonged external pressure wrapping in the early cohort. Therefore, we incorporated subgaleal to muscular sutures, which were designed to close this potential space and retrospectively analyzed our results. RESULTS: Twenty-one patients treated with a Dolenc approach and resection of the lateral wall of the cavernous sinus over a 2-year period were included. Prior to incorporation of this technique, 12 patients were treated and 3 (25%) experienced postoperative pseudomeningoceles requiring multiple clinic visits and frequent dressing. After incorporation of subgaleal retention sutures, no patient (0%) experienced this complication. CONCLUSION: Although basic, subgaleal to temporalis muscle retention sutures likely aid in eliminating this potential dead space, thereby preventing patient distress postoperatively. This technique is simple and further emphasizes the importance of dead space elimination in complex closures.
AB - BACKGROUND: Extradural approach to the cavernous sinus, the "Dolenc"approach recognizing its developing Dr. Vinko Dolenc, is a critically important skull base approach. However, resection of the lateralwall of the cavernous sinus,most commonly for cavernous sinus meningiomas, results commonly in a defect that often cannot be reconstructed in a water-tight fashion. This may result in troublesome pseudomeningocele postoperatively. OBJECTIVE: To describe a technique designed to mitigate the development of pseudomeningocele. METHODS: We found the Dolenc approach critical for resection of cavernous lesions. However, a number of pseudomeningoceles were managed with prolonged external pressure wrapping in the early cohort. Therefore, we incorporated subgaleal to muscular sutures, which were designed to close this potential space and retrospectively analyzed our results. RESULTS: Twenty-one patients treated with a Dolenc approach and resection of the lateral wall of the cavernous sinus over a 2-year period were included. Prior to incorporation of this technique, 12 patients were treated and 3 (25%) experienced postoperative pseudomeningoceles requiring multiple clinic visits and frequent dressing. After incorporation of subgaleal retention sutures, no patient (0%) experienced this complication. CONCLUSION: Although basic, subgaleal to temporalis muscle retention sutures likely aid in eliminating this potential dead space, thereby preventing patient distress postoperatively. This technique is simple and further emphasizes the importance of dead space elimination in complex closures.
KW - Cavernous sinus surgery
KW - Pseudomeningoceole
KW - Skull base surgery
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U2 - 10.1093/ons/opw044
DO - 10.1093/ons/opw044
M3 - Article
C2 - 28838106
AN - SCOPUS:85028985163
SN - 2332-4252
VL - 13
SP - 448
EP - 452
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 4
ER -