Endonasal Suturing of Nasoseptal Flap to Nasopharyngeal Fascia Using the V-Loc™ Wound Closure Device: 2-Dimensional Operative Video

Operative Neurosurgery
Nathan T ZwagermanPaul A Gardner

Abstract

We present a case of cerebrospinal fluid (CSF) leak after endoscopic endonasal resection of a large clival chordoma in an obese patient. The leak was at the lower reconstruction at the craniocervical junction and had failed repositioning. Using the V-Loc™ wound closure device (Covidien, New Haven, Connecticut) to suture the nasoseptal flap to the nasopharyngeal fascia, a water-tight seal was created and, along with a lumbar drain, the patient healed successfully.CSF leak after an endoscopic endonasal approach (EEA) to intradural pathologies remains one of the more common complications.1-4 Various closure techniques have been developed5-8 with success in mitigating this risk, but all have their limitations and rely on multiple layers including vascularized flaps like the nasoseptal flap.9-11 Endonasal suturing of graft materials offers the advantage of creating a water-tight seal. We present the use of the V-Loc™ wound closure device (Covidien) to successfully seal a postoperative CSF leak. The absorbable V-Loc™ wound closure device does not require the surgeon to tie knots, which is the most challenging step in a deep, 2-dimensional corridor. The suture is barbed and is anchored by threading the needle through a prefabricated l...Continue Reading

References

Nov 15, 2007·American Journal of Rhinology·Ross M GermaniRoy R Casiano
Feb 5, 2009·Neurosurgery·Martina StipplerAmin B Kassam
Oct 8, 2009·American Journal of Rhinology & Allergy·Adam M ZanationAmin B Kassam
Apr 28, 2010·The Laryngoscope·Adam J LuginbuhlMarc Rosen
Nov 29, 2011·World Neurosurgery·Victor Garcia-NavarroTheodore H Schwartz
Apr 1, 2014·Journal of Neurosurgery·Maria KoutourousiouPaul A Gardner
Nov 14, 2014·Neurosurgical Focus·Maria KoutourousiouPaul A Gardner

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Citations

Jan 7, 2019·Acta Veterinaria Scandinavica·Gessica GiustoMarco Gandini
Aug 28, 2020·Frontiers in Oncology·Cathal John HannanMohsen Javadpour
Feb 16, 2020·Neurosurgical Review·Francesco BelottiFrancesco Doglietto
Mar 30, 2020·Journal of Neuro-oncology·Carl H SnydermanPaul A Gardner

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