“Parachute” Technique for Reconstruction of Small Skull Base Defects of the Ventral Skull Base

Cerebrospinal fluid (CSF) rhinorrhea is a consequence of a breakdown of the layers of the arachnoid membrane, dura matter, the bony skull base and periosteum, and the nasalmucosa. In the past few years, several endoscopic techniques have been described to close ventral skull base CSF leaks. These include local pedicled flaps (e.g., nasoseptal flap, turbinates), regional pedicled flaps (e.g., pericranium, fascia temporalis), free grafts (e.g., abdominal fat, fascia lata), microanastomosed free flaps, as well as synthetic grafts. Nowadays, most authors use multiple-layer reconstruction by combining these techniques to improve the success rate of endoscopic skull base reconstruction. The choice of skull base reconstruction technique depends on the location and the size of the defect, as well as intracranial pressure. The graft can be placed in the extracranial or extradural spaces that are often used, or in the intradural space, which is technically more demanding. In cases of small-size CSF leaks, we propose a new surgical technique, with a good success rate, that allows centering the intradural graft adequately on the defect. This “parachute” placement can be used with both autologous free grafts and synthetic materials.