Evaluating the Feasibility of the Amplatzer Septal Occluder for Skull Base Reconstruction in Endoscopic Endonasal Surgery: A Cadaveric Study

Introduction: Effective reconstruction of skull base defects following endonasal endoscopic surgery is crucial to prevent complications such as cerebrospinal fluid (CSF) leakage and infection. Traditional techniques may be insufficient for large or complex defects. This study evaluates the feasibility of using the Amplatzer Septal Occluder (ASD) as an adjunctive tool for skull base reconstruction in a cadaveric model.

Methods: Two fresh cadavers were used to simulate endonasal endoscopic approaches for resecting pathologies such as pituitary adenomas and meningiomas. Two defects, measuring 10 x 10 mm, were created in the sella turcica and planum sphenoidale. The ASD was deployed using the standard intravascular delivery system, with the distal disc positioned intracranially and the proximal disc in the nasal cavity. High-resolution endoscopic images and external views were used to evaluate the anatomical fit and coverage of the device.

Results: The ASD provided stable and effective coverage of the defects without compressing critical neurovascular structures. The device conformed well to the irregular contours of the skull base, and its placement was successfully documented through imaging. The anatomical fit demonstrated the potential utility of ASD as part of a multilayer reconstruction strategy.

Conclusion : The Amplatzer Septal Occluder shows promise as a supplementary tool for skull base reconstruction in endonasal endoscopic surgery. Its integration into a comprehensive, multilayer closure strategy could enhance stability and reduce postoperative complications. Future research should explore the development of customized devices with bioresorbable materials and the use of injectable bioactive substances to optimize outcomes in clinical settings.