BACKGROUND : The expanded endoscopic endonasal approach (EEA) is currently well-accepted for a variety of ventral skull base tumors. Such approach often results in a trans-dural defect and intraoperative cerebrospinal fluid (CSF) leak and adequate reconstruction is necessary to prevent postoperative CSF leak and its complications. Reconstruction is usually performed utilizing a variety of materials along with the nasoseptal flap (NSF).

OBJECTIVE : This work's aim is to describe a new reconstructive technique called 'Soft Gasket Seal' (SGS) in detail and compare it with the standard reconstructive technique at our institution for craniopharyngiomas operated via transtuberculum EEA.

METHODS : A retrospective chart review was achieved to identify patients who underwent transtubercular EEA for craniopharyngioma between 2010 and 2018, by the same neurosurgical and otolaryngology team using either the SGS or the standard reconstructive technique.

RESULTS : Of 36 patients who met criteria and were considered for analysis, 15 patients underwent the Soft Gasket Seal reconstruction and 21, the standard reconstruction. There were 16 female (44%) and 20 male (56%) patients. The median age was 42.2±20.9 years. The rate of postoperative CSF leak in the group of patients treated with the standard technique was 14.2%, and 6.6% in the SGS group (OR 0.43 [CI 95% 0.007 - 6.15, p = 0.62).

CONCLUSION : The SGS technique provides a simple reconstructive technique in conjunction with the NSF, showing a tendency of lower complications when compared to our standard technique, while avoiding donor site morbidity. Such results are encouraging, but further studies are necessary to confirm these findings.