Asymmetric sliding knots for microsutures for skull base defect repair after transnasal endoscopic surgery

The advantage of asymmetrical sliding knot is that it is tightened by pulling only one «main» end of suture, while the other «wrapped» end is inserted into the wound. This method eliminates the need for additional instruments or devices to insert the knot into a narrow and deep wound. OBJECTIVE: To evaluate feasibility of asymmetrical sliding knots for microsutures in transnasal endoscopic skull base repair. MATERIAL AND METHODS: Asymmetric sliding suture was used to attach free autofascial flap to dura mater edges in 25 cases of transnasal endoscopic surgeries with intraoperative cerebrospinal fluid leakage. Craniopharyngiomas were resected in 19 cases, pituitary adenoma in 1 case, meningocele in 1 case, sinonasal carcinomas in 2 cases, chondrosarcoma in 1 case and chordoma in 1 case. RESULTS: Postoperative cerebrospinal fluid leakage was not observed in any case. CONCLUSION: We confirmed feasibility of asymmetric sliding knots to form microsutures in transnasal endoscopic skull base repair. The key technical parameters of necessary sutures, specifics of needle insertion through the dura mater and free autofascial flap, limitations and difficulties encountered by the authors are described. Sliding interrupted microsutures can be recommended to form dense layer of autologous tissues in transnasal endoscopic skull base repair.