{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:35:25Z","timestamp":1791473725074,"version":"4.3.4"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Advances in technique and instrumentation have improved outcomes after resection of anterior skull base tumors. However, cerebrospinal fluid (CSF) leak occurs in 4%-20% of patients. To reduce the risk of CSF leak, we have developed a novel reconstruction technique that consists of a 4-layered graft with patchwork suturing and hard material.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of this reconstruction technique when used for resection of anterior skull base tumors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This case series included 59 patients with anterior skull base tumors in whom the 4-layered closure technique was used. The main outcome measures were complications, including CSF leak, meningitis, postoperative bleeding, and infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>There were no CSF leak cases or serious complications after closure of the anterior skull base using the 4-layered technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>Closure of the anterior skull base in 4 layers prevented CSF leak and was not associated with any serious complications. However, further studies in larger numbers of patients are needed to confirm our outcomes using this closure method.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1227\/ons.0000000000000013","type":"journal-article","created":{"date-parts":[[2021,12,14]],"date-time":"2021-12-14T16:00:21Z","timestamp":1639497621000},"page":"e1-e6","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":12,"title":["Optimal Multiple-Layered Anterior Skull Base Reconstruction Using a 360\u00b0 Suturing Technique"],"prefix":"10.1227","volume":"22","author":[{"given":"Kazuhiro","family":"Omura","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, The Jikei University School of Medicine, Tokyo, Japan;"},{"name":"Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6425-4574","authenticated-orcid":false,"given":"Kazuhiro","family":"Nomura","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudo","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Aoki","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teppei","family":"Takeda","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, The Jikei University School of Medicine, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Tochigi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyoshi","family":"Otori","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, The Jikei University School of Medicine, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromi","family":"Kojima","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, The Jikei University School of Medicine, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,11,29]]},"reference":[{"key":"R1-20250821","doi-asserted-by":"crossref","first-page":"e436","DOI":"10.1016\/j.wneu.2018.04.225","article-title":"Endoscopic endonasal reconstruction of anterior skull base defects: what factors really affect the outcomes?","volume":"116","author":"Turri-Zanoni","year":"2018","journal-title":"World Neurosurg."},{"key":"R2-20250821","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.wneu.2020.04.089","article-title":"Endoscopic anterior skull base reconstruction: a meta-analysis and systematic review of graft type","volume":"139","author":"Abiri","year":"2020","journal-title":"World 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A prospective, randomized controlled trial","volume":"131","author":"Zwagerman","year":"2019","journal-title":"J Neurosurg."},{"issue":"3","key":"R10-20250821","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s11060-020-03465-0","article-title":"Reconstruction after endoscopic surgery for skull base malignancies","volume":"150","author":"Snyderman","year":"2020","journal-title":"J Neurooncol."},{"issue":"5 suppl 2","key":"R11-20250821","first-page":"ONSE342","article-title":"\u201cGasket-seal\u201d watertight closure in minimal-access endoscopic cranial base surgery","volume":"62","author":"Leng","year":"2008","journal-title":"Neurosurgery."},{"issue":"7","key":"R12-20250821","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1007\/s00405-020-05911-1","article-title":"Reconstruction of skull base bone defects using an in situ bone flap after endoscopic endonasal transplanum-transtuberculum approaches","volume":"277","author":"Jin","year":"2020","journal-title":"Eur Arch Otorhinolaryngol."},{"issue":"3","key":"R13-20250821","doi-asserted-by":"crossref","first-page":"861","DOI":"10.3171\/2017.11.JNS172141","article-title":"Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients","volume":"130","author":"Conger","year":"2019","journal-title":"J Neurosurg."},{"issue":"6","key":"R14-20250821","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1007\/s00276-015-1610-9","article-title":"A unilateral septal flap based on the anterior ethmoidal artery (Castelnuovo\u2019s flap): CT cadaver study","volume":"38","author":"Gras-Cabrerizo","year":"2016","journal-title":"Surg Radiol Anat."},{"issue":"3","key":"R15-20250821","doi-asserted-by":"crossref","first-page":"194","DOI":"10.14639\/0392-100X-748","article-title":"Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes","volume":"36","author":"Battaglia","year":"2016","journal-title":"Acta Otorhinolaryngol Ital."},{"key":"R16-20250821","doi-asserted-by":"crossref","first-page":"e409","DOI":"10.1016\/j.wneu.2019.04.166","article-title":"Septal flip flap for anterior skull base reconstruction after endoscopic transnasal craniectomy: long-term outcomes","volume":"128","author":"Bozkurt","year":"2019","journal-title":"World Neurosurg."},{"issue":"8","key":"R17-20250821","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1002\/alr.22122","article-title":"Lacrimal sac exposure and a superior lateral anterior pedicle flap to improve outcomes of Draf type II and III procedures","volume":"8","author":"Omura","year":"2018","journal-title":"Int Forum Allergy Rhinol."},{"issue":"4","key":"R18-20250821","doi-asserted-by":"crossref","first-page":"e350","DOI":"10.1097\/SCS.0000000000005407","article-title":"Effect of a superior lateral anterior pedicle flap for Draf procedures","volume":"30","author":"Omura","year":"2019","journal-title":"J Craniofac Surg."}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1227\/ONS.0000000000000013","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:02:22Z","timestamp":1786122142000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1227\/ONS.0000000000000013"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,29]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1227\/ons.0000000000000013","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,29]]},"assertion":[{"value":"2021-04-30","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-24","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}