A Cadaveric Study Evaluating the Feasibility of the Amplatzer Septal Occluder for Skull Base Reconstruction in Endoscopic Endonasal Surgery: Can Occluders Offer a Viable Alternative for Skull Base Repair?

Aydin Aydoseli; Cafer Ikbal Gulsever; Duran Sahin; Irem Yaren Uysal; Mustafa Selim Sahin; Adem Tutum; Muhammed Emre Yılmaz; Ilyas Dolas; Tugrul Cem Unal

doi:10.1227/ons.0000000000001759

A Cadaveric Study Evaluating the Feasibility of the Amplatzer Septal Occluder for Skull Base Reconstruction in Endoscopic Endonasal Surgery: Can Occluders Offer a Viable Alternative for Skull Base Repair?

Oper Neurosurg. 2025 Aug 25. doi: 10.1227/ons.0000000000001759. Online ahead of print.

Authors

Aydin Aydoseli¹, Cafer Ikbal Gulsever^{1

2}, Duran Sahin¹, Irem Yaren Uysal¹, Mustafa Selim Sahin¹, Adem Tutum³, Muhammed Emre Yılmaz³, Ilyas Dolas¹, Tugrul Cem Unal¹

Affiliations

¹ Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
² Department of Neurosurgery, Hakkari State Hospital, Hakkari, Turkey.
³ Department of Forensic Medicine, Istanbul Forensic Medicine Institute, Istanbul, Turkey.

PMID: 40853148
DOI: 10.1227/ons.0000000000001759

Abstract

Background and objectives: Effective reconstruction of skull base defects after endonasal endoscopic surgery is essential to prevent complications such as cerebrospinal fluid leakage and infection. Traditional methods may not always provide optimal outcomes for certain defects. This study evaluates the feasibility of using the Amplatzer Septal Occluder (ASO) as an adjunctive tool for skull base reconstruction in a cadaveric model.

Methods: Three fresh cadavers were used to simulate endonasal endoscopic approaches for resecting skull base pathologies. Defects measuring 8 × 8 mm and 10 × 10 mm were created in the sella turcica, tuberculum sellae, planum sphenoidale, and olfactory groove. The ASO was deployed using a standard delivery system, with the distal disc positioned intracranially and the proximal disc in the nasal cavity. High-resolution endoscopic imaging and scopic views were obtained to assess the anatomic fit and functional integrity of the reconstruction.

Results: The ASO provided stable coverage for all defect sites without compressing critical neurovascular structures. The device conformed well to the irregular contours of the skull base. Functional testing using barium liquid demonstrated minimal to no leakage into the nasal cavity, suggesting the potential for a watertight seal. Imaging highlighted the ASO's feasibility as a structural component in multilayer reconstruction strategies.

Conclusion: The ASO demonstrates significant promise as a supplementary tool for skull base reconstruction in endonasal endoscopic surgery. Its incorporation into a multilayer closure strategy could improve defect stability and reduce postoperative complications. Future studies are necessary to explore device customization, bioresorbable materials, and injectable bioactive substances to evaluate outcomes before clinical implementation in humans.

Keywords: Amplatzer septal occluder; Cerebrospinal fluid leakage; Endonasal endoscopic surgery; Skull base reconstruction.