2026 Poster Presentations
P236: EXPERIMENTAL EVALUATION OF SOFT GASKET SEAL RECONSTRUCTION IN DURAL DEFECT MODELS: ANTERIOR AND POSTERIOR FOSSA SIMULATIONS
Rodrigo Delpino Gehrke, MD1; Federico Valeri, MD2; Je Beom Hong, MD2; Kara A. Parikh, MD2; Moataz D. Abouammo, MD1; Francis Lorraine-Miller, MD1; Yongli Wang, MD1; Rebecca Leme Gallardo, MD1; James Mamaril-Davis, MD2; Christen O'Neal Swann, MD2; Ricardo L. Carrau, MD, MBA1; Daniel M. Prevedello, MD2; 1Department of Otolaryngology/Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; 2Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
Introduction: Cerebrospinal fluid (CSF) leakage is a critical complication following skull base surgery, particularly in procedures involving dural defects of considerable size or posterior fossa exposure. While soft gasket seal reconstruction has been proposed as a repair method, its efficacy has not been systematically evaluated. The present study aimed to investigate the leakage-preventing effect of soft gasket seal reconstruction using experimental dural defect models simulating anterior and posterior fossa conditions.
Methods: Standardized dural defects ranging from 5 to 30 mm in diameter were created in experimental models. Two reconstruction strategies were compared: conventional inlay graft and soft gasket seal. To reproduce anatomical differences, the defect surfaces were placed either horizontally or in a tilted orientation, corresponding to anterior and posterior fossa simulations. For each condition, leakage was quantified by measuring the volume of fluid (mL) collected over a 30-second interval, and the the total volume of leakage and flow rates (mL/min) were analyzed.
Results: Leakage volume increased with defect size across all models. Inlay grafts provided insufficient resistance in larger defects, with outflow volumes exceeding measurable limits (>200 mL/30s, >400 mL/min) at diameters ≥25 mm under both orientations. In contrast, soft gasket seal reconstruction consistently reduced leakage under all experimental conditions. The protective effect was most pronounced in medium-sized defects, where gasket seal reconstruction delayed the onset of uncontrolled outflow. Orientation influenced leakage primarily in small defects, with tilted positioning producing greater leakage compared to the flat condition. In larger defects, the effect of size predominated, and positional differences were minimal. The protective benefit of soft gasket seal reconstruction was reproducible in both anterior and posterior fossa simulations.
Conclusion: This simulation-based study demonstrated that soft gasket seal reconstruction provided greater resistance to CSF leakage compared with inlay grafts across a range of defect sizes. The gasket seal technique effectively reduced leakage and maintained protective efficacy in both anterior and posterior fossa conditions. These findings support the utility of soft gasket seal reconstruction as a reliable strategy for dural defect repair in skull base surgery.
