Comparison of two novel options for resuspension of inverted U-shaped nasopharyngeal flap following endonasal access to craniovertebral junction - Pilot cadaveric analysis and illustrative case report

Sep 30, 2026

Uploaded by Ivy

Suturing within the narrow endonasal corridor remains technically demanding, particularly for inverted U-shaped nasopharyngeal flap (IUNF) harvest used to expose the cranio-cervical junction. This pilot cadaveric study evaluates two innovative approaches to support meticulous flap resuspension: barbed suture with running mucosal technique and the Durastat dural repair device for interrupted mucosal suturing, avoiding knot tying and endonasal needle driver/supination. Across three cadaveric heads, both methods achieved adequate IUNF resuspension (3/3), with measured repair time and subjective assessment of precision. Results suggest the Durastat system may offer greater optimization potential if technical modification increases needle size and spring torque.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Introduction

Materials and methods

Neurosurgical Review (2026) 49:115 [https://doi.org/10.1007/s10143-025-04068-x](https://doi.org/10.1007/s10143-025-04068-x) RESEARCH Comparison of two novel options for resuspension of inverted U-shaped nasopharyngeal flap following endonasal access to craniovertebral junction: Pilot cadaveric analysis and illustrative case report Beatrice Zucca1,4 · Marissa Koscielski2 · John Na2 · Andrea de Gregorio3,4 · Ian Smith2 · Joel Kaye4 · Ahmad R. Sedaghat5 · Samer Hoz4 · Charles J. Prestigiacomo4 · Rani M. Nasser4 · Justin N. Virojanapa4 · Norberto O. Andaluz4 · Katie M. Phillips5 · Jonathan A. Forbes4 Received: 22 August 2025 / Revised: 9 December 2025 / Accepted: 14 December 2025 © The Author(s) 2026 Abstract Suturing in the narrow endonasal corridor can be technically challenging. For some endonasal procedures, including inverted U-shaped nasopharyngeal flap (IUNF) harvest for cranio-cervical junction exposure, the ability to support meticulous flap resuspension offers clinical utility. Two novel suturing techniques offer promise: (1) use of barbed suture and (2) Durastat dural repair device, obviating the need for knot tying and endonasal needle driver/supination, respectively. Perform subjective and objective evaluation of IUNF resuspension with: (1) running mucosal suturing using endonasal needle driver and barbed, loop suture and (2) interrupted mucosal suturing using the Durastat device in 3 cadaveric heads. AIUNF was created and subsequently resuspended, (1) using a 3-0 monocryl barbed Stratafix with loop and endonasal needle driver. After Stratafix suture removal,(2) resuspension using interrupted sutures with the Durastat, spring loaded device was performed. Repair time was measured objectively. Suture precision was subjectively evaluated. Adequate IUNF resuspension was provided by both methods (3/3) . The barbed suture required more procedural time on average (18:59 minutes), than the Durastat system (18:35 minutes) . The small Durastat needle often failed to puncture the mucosal flap using spring mechanism alone, indicating that technical modification to increase needle size and spring torque could improve performance. Adequate mucosal resuspension was achieved in all specimens. Stratafix offered greater consistency with needle puncture and similar precision but was more technically challenging compared to the Durastat system. With appropriate technological modifications, the authors believe the Durastat system has greater potential to optimize IUNF resuspension. Keywords Endonasal · Endoscopic · Flap resuspension · Endonasal suturing · Barbed loop suture · Durastat system. 􀀍 Jonathan A. Forbes [forbesjh@ucmail.uc.edu](forbesjh@ucmail.uc.edu) 1 Alma Mater Studiorum-University of Bologna, Bologna, Italy 2 University of Cincinnati College of Medicine, Cincinnati, OH, USA 3 Università di Milano, Milano, Italy 4 Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA 5 Department of Otolaryngology, University of Cincinnati Medical Center, Cincinnati, OH, USA Introduction Endonasal exposure of the anterior C1 ring and ventral cranio-cervical junction (CVJ) has undergone marked evolution throughout the past 30 years [1–4] . Early reports of transnasal odontoidectomy involved resection of ventral nasopharyngeal tissue for CVJ exposure—relying on secondary intention for subsequent mucosal healing [5] . In ensuing years, adoption of a midline incision in the posterior nasopharyngeal tissue became increasingly common, although limitations with visualization were noted by some authors [6] . More recently, an inverted U-shaped nasopharyngeal incision has been introduced to provide more optimal visualization of the ventral CVJ [7] . However, in 1 3 comparison to the limited midline nasopharyngeal incision, the inverted U-shaped nasopharyngeal incision is at greater risk of mucosal retraction and incisional diastasis resulting in delayed sinonasal healing. In th

FAQs

Why is flap resuspension technically challenging in endonasal procedures?

Suturing in the narrow endonasal corridor is difficult, and for inverted U-shaped nasopharyngeal flap work, maintaining precise mucosal apposition through a long, narrow corridor is particularly demanding.

What two novel techniques are compared for IUNF resuspension?

The study compares (1) running mucosal suturing using barbed loop suture with an endonasal needle driver and (2) interrupted mucosal suturing using the Durastat spring-loaded device.

How did the two techniques perform in cadaveric specimens?

Both approaches provided adequate IUNF resuspension in all specimens (3/3). Barbed suturing required slightly more average procedural time, and the Durastat system showed occasional difficulty puncturing the mucosal flap without technical adjustments.

Sep 30, 2026

Uploaded by Ivy