Endoscopic Nasoseptal Flap Repair of Skull Base Defects: Is Addition of a Dural Sealant Necessary?

Abstract

Background: We compared the incidence of postoperative cerebrospinal fluid (CSF) leaks in patients undergoing endoscopic skull base repair with a pedicled nasoseptal flap (PNSF), with or without the addition of a dural sealant. Methods: A retrospective analysis of a prospective database was performed on patients who underwent endoscopic repair of high-flow CSF leaks using a PNSF between December 2008 and August 2011. Repair materials, incidence of postoperative CSF leaks, and demographic data were collected. Results: Thirty-two high-flow CSF leaks were repaired with a PNSF alone without dural sealant (Group I), and 42 were repaired with a PNSF with the addition of a dural sealant (Group II). In Group I, there were no postoperative CSF leaks (0%), whereas in Group II, there was one delayed postoperative CSF leak, resulting in a 2.4% leak rate. The incidence of postoperative CSF leakage was not significantly different between the two groups (P > 0.05). The overall postoperative CSF leak rate was 1.4% in this cohort. Conclusions: The use of dural sealants when performing endoscopic PNSF repair of high-flow CSF leaks is not supported by our data. In addition, this practice may significantly increase surgical cost. We encountered no postoperative CSF leaks in patients with high-flow CSF leaks treated with PNSF alone without dural sealants. Meticulous surgical technique and proper positioning of the PNSF seem to obviate the need for dural sealants during endoscopic skull base reconstruction of high-flow CSF leaks.