Prevention and Treatment of CSF Leakage at Skull Base Surgery

Abstract

Introduction: CSF leak is a dangerous complication of skull base surgery. The aim of our study is prevention of CSF leakage for skull base surgery. Methods: The experimental part of the research was carried out on 50 rabbits. Fat and fascial grafts were compared for dural reconstruction. On the 3d, 7th, and 14th days postoperatively, the strength and watertightness of the dural repair were tested, then a histomorphological study was conducted. The clinical part of the research included 219 patients with anterocentral (54 patients) and posterolateral (165 patients) postoperative defects of skull base. We found main factors which assist in causing postoperative CSF leaks and designed a numerical scale for evaluation of the degree of risk. Results: Fat grafts provide the most watertight dural closure. Fat tissue is vascularized from the surrounding tissues in 7 days. We designed an algorithm of differentiated use of prevention methods depending on the degree of risk for CSF leakage: use of fat only in the case of minimal risk; use of fat with fibrin glue for moderate risk; a combination of these two actions with lumbar drainage for maximal risk. As a result, for the first group we noticed only 3 patients (5.4%) with CSF leakage. In the second group we lowered the number of patients with postoperative CSF leakage from 9.8% to 2.1% (p < 0.05). Conclusion: The use of the numeric scale of risk degree evaluation allows the determination of a CSF leak arising and the choice of the optimal algorithm for skull base reconstruction. The use of fat graft for watertight dural closure is more effective than the fascial graft.