Prophylaxis and Treatment of CSF Leak in Endonasal Skull Base Surgery

Abstract

Objective: Water-tide closer of CSF fistula and postoperative skull base defects requires effective use technique to reduce postoperative morbidity. Study Design: Retrospective analyze of endonasal procedures performed between February, 2007 and January, 2014. Surgical technique, distribution of pathology, methods of skull base reconstruction was collected. Material and Methods: A total 333 patients were operated, 356 skull base surgeries were performed. Transnasal microsurgical approach was used in 111 cases and EEA in 245 cases. Distribution of Pathology: Overall 281 pituitary tumors, 17 cranipharyngiomas, 20 nasal CSF leaks of different origin, 11 different tumors of skull base, 2 tuberculum sellae meningiomas, 2 Rathke cleft cysts. Results: Intraoperative CSF leak was marked in 79 cases. Skull base reconstruction with artificial materials and fibrin glue was performed in 152 cases; with fat graft, fascia lata and fibrin glue 20 cases; reconstruction with vascular pedicle mucosal flap of the nasal septum (HB-flap) 159 cases; ventral surface reconstruction with vascular pedicle pericranial flap 2 cases. Postoperative CSF leak was found in 18 cases. Total 11 patients were reoperated due to CSF leak, 4 of them twice. In seven cases CSF leak resolved conservatively on lumbar drainage. Postoperative meningitis was marked in six cases. Conclusions: Vascular pedicle flaps gives more effective watertight closing especially in cases of extended approaches and reduces risks of CSF leak postoperatively.