Abstract
Objective: A tight skull base reconstruction is important for patients undergoing endonasal endoscopic surgery. We report here details of our skull base reconstruction procedure using a multilayer method for intraoperative cerebrospinal fluid (CSF) leakage occurring during endonasal endoscopic surgery for tumor removal. Methods: To achieve a successful tight repair in cases with high-flow CSF leakage, we have adopted a multilayer method using inlay and onlay fascia, fat from abdomen, and rigid hard bone from nasal septal bone to stop CSF pulsation, as well as a nasoseptal flap to cover the skull base defect. Furthermore, a sinus balloon is inserted into the sphenoid sinus for a few days to secure the above listed materials keep them from falling. Results: Of the 144 patients who underwent endonasal endoscopic surgery performed from November 2008 to March 2015 at our institution, 48 had CSF leakage. The mean age of those patients was 54.9 years old and 41 had a pituitary adenoma, 5 at Rathke’s cleft cyst, 1 a chordoma, and 1 a malignant lymphoma. The mean tumor size was 29.1 mm. Esposito grade 1, 2, and 3 CSF leakage was seen in 18, 16, and 14 cases, respectively. Grade 3 cases had significantly larger tumors as compared to grade 1. There were no differences among the groups regarding the amount of gross total removal. Utilizing a multilayer method in 14 cases with high-flow CSF leakage during the operation, we were able to achieve a tight skull base reconstruction in all cases with no late CSF leakage. Conclusion: Skull base reconstruction with a multilayer method was effective to achieve a tight repair and stop intraoperative high-flow CSF leakage.
Highlights
Endoscopic endonasal surgery is a powerful and effective tool for treatment of skull base tumors
We examined the usefulness of our multilayer method for skull base reconstruction using inlay and onlay fascia, fat, and rigid hard bone to stop cerebrospinal fluid (CSF) pulsation, as well as a nasoseptal flap to prevent high-flow CSF leakage
Of 144 cases of endonasal endoscopic surgery performed from November 2008 to March 2015, we encountered 48 with CSF leakage
Summary
Endoscopic endonasal surgery is a powerful and effective tool for treatment of skull base tumors. With increased tumor volume removed, the risk of CSF leakage is increased, it is important to perform a tight skull base reconstruction. Several different methods for skull base reconstruction have been reported [2-4], among which a vascularized nasoseptal flap has been repeatedly shown to be effective [5-7], though the risk of CSF leakage remains due to soft reconstruction in cases with a high level of CSF flow. We examined the usefulness of our multilayer method for skull base reconstruction using inlay and onlay fascia, fat, and rigid hard bone to stop CSF pulsation, as well as a nasoseptal flap to prevent high-flow CSF leakage
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
