The advantages of using auto-fat tissue in the reconstruction of defects of the skull base in patients with CSF leak

Abstract

Relevance: At present, the method of repair of the cerebrospinal fluid fistula using mucous flaps according to the “overlay” technique is widely used in the reconstruction of the skull base and is generally accepted. We have developed an original method for reconstructing defects of the skull base in the presence of a cerebrospinal fluid fistula, using an auto-fat tissue and placing it in two layers. Objectives: To conduct a comparative assessment of methods for the reconstruction of the skull base defect in patients with CSF leak using endoscopic endonasal approach. Materials and methods: Under our supervision there were 46 patients with CSF leak. Depending on the technique of cerebrospinal fluid fistula repair, all patients were divided into 2 groups. The first group of 20 patients consisted of patients who underwent surgery with auto-fat tissue according to our proposed technique. The second group - 26 patients were patients who underwent repair of the skull base defect using the standard overlay technique - a mucous flap on the feeding vascular pedicle. The criterion for evaluating the effectiveness of surgical treatment was patient complaints and data from objective research methods (endoscopic examination of the nasal cavity). Results: After 3 months after surgical treatment, a patient of group 1 had a recurrence of liquorrhea, patients of group 2 after 3 months had a recurrence of liquorrhea in 3 patients, after 6 months in 2 patients of group 2 there was a recurrence of liquorrhea. Findings: When the size of the bone defect of the base of the skull is up to 0.6 cm, the original technique proposed by us for plastics of the cerebrospinal fluid fistula with an auto-fat tissue in two layers provides a tight closure of the bone defect and the defect of the dura mater. When using this method of plastics, the risk of the development of a recurrence of CSF leak is significantly reduced in comparison with the plastics of the cerebrospinal fluid fistula with the use of overlay grafts.