Endoscopic Endonasal Reconstruction of Intraoperative Cerebrospinal Fluid Leak in Different Skull Base Regions: Outcomes, Meningitis, and Risk Factors.

Various nonvascularized or vascularized techniques have been adopted in endoscopic endonasal surgery (EES) for repairing intraoperative cerebrospinal fluid (CSF) leaks after tumor resection. Vascularized nasoseptal flaps, free nasoseptal grafts, free turbinate grafts, and fascia lata and mashed muscle are frequently used. Outcomes of those grafts applied in the defects of different regions need to be clarified. The data from a series of 162 patients with skull base tumor who underwent EES that had intraoperative CSF leak between Jan 2012 and Jan 2021 were retrospectively analyzed. The regions included anterior skull base, sellar region, clivus and infratemporal fossa. Repair failure rate (RFR), meningitis rate, and associated risk factors were assessed. In total, 172 reconstructions were performed in 162 patients for the 4 sites of the skull base. There were 7 cases (4.3%) that had postoperative CSF leaks, which required second repair. The RFR for anterior skull base, sellar region, clivus, and infratemporal fossawas 2.6%, 2.2%, 16.7%, and 0%, respectively. The clivus defect was an independent risk factor for repair failure (P < 0.01). The postoperative meningitis rate was 5.6%. Repair failure was an independent risk factor for meningitis (P < 0.01). Vascularized nasoseptal flap, free nasoseptal graft, free turbinate graft, and fascia lata and mashed muscle are reliable autologous materials for repairing the dural defects in different regions during EES. Clivus reconstruction remains a great challenge, which had a higher RFR and meningitis rate. Repair failure is significantly associated with postoperative meningitis.

Wei W ，Yan B ，Zhang Q ，Qi Y ，Ren Q ，Wang L ，Liu J ，Yang X ，Wang Z ... -  《-》

Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients.

Conger A ，Zhao F ，Wang X ，Eisenberg A ，Griffiths C ，Esposito F ，Carrau RL ，Barkhoudarian G ，Kelly DF ... -  《-》

Various modifications of a vascularized nasoseptal flap for repair of extensive skull base dural defects.

Moon JH ，Kim EH ，Kim SH 《-》

Risk factors for cerebrospinal leak after endoscopic skull base reconstruction with nasoseptal flap.

The use of expanded endonasal surgery (EES) in the treatment of skull base neoplasms has increased significantly in recent years. Since 2006, the nasoseptal flap (NSF) has become the workhorse for the closure of skull base defects involving the anterior and central skull base. We hypothesized that defect site impacts the rate of cerebrospinal fluid (CSF) leak following EES. Retrospective cohort study. Patients who underwent skull base defect repair using a NSF at the University of California at San Francisco (UCSF) minimally invasive skull base center were retrospectively reviewed. Patient demographics, disease, and defect location and size were recorded along with the presence of a postoperative CSF leak. Data were analyzed using Fisher's exact test. One hundred and twenty-one patients met inclusion criteria. Ten patients had a NSF failure with CSF leakage, 2 in the anterior skull base (frontal sinus, ethmoid, cribriform, planum), and 8 in the central skull base (sella, clivus) (P = .047). Dural defect size ≥2.0 cm(2) in the central skull base strongly correlated with the risk of flap failure (P = .034). This study of endoscopic closure of skull base defects using a NSF demonstrates there is an association between both surgical site and dural defect size with NSF failure. Expanded defects of the sella and clivus have an increased risk of failure and may warrant augmented techniques.

Gruss CL ，Al Komser M ，Aghi MK ，Pletcher SD ，Goldberg AN ，McDermott M ，El-Sayed IH ... -  《-》

Efficacy of simultaneous pericranial and nasoseptal "double flap" reconstruction of anterior skull base defects after combined transbasal and endoscopic endonasal approaches.

Gabriel PJ ，Kohli G ，Hsueh WD ，Eloy JA ，Liu JK ... -  《-》