Introduction: The vascularized pedicled nasoseptal flap (PNSF) has become the preferred method of reconstruction of high-flow cerebrospinal fluid (CSF) leaks from large defects created after endoscopic skull base surgery. Often, the PNSF is used in conjunction with postoperative lumbar drainage. Currently, there is no data that supports whether addition of postoperative lumbar drainage reduces the incidence of CSF leak after endoscopic skull base reconstruction with a PNSF. In this study, we compare the incidence of postoperative CSF leakage in patients undergoing endoscopic PNSF reconstruction with or without the addition of postoperative lumbar drainage.
Methods: A retrospective analysis was performed on patients who underwent endoscopic reconstruction of high-flow CSF leaks using a PNSF between August 2009 and August 2011. Incidence of postoperative CSF leaks, the use of lumbar drainage, and demographic data were collected.
Results: Forty-five high-flow CSF leaks were repaired with a PNSF alone without lumbar drainage (Group I), and 15 were repaired with a PNSF with postoperative lumbar drainage (Group II). In Group I, there were no postoperative CSF leaks (0%), whereas in Group II, there was one delayed CSF leak (6.7%). The incidence of postoperative CSF leakage was not significantly different between the groups (p>0.05). The overall postoperative CSF leak rate was 1.7%.
Conclusions: The use of postoperative lumbar drainage after endoscopic PNSF reconstruction of high-flow CSF leaks may not be necessary. In our experience, meticulous multilayered-reconstruction and careful positioning and buttressing of the PNSF seem to obviate the need for postoperative lumbar drainage.
Patient Care: The use of postoperative lumbar drainage after endoscopic PNSF reconstruction of high-flow CSF leaks may not be necessary. Therefore the patient will not be exposed to a possible unnecessary procedure and the complications associated with the use of lumbar drain can be avoided.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the role of the vascularized pedicled nasoseptal flap in reconstruction of skull base defects 2) Discuss the literature regarding using of lumbar drainage to prevent postoperative cerebrospinal fluid leak after endoscopic skull base surgery and 3) Discuss the arguments for and against cerebrospinal fluid diversion for endoscopic skull base surgery