Introduction: For patients undergoing endoscopic endonasal skull base surgery, cerebrospinal fluid leak (CSF) is one of the major post-operative risks. Modern techniques of skull base reconstruction, including use of vascular pedicle nasoseptal flaps and rigid construction with cartilage, have allowed for decreased rates of this complication.
Methods: All patients who underwent isolated endoscopic endonasal surgery for skull-base lesions and repair at the Massachusetts General Hospital and/or Massachusetts Eye and Ear Infirmary were identified through retrospective chart review.
Results: From 2008 to 2015, we identified 61 patients who underwent endoscopic endonasal approaches for skull base pathologies, excluding cases where a combined transfacial and/or craniotomy was utilized. Median age was 51.35 (range 11 to 78 years). Vascular pedicle nasoseptal flap was used in 77% of cases (47 patients) and mucosal free flaps in 8% of cases (5 patients). Rigid repair with cartilage was used in 36% of cases (22 patients). CSF leak rate was 11.5% (7 patients). Five of 7 patients had original skull base repair involving vascular nasoseptal flap. Pre-operative lumbar drain rate was 14.7%. Two patients who developed CSF leaks had pre-op lumbar drains. One of the 7 patients with CSF leak had rigid repair. Three patients required operative repair of CSF leak, two required lumbar drains, one required a VP shunt, and one self-resolved.
Conclusions: Modern endoscopic endonasal skull base repair techniques have advanced to include vascular pedicle nasoseptal flaps and rigid construction. Our series showed that rigid reconstruction of the skull base was protective against CSF leak, regardless of free or vascular flap. Pre-operative lumbar drain use did not appear to diminish risk of post-operative CSF leak.
Patient Care: It will help with education of post-operative complication risk and guide operative management, which may include incorporating rigid repair.
Learning Objectives: The goal of this abstract is to enhance understanding of the modern repair for endoscopic endonasal skull base repair and the risk of CSF leak.