The advantages of using a fragment of the fascia lata and autobone in the reconstruction of defects in the base of the skull in patients with CSF leak

Relevance: Diagnosis and treatment of patients with CSF leak, today, is not a fully resolved problem. With small defects in the base of the skull, the overlay technique has worked relatively well. However, when the size of the bone defect is more than 0.6 cm, the surgeon has to resort to the underlay technique of transplant placement. Thus, the search for the optimal technique for reconstruction surgery of the cerebrospinal fluid fistula, especially with large defects of the skull base, is a complex and urgent problem. Purpose of the study: To conduct a comparative assessment of the techniques for reconstruction of the skull base defect lager than 0,6 cm in the anterior cranial fossa in patients with CSF leak using endoscopic endonasal approach. Materials and methods: We observed 44 patients with CSF leak. Depending on the technique of cerebrospinal fluid fistula repair, all patients were divided into 2 groups. The first group of 21 patients was patients who underwent reconstruction surgery of the skull base defect using a generally accepted technique using a fragment of the fascia lata and nasoseptal flap. The second group – 23 patients, consisted of patients who underwent reconstruction surgery with a fragment o fascia lata with fixation of it by a fragment of an autobone according to our technique, followed by the use of a nasoseptal flap. The criterion for evaluating the effectiveness of the surgical treatment was lack of relapse of CSF leak and data from objective research methods (endoscopic examination of the nasal cavity). Results: 1 month after surgical treatment, 3 (14,28%)patients of the 1st group experienced a recurrence of CSF leak, and 1(4,34%) patient of the 2nd group had a recurrence of CSF leak. In 2 patients of the 1st group there was a relapse of CSF leak in the 3rd month of observation, there was no recurrence of CSF leak in patients of the 2nd group, after 6 months in 1 patient of the 1st group there was a relapse of liquorrhea. Conclusions: In patients with CSF leak with a bone defect greater than 0.6 cm, it is appropriate to use the sandwich technique. The technique of reconstruction CSF fistula using a fascia lata with its fixation by autologous bone can significantly reduce the risk of CSF recurrence in comparison with the use of generally accepted techniques for CSF leak. The use of autobone in reconstruction of the cerebrospinal fluid fistula does not affect the change in the architectonics of the nose compared to the generally accepted technique.

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

OTORHINOLARYNGOLOGY 2-3(2) 2019 - OTORHINOLARYNGOLOGY ◽

10.37219/2528-8253-2018-2-18 ◽

2018 ◽

pp. 18-23

Author(s):

Dmitry Zabolotny ◽

Diana Zabolotnaya ◽

Eldar Ismagilov

Keyword(s):

Cerebrospinal Fluid ◽

Surgical Treatment ◽

Skull Base ◽

Csf Leak ◽

Fat Tissue ◽

Cerebrospinal Fluid Fistula ◽

Overlay Technique ◽

Skull Base Defect ◽

Group 2 ◽

Fluid Fistula

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.

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Endoscopic Endonasal Reconstruction of High-Flow Cerebrospinal Fluid Leak with Fascia Lata “Button” Graft and Nasoseptal Flap: Surgical Technique and Case Series

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1693124 ◽

2019 ◽

Vol 81 (06) ◽

pp. 645-650

Author(s):

Roshni V. Khatiwala ◽

Karthik S. Shastri ◽

Maria Peris-Celda ◽

Tyler Kenning ◽

Carlos D. Pinheiro-Neto

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Fascia Lata ◽

High Flow ◽

Csf Leak ◽

Nasoseptal Flap ◽

Endoscopic Endonasal ◽

Skull Base Reconstruction ◽

Csf Diversion ◽

Csf Leaks

Abstract Background The endoscopic endonasal approach (EEA) has become increasingly used for resection of skull base tumors in the sellar and suprasellar regions. A nasoseptal flap (NSF) is routinely used for anterior skull base reconstruction; however, there are numerous additional allografts and autografts being used in conjunction with the NSF. The role of perioperative cerebrospinal fluid (CSF) diversion is also unclear. Objective This study was aimed to analyze success of high-flow CSF leak repair during EEA procedures without use of CSF diversion through lumbar drainage. Methods A retrospective chart review of patients who had intraoperative high-flow CSF leak during EEA procedures at our institution between January 2013 and December 2017 was performed. CSF leaks were repaired with use of a fascia lata button graft and nasoseptal flap, without use of perioperative lumbar drains. Results A total of 38 patients were identified (10 male, 28 female). Patient BMIs ranged from 19.7 to 49 kg/m2 (median = 31 kg/m2), with 18 patients meeting criteria for obesity (BMI > 30 kg/m2) and 12 patients overweight (25 kg/m2 < BMI < 29.9 kg/m2). There was no incidence of postoperative CSF leak. Conclusion In our experience, the nasoseptal flap used in conjunction with the fascia lata button graft is a safe, effective and robust combination for cranial base reconstruction with high-flow intraoperative CSF leaks, without need for lumbar drains.

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Extradural cartilage inlay graft in cerebrospinal fluid fistula repair

The Journal of Laryngology & Otology ◽

10.1017/s0022215110001295 ◽

2010 ◽

Vol 124 (12) ◽

pp. 1294-1297 ◽

Cited By ~ 3

Author(s):

P Thulasi Das ◽

D Balasubramanian

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Success Rate ◽

Bony Defect ◽

Cerebrospinal Fluid Fistula ◽

Fistula Repair ◽

Cerebrospinal Fluid Rhinorrhoea ◽

Skull Base Defects ◽

Fluid Fistula

AbstractObjective:To present our experience in managing cerebrospinal fluid rhinorrhoea using the cartilage inlay (underlay) technique to repair skull base defects larger than 4 mm.Study design:Retrospective study involving patients presenting with cerebrospinal fluid rhinorrhoea between 1994 and 2008.Setting:Patients were treated in a tertiary referral centre for nose and sinus diseases. Patients' medical records were reviewed and analysed.Results:A total of 62 patients were operated upon using a cartilage inlay technique to repair bony skull base defects ranging in size from 4 to 20 mm (widest diameter). Of these 62 patients, 16 constituted revisions of earlier procedures undertaken elsewhere. The success rate of the technique was 100 per cent. Patient follow up ranged from six months to 16 years, with a median follow up of 15 months. Three patients had minor post-operative sinus infections; no serious complications were encountered.Conclusion:Extradural cartilage inlay appears to be an effective technique in the management of cerebrospinal fluid rhinorrhoea, especially for large defects and revision procedures. To our knowledge, the described patients represent the largest reported series of cerebrospinal fluid rhinorrhoea cases managed using the cartilage inlay technique. We believe that the crucial factors in our high success rate for cerebrospinal fluid fistula repair are: precise identification of the bony defect; meticulous preparation of the graft bed; careful elevation of the dura; judicious use of just enough graft tissue; and adequate graft support.

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32 Cerebrospinal Fluid Fistula in Skull Base Surgery

Handbook of Skull Base Surgery ◽

10.1055/b-0036-131034 ◽

2016 ◽

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Skull Base Surgery ◽

Cerebrospinal Fluid Fistula ◽

Fluid Fistula

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The use of platelet gel for repair of a cerebrospinal fluid fistula of the skull base (a case report and literature review)

Voprosy neirokhirurgii imeni N N Burdenko ◽

10.17116/neiro201882186-92 ◽

2018 ◽

Vol 82 (1) ◽

pp. 86

Author(s):

O. I. Sharipov ◽

M. A. Kutin ◽

A. V. Bayuklin ◽

A. A. Imaev ◽

A. A. Abdilatipov ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Case Report ◽

Literature Review ◽

Skull Base ◽

Cerebrospinal Fluid Fistula ◽

Platelet Gel ◽

Fluid Fistula

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Traumatic cerebrospinal fluid fistula simulating tears

Journal of Neurosurgery ◽

10.3171/jns.1978.49.1.0121 ◽

1978 ◽

Vol 49 (1) ◽

pp. 121-123 ◽

Cited By ~ 14

Author(s):

Kiran K. Joshi ◽

H. Alan Crockard

Keyword(s):

Cerebrospinal Fluid ◽

Young Child ◽

Cribriform Plate ◽

Csf Leak ◽

Cerebrospinal Fluid Fistula ◽

Medial Aspect ◽

Csf Rhinorrhea ◽

Content Type ◽

Fluid Fistula ◽

Fine Print

✓ A young child developed delayed cerebrospinal fluid (CSF) rhinorrhea and CSF leak from the eye presenting as tears. The “tears” were CSF which had tracked from the cribriform plate through the ethmoidal air sinuses to the medial aspect of the left orbit. There was marked chemosis and it was considered likely that the tears had leaked through damaged conjunctiva.

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The Surgical Treatment of Posttraumatic Skull Base Defects with Cerebrospinal Fluid Leak

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1606555 ◽

2017 ◽

Vol 79 (02) ◽

pp. 205-216 ◽

Cited By ~ 1

Author(s):

Ashish Thapa ◽

Bing-Xi Lei ◽

Mei-Guang Zheng ◽

Zhong-Jun Li ◽

Zheng-Hao Liu ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Surgical Treatment ◽

Skull Base ◽

Surgical Approach ◽

Common Factors ◽

Csf Leak ◽

Surgical Approaches ◽

Skull Base Defect ◽

The Common ◽

Skull Base Defects

Objectives The objective was to explore further the surgical treatment of posttraumatic skull base defects with cerebrospinal fluid (CSF) leak and to identify the most common factors affecting the surgical treatment of posttraumatic skull base defect with CSF leak retrospectively. Materials and Methods This study included 144 patients with head trauma having skull base defect with CSF leak who had been surgically treated at Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from 1998 to June 2016. There were 113 (78.5%) males and 31 (21.5%) females, with age ranging from 1 to 78 years and mean age of 26.58 ± 14.95 years. We explored the surgical approaches for the treatment of the skull base defect and the graft materials used and also measured the association among surgical approaches; location, size, and type of skull base defects; presence or absence of associated intracranial pathologies; postoperative complications; outcome; age; Glasgow outcome score (GOS) at discharge; and days of hospital stay. Results The location, size, and types of skull base defect and the presence of associated intracranial pathologies were the common factors identified not only for choosing the appropriate surgical approach but also for choosing the materials for defect repair, timing of the surgery, and the method used for the defect as well as leak repair. The statistically significant correlation with p < 0.001 was found in this study. Conclusion From this study, we could conclude that size, location, and types of the defect and the presence of associated intracranial injuries were the common factors that affected the surgical treatment of posttraumatic skull base defect with CSF leak. Hence, the importance of careful evaluation of these factors is essential for proper selection of the surgical approach and for avoiding unnecessary hassles.

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