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.

The efficacy of an endoscopic endonasal approach in the repair of cerebrospinal fluid fistula: a clinical analysis

<p class="abstract"><strong>Background:</strong> Cerebrospinal fluid (CSF) fistula is an abnormal CSF leakage due to bone and/or dural defect of the skull base and usually operated with endonasal endoscopic approach. The aim of this study was to determine the efficacy of an endonasal endoscopic approach in the repair of CSF leakage and to find the reasons of the recurrence of endoscopic procedure.</p><p class="abstract"><strong>Methods:</strong> The medical records of 24 patients that presented with the diagnosis of cerebrospinal fluid fistula and who had undergone endonasal endoscopic repair surgery were reviewed retrospectively. </p><p class="abstract"><strong>Results:</strong> 13 patients (54.2%) were found to have spontaneous CSF fistulas without any history of trauma, while 11 patients (45.8%) had posttraumatic CSF fistulas. The mean body mass index (BMI) of patients was 31. 3 kg/m² (20.1-49.6). Nasal septal cartilage was used as a graft material in 19 patients (79%) while only fascia was used in 5 patients (21%). The evaluation of long-term results revealed recurrence in 4 patients (16.6%). Two of these patients required a second surgical repair.</p><p class="abstract"><strong>Conclusions:</strong> An endoscopic endonasal approach is a safe method with less morbidity and a reliable outcome in the repair of CSF fistulas. The most important causative factors in the recurrence of endoscopic repair of CSF leak might be to have high BMI and not to use multilayered graft material for closure of fistula.</p><p class="abstract"> </p>