TY - JOUR
T1 - Layered sellar reconstruction with avascular free grafts
T2 - Acceptable alternative to the nasoseptal flap for repair of low-volume intraoperative cerebrospinal fluid leak
AU - Roxbury, Christopher R.
AU - Saavedra, Tiffany
AU - Ramanathan, Murugappan
AU - Lim, Michael
AU - Ishii, Masaru
AU - Gallia, Gary L.
AU - Reh, Douglas D.
N1 - Publisher Copyright:
© 2016, OceanSide Publications, Inc., U.S.A.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background: Although the nasoseptal flap has become the method of choice for reconstruction of intraoperative cerebrospinal fluid (CSF) leak in endoscopic minimally invasive surgery of the skull base, layered avascular graft techniques, including allografts and middle turbinate mucosal autografts, may provide comparable reconstructive success with decreased nasal morbidity. Objective: To describe a method of reconstruction of intraoperative CSF leak in endoscopic surgery of the sella turcica and analyze its postoperative success rate and associated comorbidities. Methods: A retrospective review of expanded endonasal sellar tumor resections from 2008-2014 was performed, and cases of layered intraoperative skull base reconstruction with avascular free grafts were identified. Demographic factors and comorbidities that predisp reconstruction failure (obstructive sleep apnea, obesity) were determined. Reconstruction-related nasal complications were a identified. Pos operative CSF leak rate was determined, and statistical analysis was performed to identify predictive factors for reconstructive failure. Results: Seventy-three cases were identified. Layered closure with avascular free grafts was performed. There were five cases of postoperative CSF leak (6.85%). The mean follow-up was 19 months (range, 1-76 months). Intraoperative high-f CSF leak was a significant predictor of reconstruction failure on univariate (odds ratio 22 [95% confidence interval, 2.26-214]; p = 0.008) and multivariate analysis (odds ratio 33.6 [95% confidence interval, 2.30-492]; p = 0.010). There were no significant differences in postoperative leak rates among bony overlay graft types. There were five patients (7.9%) who experienced persistent crusting after surgery. There were no significant differences in crusting rates between allograft and m al grafts. There were no postoperative mucoceles. Conclusion: In cases of low-volume intraoperative CSF leak, layered skull base repair with avascular free grafts was an acceptable alternative to the nasoseptal flap, which may reduce prolonged sinonasal healing and donor-site morbidities.
AB - Background: Although the nasoseptal flap has become the method of choice for reconstruction of intraoperative cerebrospinal fluid (CSF) leak in endoscopic minimally invasive surgery of the skull base, layered avascular graft techniques, including allografts and middle turbinate mucosal autografts, may provide comparable reconstructive success with decreased nasal morbidity. Objective: To describe a method of reconstruction of intraoperative CSF leak in endoscopic surgery of the sella turcica and analyze its postoperative success rate and associated comorbidities. Methods: A retrospective review of expanded endonasal sellar tumor resections from 2008-2014 was performed, and cases of layered intraoperative skull base reconstruction with avascular free grafts were identified. Demographic factors and comorbidities that predisp reconstruction failure (obstructive sleep apnea, obesity) were determined. Reconstruction-related nasal complications were a identified. Pos operative CSF leak rate was determined, and statistical analysis was performed to identify predictive factors for reconstructive failure. Results: Seventy-three cases were identified. Layered closure with avascular free grafts was performed. There were five cases of postoperative CSF leak (6.85%). The mean follow-up was 19 months (range, 1-76 months). Intraoperative high-f CSF leak was a significant predictor of reconstruction failure on univariate (odds ratio 22 [95% confidence interval, 2.26-214]; p = 0.008) and multivariate analysis (odds ratio 33.6 [95% confidence interval, 2.30-492]; p = 0.010). There were no significant differences in postoperative leak rates among bony overlay graft types. There were five patients (7.9%) who experienced persistent crusting after surgery. There were no significant differences in crusting rates between allograft and m al grafts. There were no postoperative mucoceles. Conclusion: In cases of low-volume intraoperative CSF leak, layered skull base repair with avascular free grafts was an acceptable alternative to the nasoseptal flap, which may reduce prolonged sinonasal healing and donor-site morbidities.
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U2 - 10.2500/ajra.2016.30.4356
DO - 10.2500/ajra.2016.30.4356
M3 - Article
C2 - 27657903
AN - SCOPUS:84986903094
SN - 1945-8924
VL - 30
SP - 367
EP - 371
JO - American Journal of Rhinology and Allergy
JF - American Journal of Rhinology and Allergy
IS - 5
ER -