• Edward D McCoul, Vijay K Anand, Ameet Singh, Gurston G Nyquist, Madeleine R Schaberg, and Theodore H Schwartz.
• Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York.
• World Neurosurg. 2014 Jan 1;81(1):136-43.

ObjectiveTo describe the effect on postoperative cerebrospinal fluid (CSF) leak after anterior skull base (ASB) surgery and complications associated with the addition of the vascularized nasoseptal flap (NSF) to an existing reconstruction protocol.MethodsA prospective database of all patients undergoing endoscopic ASB approaches was reviewed. Patients were divided into three groups based on the date the use of the NSF was adopted. Group A included patients with high-volume CSF leak closed using the NSF in addition to a multilayer closure. Group B included patients operated on during the same time period with no high-volume leak and no NSF. Group C included patients operated on before the adoption of the NSF with all types of CSF leak. Rates of intraoperative and postoperative CSF leak were analyzed for statistical significance.ResultsOf 415 consecutive patients undergoing endoscopic ASB surgery, there were 96 in group A, 114 in group B, and 205 in group C. CSF leak rates in group A (3.1%) and group B (2.6%) were significantly lower than in group C (5.9%; P < 0.05). Lumbar drains and the gasket seal closure were performed more frequently in group A (75% and 32%) compared with group B (21% and 12%) and group C (28% and 11%). NSF carried a 2% risk of postoperative mucocele.ConclusionsThe addition of NSF to an algorithm for multilayer closure can decrease the rate of postoperative CSF leak.Copyright © 2014 Elsevier Inc. All rights reserved.

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