• Calvin L Gruss, Mohammed Al Komser, Manish K Aghi, Steven D Pletcher, Andrew N Goldberg, Michael McDermott, and Ivan H El-Sayed.
• School of Medicine, Vanderbilt University, Nashville, Tennessee, USA Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, California, USA calvin.l.gruss@vanderbilt.edu.
• Otolaryngol Head Neck Surg. 2014 Sep 1;151(3):516-21.

ObjectiveThe use of expanded endonasal surgery (EES) in the treatment of skull base neoplasms has increased significantly in recent years. Since 2006, the nasoseptal flap (NSF) has become the workhorse for the closure of skull base defects involving the anterior and central skull base. We hypothesized that defect site impacts the rate of cerebrospinal fluid (CSF) leak following EES.Study DesignRetrospective cohort study.Setting/Subjects/MethodsPatients who underwent skull base defect repair using a NSF at the University of California at San Francisco (UCSF) minimally invasive skull base center were retrospectively reviewed. Patient demographics, disease, and defect location and size were recorded along with the presence of a postoperative CSF leak. Data were analyzed using Fisher's exact test.ResultsOne hundred and twenty-one patients met inclusion criteria. Ten patients had a NSF failure with CSF leakage, 2 in the anterior skull base (frontal sinus, ethmoid, cribriform, planum), and 8 in the central skull base (sella, clivus) (P = .047). Dural defect size ≥2.0 cm(2) in the central skull base strongly correlated with the risk of flap failure (P = .034).ConclusionsThis study of endoscopic closure of skull base defects using a NSF demonstrates there is an association between both surgical site and dural defect size with NSF failure. Expanded defects of the sella and clivus have an increased risk of failure and may warrant augmented techniques.© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

46 keywords...

hide…