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J Neurol Surg B Skull Base 2016; 77(03): 271-278
DOI: 10.1055/s-0035-1568871
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Endonasal Reconstruction of Skull Base: Repair Protocol

Amir R. Dehdashti
1   Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania, United States
2   Department of Neurosurgery, Northshore University Hospital, Manhasset, New York, Hofstra Northshore-LIJ School of Medicine, New York, United States
,
Douglas Stofko
1   Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania, United States
,
Jessica Okun
1   Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania, United States
,
Chelsea Obourn
3   Department of Otolaryngology, Geisinger Clinic, Danville, Pennsylvania, United States
,
Thomas Kennedy
3   Department of Otolaryngology, Geisinger Clinic, Danville, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

30 March 2015

09 October 2015

Publication Date:
30 November 2015 (online)

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Abstract

Background Endoscopic endonasal skull base reconstructions have been associated with postoperative cerebrospinal fluid (CSF) leaks.

Objective A repair protocol for endoscopic endonasal skull base reconstruction is presented with the objective of decreasing the overall leak rate.

Methods A total of 180 endoscopic endonasal skull base reconstructions were reviewed. Reconstructions were classified I to IV according to the reconstruction method, determined by severity of intraoperatively encountered CSF leaks for types I to III, and planned preoperatively for type IVs, which required nasoseptal flap.

Results A total of 11 patients(6%) had postoperative leaks: 0 in type I (0%), 2 in type II (5%), 7 in type III (18%), and 2 (4%) in type IV reconstruction. Type III leak rate was higher than all other reconstructions. Total 31 intraoperative and 16 postoperative lumbar drains were placed. More patients had lumbar drains placed postoperatively for type III and intraoperatively for type IV than all other groups. There were significant overall differences in postoperative CSF leaks and lumbar drain placement between the four reconstruction types. No patient with type III reconstruction and intraoperative lumbar drain had postoperative CSF leak.

Conclusions A repair protocol for endoscopic endonasal reconstructions determined by intraoperative CSF leak and preoperative planning minimizes unnecessary repair materials and additional morbidity. Our experience leads to a routine prophylactic lumbar drain placement in all type III leak and reconstructions. We also favor the type III reconstruction for minor intraoperative leaks, and a more generous use of type IV reconstructions in expectation of significant intraoperative CSF leak. The option of rescue flap technique in type III leaks should be strongly considered.

Keywords

endoscopic endonasal - nasoseptal flap - pituitary adenoma - transsphenoidal - expanded endoscopic
 

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