Abstract
Background The use of vascularized flap to reconstruct the skull base defects has dramatically
changed the postoperative cerebrospinal fluid (CSF) leak rates allowing the expansion
of endoscopic skull base procedures. At present, there is insufficient scientific
evidence to permit identification of the optimal reconstruction technique after the
endoscopic endonasal approach (EEA).
Objective The main purpose of this article is to establish the risk factors for failure in
the reconstruction after EEA and whether the use of a surgical reconstruction protocol
can improve the surgical results.
Material and Methods A retrospective cohort study was conducted in our institution, selecting patients
that underwent EEA with intraoperative CSF leak. Two reconstructive protocols were
defined based on different reconstructive techniques; both were vascularized but one
monolayer and the other multilayer. A multivariate analysis was performed with outcome
variable presentation of postoperative leak.
Results One hundred one patients were included in the study. Patients reconstructed with
protocol 1, with the diagnosis different to the pituitary adenoma and older than 45
years old had higher risk of presenting postoperative leak, and with statistically
significant differences when we adjusted for the remaining variables.
Conclusion The vascularized reconstructions after endoscopic endonasal skull base approaches
have demonstrated to be able to obtain a low rate of postoperative CSF leak. The multilayer
vascularized technique may provide a more evolved technique, even reducing the postoperative
leak rates comparing with the monolayer vascularized one. The reconstructive protocol
employed in each case, as well as age and histological diagnosis, is independent risk
factor for presenting postoperative leak.
Keywords
cerebrospinal fluid leak - endonasal - endoscopic - reconstruction - skull base -
vascularized flap
