Incidence of Postoperative CSF Leak Using a Single-Layer Closure with Acellular Dermal Allograft for Anterior Skull Base Defects

Background: Postoperative cerebrospinal fluid (CSF) leak following endoscopic skull base surgery is a serious and potentially life-threatening complication. Various closure techniques often involving multiple layers have been proposed to minimize postoperative complications. Autologous materials, such as the pedicled nasoseptal flap or abdominal fat graft, can be associated with donor site morbidity. Thus, there has been significant interest in the use of synthetic materials. The objective of this study was to report the incidence of postoperative CSF leaks following repair of anterior skull base defects with a single layer closure using acellular dermal graft (alloderm) for sellar tumors.

Methods: A single-institution retrospective chart review was performed from January 2015 to 2019 for patients undergoing endoscopic endonasal transsphenoidal resection of sellar lesions. Patients who did not receive alloderm or received alloderm as part of a multilayer closure were excluded.

Results: Overall, there was an intraoperative CSF leak of 11.1% (4/36) and postoperative CSF leak of 0% (0/36). Of the 36 patients, 27 (75%) were female and the median age was 54 years (range: 23–77). Fifty-eight percent of the pituitary tumors (21/36) were functional and the median size of the tumor was 1.95 cm (range: 0.4–3.8 cm). The alloderm graft was secured with gel foam in 19% (7/36) of the patients and with adhesive glue in 81% (29/36) of the patients. Five patients (14%) had lumbar drains placed, all of which were placed intraoperatively. Postoperatively, there were no graft failures or development of meningitis.

Conclusion: In this retrospective cohort study, alloderm was sufficient in providing a single-layer, water-tight closure for sellar reconstruction. When mucosal grafts are not available or patient anatomy prevents the harvesting of a pedicled flap, alloderm should be considered. However, larger, prospective multicenter studies are needed to evaluate the effectiveness of alloderm alone for closure of anterior skull base defects.

Publication History

Article published online:
12 February 2021