Impact of Chemoradiotherapy on CSF Leak Repair after Skull Base Surgery

Marcus V. Ortega Alves; Dianna Roberts; Nicholas B. Levine; Franco DeMonte; Ehab Y. Hanna; Michael E. Kupferman

doi:10.1055/s-0034-1373659

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2014; 75(05): 354-357
DOI: 10.1055/s-0034-1373659

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Impact of Chemoradiotherapy on CSF Leak Repair after Skull Base Surgery

Authors

Marcus V. Ortega Alves

¹Department of Medicine, Tufts University, Somerville, Massachusetts, United States
Dianna Roberts

²Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Nicholas B. Levine

³Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Faculty Center, Houston, Texas, United States
Franco DeMonte

³Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Faculty Center, Houston, Texas, United States
Ehab Y. Hanna

²Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Michael E. Kupferman

²Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States

Abstract

Background Transnasal endoscopic resection (TER) has become the treatment of choice for many skull base tumors. A major limitation of TER is the management of large dural defects and the need for repair of cerebrospinal fluid (CSF) leaks, particularly among patients who are treated with chemotherapy (CTX) or radiotherapy (RT). The objective of this study is to determine the impact of CTX and RT on the success of CSF leak repair after TER.

Methods We performed a retrospective chart review of a single-institution experience of TER from 1992 to 2011.

Results We identified 28 patients who had endoscopic CSF leak repair after resection of malignant skull base tumors. Preoperative RT was utilized in 18 patients, and 9 had undergone CTX. All patients required CSF leak repair with rotational flaps after cribriform and/or dural resection. CSF leak repair failed in three patients (11%). A history of RT or CTX was not associated with failed CSF leak repair.

Conclusion Adjuvant or neoadjuvant CTX or RT is not associated with failed CSF leak repair. Successful CSF leak repair can be performed in patients with malignant skull base tumors with an acceptable risk profile.

Keywords

cerebrospinal fluid leak - endonasal endoscopic surgery - skull base tumors - skull base reconstruction - chemotherapy - radiotherapy - postoperative complications - pedicled septal mucosal flap - neurological sequelae - neurosurgical patients

Full Text

References

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