BACKGROUND: Although rare, recalcitrant cerebrospinal fluid (CSF) leak after skull base tumor resection or major head trauma is a difficult therapeutic challenge, often complicated by lack of local vascularized tissue in a scarred, radiated field. Craniotomy with a free tissue transfer has been described for CSF leak repair from these complicated skull base defects. OBJECTIVE: : We present our experience with a novel extracranial approach to manage refractory CSF leaks with a radial forearm free flap set in through a transantral and ethmoid sinus approach. METHODS: Five patients with recalcitrant CSF leaks in the anterior skull base underwent radial forearm free tissue transfer via a hybrid transantral-endoscopic approach. RESULTS: There were 4 female patients and 1 male patient. Average age was 58 years (range, 30-72 years). Four patients had previous neurosurgical anterior skull base tumor resections, and 1 patient had significant head trauma leading to a recalcitrant CSF leak. All 5 patients had undergone multiple prior endoscopic and/or open repairs. All 5 patients had successful resolution of their leak after undergoing radial forearm free tissue transfer. Two of 5 patients required a second minor endoscopic procedure. No patients required a craniotomy. CONCLUSION: An extracranial transantral-endoscopic approach for the inset of radial forearm free flap is a safe treatment technique that precludes the need for a craniotomy and promotes effective repair of CSF leaks refractory to traditional endoscopic procedures. ABBREVIATION: RFFF, radial forearm free flap.
BACKGROUND: Although rare, recalcitrant cerebrospinal fluid (CSF) leak after skull base tumor resection or major head trauma is a difficult therapeutic challenge, often complicated by lack of local vascularized tissue in a scarred, radiated field. Craniotomy with a free tissue transfer has been described for CSF leak repair from these complicated skull base defects. OBJECTIVE: : We present our experience with a novel extracranial approach to manage refractory CSF leaks with a radial forearm free flap set in through a transantral and ethmoid sinus approach. METHODS: Five patients with recalcitrant CSF leaks in the anterior skull base underwent radial forearm free tissue transfer via a hybrid transantral-endoscopic approach. RESULTS: There were 4 female patients and 1 male patient. Average age was 58 years (range, 30-72 years). Four patients had previous neurosurgical anterior skull base tumor resections, and 1 patient had significant head trauma leading to a recalcitrant CSF leak. All 5 patients had undergone multiple prior endoscopic and/or open repairs. All 5 patients had successful resolution of their leak after undergoing radial forearm free tissue transfer. Two of 5 patients required a second minor endoscopic procedure. No patients required a craniotomy. CONCLUSION: An extracranial transantral-endoscopic approach for the inset of radial forearm free flap is a safe treatment technique that precludes the need for a craniotomy and promotes effective repair of CSF leaks refractory to traditional endoscopic procedures. ABBREVIATION: RFFF, radial forearm free flap.
Authors: Joseph Zenga; Jeffrey D Sharon; Paul Santiago; Brian Nussenbaum; Bruce H Haughey; Ida K Fox; Terence M Myckatyn; Jason A Diaz; Michael R Chicoine Journal: J Neurol Surg B Skull Base Date: 2015-05-22
Authors: Rajan P Dang; Lauren T Roland; Jeffrey D Sharon; Michelle Doering; Michael R Chicoine; Patrik Pipkorn Journal: J Neurol Surg B Skull Base Date: 2019-09-12
Authors: Rajan P Dang; Abhinav R Ettyreddy; Zain Rizvi; Michelle Doering; Angela L Mazul; Joseph Zenga; Ryan S Jackson; Patrik Pipkorn Journal: J Neurol Surg B Skull Base Date: 2021-02-18
Authors: N Oker; P Lang; D Bresson; B George; J-P Guichard; M Wassef; E Sauvaget; S Froelich; R Kania; P Herman Journal: Eur Arch Otorhinolaryngol Date: 2014-04-16 Impact factor: 2.503
Authors: Jake J Lee; Elizabeth H Wick; Michael R Chicoine; Joshua L Dowling; Eric C Leuthardt; Paul Santiago; Patrik Pipkorn Journal: Oper Neurosurg (Hagerstown) Date: 2021-11-15 Impact factor: 2.817