Edward D McCoul1, Vijay K Anand1, Ameet Singh2, Gurston G Nyquist3, Madeleine R Schaberg4, Theodore H Schwartz5. 1. Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York. 2. Department of Otolaryngology, George Washington University Medical Center, Washington, DC. 3. Department of Otolaryngology, Jefferson Medical College, Philadelphia, Pennsylvania. 4. Department of Otolaryngology, New York Eye and Ear Infirmary, New York, New York, USA. 5. Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York; Department of Neurological Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York; Department of Neurology and Neuroscience, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York. Electronic address: schwarh@med.cornell.edu.
Abstract
OBJECTIVE: To describe the effect on postoperative cerebrospinal fluid (CSF) leak after anterior skull base (ASB) surgery and complications associated with the addition of the vascularized nasoseptal flap (NSF) to an existing reconstruction protocol. METHODS: A prospective database of all patients undergoing endoscopic ASB approaches was reviewed. Patients were divided into three groups based on the date the use of the NSF was adopted. Group A included patients with high-volume CSF leak closed using the NSF in addition to a multilayer closure. Group B included patients operated on during the same time period with no high-volume leak and no NSF. Group C included patients operated on before the adoption of the NSF with all types of CSF leak. Rates of intraoperative and postoperative CSF leak were analyzed for statistical significance. RESULTS: Of 415 consecutive patients undergoing endoscopic ASB surgery, there were 96 in group A, 114 in group B, and 205 in group C. CSF leak rates in group A (3.1%) and group B (2.6%) were significantly lower than in group C (5.9%; P < 0.05). Lumbar drains and the gasket seal closure were performed more frequently in group A (75% and 32%) compared with group B (21% and 12%) and group C (28% and 11%). NSF carried a 2% risk of postoperative mucocele. CONCLUSIONS: The addition of NSF to an algorithm for multilayer closure can decrease the rate of postoperative CSF leak.
OBJECTIVE: To describe the effect on postoperative cerebrospinal fluid (CSF) leak after anterior skull base (ASB) surgery and complications associated with the addition of the vascularized nasoseptal flap (NSF) to an existing reconstruction protocol. METHODS: A prospective database of all patients undergoing endoscopic ASB approaches was reviewed. Patients were divided into three groups based on the date the use of the NSF was adopted. Group A included patients with high-volume CSF leak closed using the NSF in addition to a multilayer closure. Group B included patients operated on during the same time period with no high-volume leak and no NSF. Group C included patients operated on before the adoption of the NSF with all types of CSF leak. Rates of intraoperative and postoperative CSF leak were analyzed for statistical significance. RESULTS: Of 415 consecutive patients undergoing endoscopic ASB surgery, there were 96 in group A, 114 in group B, and 205 in group C. CSF leak rates in group A (3.1%) and group B (2.6%) were significantly lower than in group C (5.9%; P < 0.05). Lumbar drains and the gasket seal closure were performed more frequently in group A (75% and 32%) compared with group B (21% and 12%) and group C (28% and 11%). NSF carried a 2% risk of postoperative mucocele. CONCLUSIONS: The addition of NSF to an algorithm for multilayer closure can decrease the rate of postoperative CSF leak.
Authors: Herbert Daniel Jiménez Zapata; Víctor Rodríguez Berrocal; Carlos Vior Fernández; Franklin Mariño Sánchez; Alfredo García Fernández Journal: J Neurol Surg B Skull Base Date: 2019-05-28
Authors: Brett E Youngerman; Jennifer A Kosty; Mina M Gerges; Abtin Tabaee; Ashutosh Kacker; Vijay K Anand; Theodore H Schwartz Journal: Acta Neurochir (Wien) Date: 2020-02-11 Impact factor: 2.216