Chang-Min Ha1, Sang Duk Hong2, Jung Won Choi1, Ho Jun Seol1, Do-Hyun Nam1, Jung-Il Lee1, Doo-Sik Kong3. 1. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 2. Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 3. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: neurokong@gmail.com.
Abstract
OBJECTIVE: Sellar reconstruction following endoscopic endonasal surgery (EES) requires modification based on the degree of cerebrospinal fluid (CSF) leak. For high-flow (grade II or III according to Esposito et al. 2007) intraoperative CSF leak, lumbar drainage (LD), in addition to the multilayer closing technique, is generally recommended. However, LD occasionally has complications including postpuncture headache, overdrainage symptoms, and increased length of stay. We retrospectively evaluated the outcome of our graded reconstruction strategy using a multilayer technique with a novel material, without LD, after EES. METHODS: Ninety-seven patients who underwent EES with grade II or III intraoperative CSF leak between June 2020 and March 2021 were retrospectively reviewed. For grade II CSF leak, fibrin sealant and a nasoseptal flap were placed; for grade III CSF leak, a multilayer technique was used in combination with collagen matrix, an acellular dermal graft, injectable hydroxyapatite (HXA), and a nasoseptal flap. Postoperatively, routine LD was not performed. RESULTS: This study included 48 (49.5%) grade II and 49 (50.5%) grade III CSF leaks. At follow-up (mean, 8.7 months), no patient showed postoperative CSF leak in either group. No HXA-associated complications occurred. CONCLUSIONS: A graded surgical repair strategy after EES could avoid postoperative CSF leak. Combined use of injectable HXA and acellular dermal grafts for high-flow CSF leak can limit LD requirement without significant risks.
OBJECTIVE: Sellar reconstruction following endoscopic endonasal surgery (EES) requires modification based on the degree of cerebrospinal fluid (CSF) leak. For high-flow (grade II or III according to Esposito et al. 2007) intraoperative CSF leak, lumbar drainage (LD), in addition to the multilayer closing technique, is generally recommended. However, LD occasionally has complications including postpuncture headache, overdrainage symptoms, and increased length of stay. We retrospectively evaluated the outcome of our graded reconstruction strategy using a multilayer technique with a novel material, without LD, after EES. METHODS: Ninety-seven patients who underwent EES with grade II or III intraoperative CSF leak between June 2020 and March 2021 were retrospectively reviewed. For grade II CSF leak, fibrin sealant and a nasoseptal flap were placed; for grade III CSF leak, a multilayer technique was used in combination with collagen matrix, an acellular dermal graft, injectable hydroxyapatite (HXA), and a nasoseptal flap. Postoperatively, routine LD was not performed. RESULTS: This study included 48 (49.5%) grade II and 49 (50.5%) grade III CSF leaks. At follow-up (mean, 8.7 months), no patient showed postoperative CSF leak in either group. No HXA-associated complications occurred. CONCLUSIONS: A graded surgical repair strategy after EES could avoid postoperative CSF leak. Combined use of injectable HXA and acellular dermal grafts for high-flow CSF leak can limit LD requirement without significant risks.
Authors: Shin Heon Lee; Chang-Min Ha; Sang Duk Hong; Jung Won Choi; Ho Jun Seol; Do-Hyun Nam; Jung-Il Lee; Doo-Sik Kong Journal: Front Oncol Date: 2022-05-04 Impact factor: 5.738