Nasoseptal flap repair after endoscopic transsellar versus expanded endonasal approaches: Is there an increased risk of postoperative cerebrospinal fluid leak?

Authors

  • Jean Anderson Eloy MD, FACS,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    2. Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    3. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey , University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    • Assistant Professor and Vice Chairman, Director of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, UMDNJ-New Jersey Medical School, 90 Bergen St., Suite 8100, Newark, NJ 07103
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  • Osamah J. Choudhry BA,

    1. Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • Pratik A. Shukla BA,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • Arjuna B. Kuperan MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • Mark E. Friedel MD, MPH,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • James K. Liu MD

    1. Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    2. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey , University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • Presented at the Triological Society Combined Sections Meeting, Miami, Florida, U.S.A., January 26–28, 2012.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

The development of expanded endoscopic endonasal approaches (EEAs) has allowed resection of cranial-base lesions beyond the sella. One major criticism is an increased risk of postoperative cerebrospinal fluid (CSF) leakage because of the larger skull base defect. We evaluated our experience with vascularized pedicled nasoseptal flap (PNSF) reconstruction and compared the postoperative CSF leak rates between patients undergoing endoscopic transsphenoidal (transsellar) approaches versus expanded EEA (transplanum-transtuberculum, transcribriform, transclival).

Study Design:

Retrospective analysis at a tertiary care medical center.

Methods:

A retrospective review of a prospective database was performed on patients who underwent PNSF reconstruction for intraoperative high-flow CSF leaks after EEA between December 2008 and August 2011. Demographic data, repair materials, surgical approach, and incidence of postoperative CSF leaks were collected.

Results:

Thirty-seven transsellar defects (group I) were repaired with a PNSF, and 32 expanded EEA defects (19 transplanum-transtuberculum, 10 transcribriform, three transclival) (group II) were repaired with a PNSF. No postoperative CSF leaks occurred in group I. One delayed postoperative CSF leak was encountered in group II leading to a 3.1% leak rate in that group. The incidence of postoperative CSF leakage was not significantly different between the two groups (P > .05). Our overall success rate in this series using a PNSF was 98.6%.

Conclusions:

Based on our data, there is no significant increased risk of postoperative CSF leak between transsellar and expanded EEA defects when a PNSF is used. The potential risk of postoperative CSF leaks associated with larger defects created through expanded EEA can be minimized by multilayered closure with a PNSF and meticulous surgical technique.

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