Effects of cruciate embedding fascia-bone flap technique on grade II-III cerebral spinal fluid leak in endoscopic endonasal surgery

作者全名："Zhao, WenJi; Yang, Gang; Li, RuiChun; Huo, Gang; Gao, Dong; Cao, MingChuan; Wang, XiaoShu"

作者地址："[Zhao, WenJi; Yang, Gang; Huo, Gang; Gao, Dong; Cao, MingChuan; Wang, XiaoShu] Chongqing Med Univ, Dept Neurosurg, Affiliated Hosp 1, 1 Youyi Rd, Chongqing 400016, Peoples R China; [Li, RuiChun] Xi An Jiao Tong Univ, Dept Neurosurg, Affiliated Hosp 1, 277 West Yanta Rd, Xian 710061, Peoples R China"

通信作者："Wang, XS (通讯作者)，Chongqing Med Univ, Dept Neurosurg, Affiliated Hosp 1, 1 Youyi Rd, Chongqing 400016, Peoples R China."

来源：BMC SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000830708200001

JCR分区：Q3

影响因子：1.9

年份：2022

卷号：22

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Endoscopic endonasal surgery; CSF leak; Bone flap; Skull base reconstruction; Pedicle vascularized nasoseptal flap

摘要："Background Cerebral spinal fluid (CSF) leak remains an important issue in endoscopic endonasal surgery (EES). A standard protocol for skull base closure has not yet been established, and the application of rigid buttress has not been given sufficient attention. To emphasize the functions of support and fixation from rigid buttress in reconstruction, we introduced the cruciate embedding fascia-bone flap (CEFB) technique using autologous bone graft to buttress the fascia lata attachment to the partially sutured skull base dural defect and evaluated its efficacy in a consecutive case series of grade II-III CSF leaks in EES. Methods Data from consecutive patients diagnosed with sellar region lesions with grade II-III CSF leaks during EES were collected from May 2015 to May 2020. Skull base reconstructions were performed with the CEFB or the conventional pedicle vascularized nasoseptal flap (PNSF). Related clinical data were analysed. The combined use of the CEFB and PNSF was applied to an additional supplemental case series of patients with grade III leak and multiple high-risk factors. Results There were 110 and 65 patients included in the CEFB and PNSF groups, respectively. The CEFB demonstrated similar effects on the incidence of postoperative CSF leak (2.7%), intracranial infection (4.5%), and lumbar drainage (LD) placement (5.5%) as PNSF (3.1%, 3.1%, and 6.2%), but with less epistaxis (CEFB: 0%, PNSF: 6.2%) and nasal discomforts (CEFB: 0%, PNSF: 7.7%). The LD duration (CEFB: 6.67 +/- 2.16 days, PNSF: 10.50 +/- 2.38 days), bed-stay time (CEFB: 5.74 +/- 1.58 days, PNSF: 8.83 +/- 3.78 days) and hospitalization time (CEFB: 10.49 +/- 5.51 days, PNSF: 13.58 +/- 5.50 days) were shortened in the CEFB group. The combined use of CEFB and PNSF resulted in 0 postoperative CSF leaks in the supplemental case series of 23 highly susceptible patients. Conclusion This study suggested that the new CEFB technique has the potential to prevent postoperative CSF leak in EES. The results indicated that it can be used effectively without PNSF in suitable cases or applied in addition to a PNSF with high compatibility when necessary. Its effectiveness should be further verified with a larger cohort and better design in the next step. Trial Registration Current Controlled Trials ChiCTR2100044764 (Chinese Clinical Trial Registry); date of registration: 27 March 2020. Retrospectively registered"

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