Journal of Clinical Case Reports

Skull Base Reconstruction Using Multilayer Method for Cerebrospinal Fluid Leakage During Endonasal Endoscopic Surgery for Tumor Removal

Abstract

Nishimura F, Park YS, Motoyama Y, Nakagawa I, Yamada S, Tamura K, Matsuda R, Takeshima Y, Takamura Y and Nakase H

Objective: A tight skull base reconstruction is important for patients undergoing endonasal endoscopic surgery. We report here details of our skull base reconstruction procedure using a multilayer method for intraoperative cerebrospinal fluid (CSF) leakage occurring during endonasal endoscopic surgery for tumor removal. Methods: To achieve a successful tight repair in cases with high-flow CSF leakage, we have adopted a multilayer method using inlay and onlay fascia, fat from abdomen, and rigid hard bone from nasal septal bone to stop CSF pulsation, as well as a nasoseptal flap to cover the skull base defect. Furthermore, a sinus balloon is inserted into the sphenoid sinus for a few days to secure the above listed materials keep them from falling. Results: Of the 144 patients who underwent endonasal endoscopic surgery performed from November 2008 to March 2015 at our institution, 48 had CSF leakage. The mean age of those patients was 54.9 years old and 41 had a pituitary adenoma, 5 at Rathke’s cleft cyst, 1 a chordoma, and 1 a malignant lymphoma. The mean tumor size was 29.1 mm. Esposito grade 1, 2, and 3 CSF leakage was seen in 18, 16, and 14 cases, respectively. Grade 3 cases had significantly larger tumors as compared to grade 1. There were no differences among the groups regarding the amount of gross total removal. Utilizing a multilayer method in 14 cases with high-flow CSF leakage during the operation, we were able to achieve a tight skull base reconstruction in all cases with no late CSF leakage. Conclusion: Skull base reconstruction with a multilayer method was effective to achieve a tight repair and stop intraoperative high-flow CSF leakage.