Xie Zhihai, Jiang Weihong, Zhang Hua, Zhao Suping, Xiao Jianyun
Department of Otolaryngology, Xiangya Hospital, Central South University, Changsha 410008, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2008 Sep;22(17):769-71.
To explore the methods and feasibility of the transnasal endoscopic reconstruction of the nasal-skull base defect to manage the cerebrospinal fluid leaks using intranasal autologous grafts.
Ninety six nasal-skull base defect patients with cerebrospinal fluid leaks were managed under endoscope with intranasal autologous materials. The repair materials and methods for the management of the cerebrospinal fluid leaks were tailored based on the different location and size of nasal-skull base defect. Eighteen cases with nasal-skull base defects less than 0.5 cm in diameter were repaired by an overlay technique using free mucoperiosteal graft from the middle turbinate. Thirty five patients with defects in the ethmoid roof and ethmoid plate ranging in size from 0.5 to 1.0 cm in diameter were repaired by an overlay technique using a pedicled middle turbinate flaps. Twelve cases with defects in the sellar clivus ranging in size from 0.5 to 1.0 cm in diameter were repaired by an overlay technique using a pedicled septal mucoperiosteal grafts. Nineteen cases with a diameter of 1.0 to 1.5 cm defects were repaired using free septal cartilage and mucoperiosteal grafts. Seven cases with defects in the ethmoid roof and ethmoid plate ranging from 1.5 to 2.5 cm in diameter were repaired using a pedicled middle turbinate and ethmoid plate flaps. Five sellar clival defect cases ranging from 1.5 to 2.5 cm in diameter were repaired using ethmoid plate and pedicled septal mucoperiosteal flaps.
Six months to 6 years' follow up indicated that two patient developed postoperative cerebrospinal fluid leaks one year and two years after operation, respectively. One was successfully managed by conservative treatment. The other was successfully repaired by second surgery. Three patients developed transient postoperative cerebrospinal fluid leak that was spontaneous recovered without special treatment. No other new postoperative cerebrospinal fluid leaks occurred.
We concluded that transnasal endoscopic reconstruction of the nasal-skull base defect is a highly effective method for managing the cerebrospinal fluid leak with the advantage of easily obtaining the intranasal autologous materials. The autologous materials should be varied based on different size and location of the skull base defects.
