Division of Otolaryngology - Head and Neck Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
Department of Otolaryngology - Head & Neck Surgery, M. D. Anderson Cancer Center, Houston, Texas, USA.
Head Neck. 2021 Sep;43(9):2795-2806. doi: 10.1002/hed.26709. Epub 2021 May 11.
The incidence of cerebrospinal fluid leak after ventral skull base reconstruction is a primary outcome of interest to skull base surgeons. Exposure to pre-operative radiation may put patients at an increased risk of skull base reconstructive failure. A systematic search identified studies which included patients receiving ventral skull base reconstruction in the setting of pre-operative radiation. A meta-analysis using a random effects model was conducted to estimate an odds ratio of cerebrospinal fluid (CSF) leak in patients exposed to pre-operative radiation. A meta-analysis of 13 studies demonstrated that the odds ratio of CSF leak was 1.73 (95% CI 0.98-3.05). The majority of studies (77%) used vascularized tissue grafts for reconstruction. We identified an increased incidence of CSF leak among patients undergoing ventral skull base reconstruction after prior radiation therapy, although not of statistical significance. Skull base surgeons should exercise caution when planning reconstruction in this population.
颅底重建后发生脑脊液漏是颅底外科医生关注的主要结果之一。术前接受放射治疗可能会增加颅底重建失败的风险。系统检索确定了包括在术前放射治疗环境下接受颅底重建的患者的研究。使用随机效应模型进行荟萃分析，以估计暴露于术前放射治疗的患者发生脑脊液（CSF）漏的优势比。对 13 项研究的荟萃分析表明，CSF 漏的优势比为 1.73（95%CI 0.98-3.05）。大多数研究（77%）使用血管化组织移植物进行重建。我们发现，在先前接受过放射治疗的患者中，行颅底重建后发生脑脊液漏的发生率增加，但无统计学意义。颅底外科医生在为该人群计划重建时应谨慎。
