Radiographic enhancement of the nasoseptal flap does not predict postoperative cerebrospinal fluid leaks in endoscopic skull base reconstruction

The Laryngoscope
Nithin D AdappaJohn Y K Lee

Abstract

Cerebrospinal fluid (CSF) leaks continue to be the most common postoperative complication in expanded endonasal skull base procedures. Currently, a multilayer closure using a vascularized nasoseptal flap is most commonly performed for large ventral skull base defects in an effort to avoid postoperative CSF leaks. We correlated nasoseptal flap enhancement with postoperative CSF leak rates in a group of skull base reconstruction patients. The nasoseptal flap enhancement was determined by immediate postoperative gadolinium-enhanced magnetic resonance imaging (MRI), which allowed for imaging of the flap's vascular pedicle. Our aim was to identify whether nasoseptal flap enhancement contributed to reduction of postoperative CSF leak rates. Retrospective cohort study. We reviewed 19 patients who underwent expanded endoscopic resections of skull base lesions of advanced complexity. We calculated the incidence of CSF leaks and measured the presence of nasoseptal flap enhancement. Of the 19 patients with immediate postoperative MRIs, three developed postoperative CSF leaks. All three CSF leaks were in cases with enhancing vascular pedicles. In contrast, we had three patients without evidence of flap enhancement, none of whom developed a...Continue Reading

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Citations

May 25, 2013·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Zarina S AliJohn Y K Lee
Oct 2, 2013·Minimally Invasive Surgery·Casey H HalpernJohn Y K Lee
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Nov 23, 2013·Journal of Neuro-oncology·John Y K LeeMarvin Bergsneider

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