Radial forearm free tissue transfer in the management of persistent cerebrospinal fluid leaks.
OBJECTIVE
Cerebrospinal fluid (CSF) leaks can occur after head trauma or skull base surgery. Persistent or spontaneous leaks should be repaired, since they put patients at risk for serious intracranial complications. Although numerous repair methods have been successful, the occasional patient develops a persistent leak. We describe our experience with free tissue transfer for repair of recalcitrant CSF leaks.


METHODS
Retrospective chart review of patients undergoing free tissue transfer for repair of a CSF leak between November 1995 and October 2004. Setting was an academic, tertiary care referral center.


METHODS
Twelve patients with persistent CSF leak were studied. Eleven of 12 patients had undergone a previous repair attempt ranging from endoscopic repair with fat graft to craniotomy and primary repair of the dural defect. All patients underwent radial forearm free tissue transfer.


RESULTS
There were six female and six male patients. Average age was 52.7 years (range, 22-80 y). The most common presenting complaints were intracranial abscess, recurrent meningitis, or pneumocephalus (n=9) and CSF otorrhea or rhinorrhea (n=8). Cause was head trauma (n=6), prior surgery (n=4), cholesteatoma (n=1), or meningoencephalocele (n=1). Eleven of 12 patients failed prior procedures (range, 0-6 procedures; mean, 1.9). Ten flaps were placed in the anterior skull base and two were in the middle or posterior skull base. Radial forearm free tissue transfer resulted in sustained resolution of CSF leakage in all 12 patients.


CONCLUSIONS
Free tissue transfer is an efficacious option in the repair of recalcitrant CSF leaks.
Weber
Stephen M
SM
Department of Otolaryngology and Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
Kim
Jason
J
Delashaw
Johnny B
JB
Wax
Mark K
MK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001922:Brain Abscess / Q000150:complications; D002558:Cerebrospinal Fluid Otorrhea / Q000601:surgery*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D002781:Cholesteatoma / Q000601:surgery; D006259:Craniocerebral Trauma / Q000601:surgery; D004677:Encephalocele; D005260:Female; D005542:Forearm / Q000601:surgery*; D006801:Humans; D008297:Male; D008581:Meningitis / Q000150:complications; D008591:Meningomyelocele / Q000601:surgery; D008875:Middle Aged; D011007:Pneumocephalus / Q000150:complications; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D013524:Surgical Flaps; D016896:Treatment Outcome