title: Choice of graft material and postoperative healing in endoscopic repair of cerebrospinal fluid leak.
abstract: OBJECTIVE
  To compare the postoperative healing profiles of graft materials used for endoscopic repair of cerebrospinal fluid (CSF) leak.
  
  
  METHODS
  Retrospective cohort study with 1 to 21 months of follow-up.
  
  
  METHODS
  Tertiary referral, academic medical center.
  
  
  METHODS
  Consecutive sample of patients undergoing endoscopic repair of CSF leak from March 2007 through May 2009.
  
  
  METHODS
  Endoscopic repair of CSF leak with acellular dermis, collagen matrix, or sinonasal mucosal grafts. Graft success, time to full graft mucosalization, and duration of graft or donor site crusting were assessed during the postoperative period.
  
  
  RESULTS
  Forty repairs were performed on 37 patients: 17 with mucosal grafts, 10 with acellular dermis, and 13 with collagen matrix grafts. The mean follow-up time was 5.3 months (range, 0.5-21.0 months). Two patients had partial graft loss; none had a recurrence of CSF leak. There was a significant difference in time to mucosalization with acellular dermis (11.7 weeks) when compared with collagen matrices (6.6 weeks) or mucosa (4.9 weeks) (P < .001). Graft crusting was more prolonged with acellular dermis (9.4 weeks) than with collagen matrices (5.1 weeks) (P = .04). No patients with mucosal grafts had graft crusting. Donor site crusting was present only in the mucosal group, with an average duration of 6.5 weeks (range, 1.0-20.0 weeks).
  
  
  CONCLUSIONS
  Mucosal grafts, acellular dermis, and collagen matrices have similar success rates in endoscopic repair of CSF leak. Acellular dermis grafts have longer time to mucosalization and more weeks of crusting than mucosal or collagen matrix grafts.
authors.affiliation: Department of Otolaryngology, Emory University, Atlanta, GA 30322, USA.
authors.forename: Kara K
authors.initials: KK
authors.lastname: Prickett
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Wise
authors.forename: John M
authors.initials: JM
authors.lastname: Delgaudio
mesh_terms: D000704:Analysis of Variance; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery; D003094:Collagen; D020405:Dermis / Q000637:transplantation*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D003094:Collagen