title: Endoscopic nasoseptal flap repair of skull base defects: is addition of a dural sealant necessary?
abstract: OBJECTIVE
  We compared the incidence of postoperative cerebrospinal fluid (CSF) leaks in patients undergoing endoscopic skull base repair with a pedicled nasoseptal flap (PNSF) with or without the addition of a dural sealant.
  
  
  METHODS
  Retrospective analysis at a tertiary care medical center.
  
  
  METHODS
  A retrospective analysis was performed at our tertiary care medical center on patients who underwent endoscopic repair of high-flow CSF leaks using a PNSF between December 2008 and August 2011. Repair materials, incidence of postoperative CSF leaks, and demographic data were collected.
  
  
  RESULTS
  Thirty-two high-flow CSF leaks were repaired with a PNSF alone without dural sealant (group A), and 42 were repaired with a PNSF with the addition of a dural sealant (group B). In group A, there were no postoperative CSF leaks (0%), whereas in group B, there was 1 delayed postoperative CSF leak, resulting in a 2.4% leak rate. The incidence of postoperative CSF leakage was not significantly different between the 2 groups (P = .38). The overall postoperative CSF leak rate was 1.4%.
  
  
  CONCLUSIONS
  The use of dural sealants when performing endoscopic PNSF repair of high-flow CSF leaks is not supported by our data. In addition, this practice may significantly increase surgical cost. We encountered no postoperative CSF leaks in patients with high-flow CSF leaks treated with PNSF alone without dural sealants. Meticulous surgical technique and proper positioning of the PNSF seem to obviate the need for dural sealants during endoscopic skull base reconstruction of high-flow CSF leaks.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey 07103, USA. jean.anderson.eloy@gmail.com
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.forename: Osamah J
authors.initials: OJ
authors.lastname: Choudhry
authors.forename: Mark E
authors.initials: ME
authors.lastname: Friedel
authors.forename: Arjuna B
authors.initials: AB
authors.lastname: Kuperan
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology* / Q000517:prevention & control*; D004724:Endoscopy; D005260:Female; D015718:Fibrin Tissue Adhesive; D006801:Humans; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000637:transplantation*; D059747:Nasal Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D012117:Resins, Synthetic; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps; D014014:Tissue Adhesives; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive; D012117:Resins, Synthetic; D014014:Tissue Adhesives; C030189:Dura-Seal