title: Efficacy of the pedicled nasoseptal flap without cerebrospinal fluid (CSF) diversion for repair of skull base defects: incidence of postoperative CSF leaks.
abstract: BACKGROUND
  The advances in endoscopic skull base surgery have led to the resection of increasingly larger cranial base lesions and the creation of larger skull base defects with the potential for increased postoperative high-flow cerebrospinal fluid (CSF) leaks. These concerns led to the development of the vascularized pedicled nasoseptal flap (PNSF), which is now used as the mainstay for repair of large skull base defects in many academic centers. In this report, we review the incidence of postoperative CSF leaks in our institution in patients undergoing endoscopic skull base repair of high-flow CSF leaks with a vascularized PNSF without concurrent CSF diversion.
  
  
  METHODS
  We performed a retrospective analysis at our tertiary care medical center on patients who underwent endoscopic repair of high-flow CSF leaks using a PNSF without CSF diversion between July 2008 and August 2011. Repair materials, incidence of postoperative CSF leaks, and demographic data were collected.
  
  
  RESULTS
  Fifty-nine high-flow CSF leaks were repaired with a PNSF and other repair materials, without the use of lumbar catheter drainage. No postoperative CSF leak occurred in this cohort of patients. The overall postoperative CSF leak rate was 0%.
  
  
  CONCLUSIONS
  Meticulous multilayer-closure of skull base defects is critical to prevent postoperative CSF leaks. Although lumbar drainage may be useful in select scenarios, it carries inherent risks of intracranial hypotension and pneumocephalus, and may not be necessary for routine management of high-flow CSF leaks in conjunction with a robust PNSF. Further prospective randomized controlled studies may be warranted to evaluate the efficacy of postoperative lumbar drainage.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ 07103, USA. jean.anderson.eloy@gmail.com
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.forename: Arjuna B
authors.initials: AB
authors.lastname: Kuperan
authors.forename: Osamah J
authors.initials: OJ
authors.lastname: Choudhry
authors.forename: Sanaz
authors.initials: S
authors.lastname: Harirchian
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003397:Craniopharyngioma / Q000453:epidemiology / Q000601:surgery; D004724:Endoscopy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008577:Meningeal Neoplasms / Q000453:epidemiology / Q000601:surgery; D008579:Meningioma / Q000453:epidemiology / Q000601:surgery; D008875:Middle Aged; D009300:Nasal Septum / Q000637:transplantation; D010911:Pituitary Neoplasms / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019291:Skull Base / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000453:epidemiology / Q000601:surgery; D013524:Surgical Flaps / Q000637:transplantation; D055815:Young Adult