Extracranial radial forearm free flap closure of refractory cerebrospinal fluid leaks:  a novel hybrid transantral-endoscopic approach.
BACKGROUND
Although rare, recalcitrant cerebrospinal fluid (CSF) leak after skull base tumor resection or major head trauma is a difficult therapeutic challenge, often complicated by lack of local vascularized tissue in a scarred, radiated field. Craniotomy with a free tissue transfer has been described for CSF leak repair from these complicated skull base defects.


OBJECTIVE
: We present our experience with a novel extracranial approach to manage refractory CSF leaks with a radial forearm free flap set in through a transantral and ethmoid sinus approach.


METHODS
Five patients with recalcitrant CSF leaks in the anterior skull base underwent radial forearm free tissue transfer via a hybrid transantral-endoscopic approach.


RESULTS
There were 4 female patients and 1 male patient. Average age was 58 years (range, 30-72 years). Four patients had previous neurosurgical anterior skull base tumor resections, and 1 patient had significant head trauma leading to a recalcitrant CSF leak. All 5 patients had undergone multiple prior endoscopic and/or open repairs. All 5 patients had successful resolution of their leak after undergoing radial forearm free tissue transfer. Two of 5 patients required a second minor endoscopic procedure. No patients required a craniotomy.


CONCLUSIONS
An extracranial transantral-endoscopic approach for the inset of radial forearm free flap is a safe treatment technique that precludes the need for a craniotomy and promotes effective repair of CSF leaks refractory to traditional endoscopic procedures.


BACKGROUND
RFFF, radial forearm free flap.
Department of Otolaryngology - Head & Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Parul
P
Sinha
Shaun C
SC
Desai
Dun H
DH
Ha
Michael R
MR
Chicoine
Bruce H
BH
Haughey
D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D005005:Ethmoid Sinus; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*