title: Triple-layer reconstruction technique for large cribriform defects after endoscopic endonasal resection of anterior skull base tumors.
abstract: BACKGROUND
  Endoscopic endonasal transcribriform (EET) resection of anterior skull base (ASB) tumors results in large defects that may extend the entirety of the cribriform plate. Endoscopic repair of these cribriform defects can often be challenging. We describe our reconstruction technique for large ASB defects after EET resection of ASB tumors. This triple-layer technique is comprised of autologous fascia lata, acellular dermal allograft, and a vascularized pedicled nasoseptal flap (PNSF). The technique is described and postoperative cerebrospinal fluid (CSF) leak rate is evaluated.
  
  
  METHODS
  Retrospective review over a 2-year period identified 10 patients who underwent a purely EET approach for resection of ASB tumors. Patients who underwent combined cranionasal approaches and those treated for ASB encephaloceles were excluded from this study. After tumor resection, patients underwent triple-layer reconstruction using autologous fascia lata inlay, acellular dermal allograft inlay/overlay, followed by a PNSF to reconstruct the cribriform defect. No postoperative lumbar drainage was used.
  
  
  RESULTS
  The average cribriform defect size was 9.1 (range, 5.0-13.8) cm(2) . All 10 patients underwent successful reconstruction with a postoperative CSF leak rate of 0% without the use of postoperative lumbar drainage. The mean follow-up period was 7.4 (range, 2-17) months. The mean age was 45.8 (range, 15-81) years with 30% of the patients being females.
  
  
  CONCLUSIONS
  The triple-layer reconstruction technique is effective in reconstructing large ASB defects after endoscopic resection of the cribriform plate. We feel that the use of postoperative lumbar drainage is not necessary when using this repair technique.
authors.affiliation: Department of Otolaryngology-Head and 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: Smruti K
authors.initials: SK
authors.lastname: Patel
authors.forename: Pratik A
authors.initials: PA
authors.lastname: Shukla
authors.forename: Mickey L
authors.initials: ML
authors.lastname: Smith
authors.forename: Osamah J
authors.initials: OJ
authors.lastname: Choudhry
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects; D005004:Ethmoid Bone / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009380:Neoplasms, Nerve Tissue / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult