title: Long-term effectiveness of a reconstructive protocol using the nasoseptal flap after endoscopic skull base surgery.
abstract: OBJECTIVE
  To describe the effect on postoperative cerebrospinal fluid (CSF) leak after anterior skull base (ASB) surgery and complications associated with the addition of the vascularized nasoseptal flap (NSF) to an existing reconstruction protocol.
  
  
  METHODS
  A prospective database of all patients undergoing endoscopic ASB approaches was reviewed. Patients were divided into three groups based on the date the use of the NSF was adopted. Group A included patients with high-volume CSF leak closed using the NSF in addition to a multilayer closure. Group B included patients operated on during the same time period with no high-volume leak and no NSF. Group C included patients operated on before the adoption of the NSF with all types of CSF leak. Rates of intraoperative and postoperative CSF leak were analyzed for statistical significance.
  
  
  RESULTS
  Of 415 consecutive patients undergoing endoscopic ASB surgery, there were 96 in group A, 114 in group B, and 205 in group C. CSF leak rates in group A (3.1%) and group B (2.6%) were significantly lower than in group C (5.9%; P < 0.05). Lumbar drains and the gasket seal closure were performed more frequently in group A (75% and 32%) compared with group B (21% and 12%) and group C (28% and 11%). NSF carried a 2% risk of postoperative mucocele.
  
  
  CONCLUSIONS
  The addition of NSF to an algorithm for multilayer closure can decrease the rate of postoperative CSF leak.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York.
authors.forename: Edward D
authors.initials: ED
authors.lastname: McCoul
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.affiliation: Department of Otolaryngology, George Washington University Medical Center, Washington, DC.
authors.forename: Ameet
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Otolaryngology, Jefferson Medical College, Philadelphia, Pennsylvania.
authors.forename: Gurston G
authors.initials: GG
authors.lastname: Nyquist
authors.affiliation: Department of Otolaryngology, New York Eye and Ear Infirmary, New York, New York, USA.
authors.forename: Madeleine R
authors.initials: MR
authors.lastname: Schaberg
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York; Department of Neurological Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York; Department of Neurology and Neuroscience, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York. Electronic address: schwarh@med.cornell.edu.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000465:Algorithms; D001284:Atrophy; D001921:Brain / Q000473:pathology; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000473:pathology; D016208:Databases, Factual; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects; D016896:Treatment Outcome