title: Combined use of a gasket seal closure and a vascularized pedicle nasoseptal flap multilayered reconstruction technique for high-flow cerebrospinal fluid leaks after endonasal endoscopic skull base surgery.
abstract: OBJECTIVE
  To assess the efficacy of the combined use of a gasket seal closure and a vascularized pedicle nasoseptal flap (VP-NSF) multilayered reconstruction technique for high-flow cerebrospinal fluid (CSF) leaks resulting from endonasal endoscopic skull base surgery.
  
  
  METHODS
  From October 2009-June 2011, a VP-NSF multilayered reconstruction technique was used (single technique group) for patients with intraoperative high-flow CSF leaks; from July 2011-February 2013, a combination of a gasket seal closure and a VP-NSF multilayered reconstruction technique was used (combined technique group). A lumbar drain was placed after the operation. The rates of postoperative CSF leaks and repair-related complications in the 2 groups were analyzed.
  
  
  RESULTS
  The single technique group comprised 18 patients with a mean follow-up of 31.7 months; there were 5 postoperative CSF leaks (27.7%). The combined technique group comprised 15 patients with a mean follow-up of 13.6 months; no CSF leaks occurred (P < 0.05). The rate of intracranial infection in the single technique group was significantly higher than in the combined technique group.
  
  
  CONCLUSIONS
  The combined use of a gasket seal closure and a VP-NSF multilayered reconstruction technique for high-flow CSF leaks after endonasal endoscopic skull base surgery may significantly reduce the rates of postoperative CSF leaks and intracranial infections. Lumbar drainage after the operation is a necessary auxiliary method.
authors.affiliation: Department of Neurosurgery at Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Hu
authors.affiliation: Department of Neurosurgery at Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Gu
authors.affiliation: Department of Neurosurgery at Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, China. Electronic address: xiaobiao_zhang@163.com.
authors.forename: Xiaobiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Anatomy/Digital Medical Research Center, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Xie
authors.affiliation: Department of Neurosurgery at Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery at Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Chongjing
authors.initials: C
authors.lastname: Sun
authors.affiliation: Department of Anatomy/Digital Medical Research Center, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Wensheng
authors.initials: W
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak; D003397:Craniopharyngioma / Q000601:surgery; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D044583:Neuroendoscopy; D009666:Nose; D010911:Pituitary Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D058106:Wound Closure Techniques
keywords: Endonasal endoscopic approach; Gasket seal closure; High-flow CSF leaks; Multilayered reconstruction; Skull base reconstruction; Vascularized pedicle nasoseptal flap