title: Management of anterior skull base defect depending on its size and location.
abstract: BACKGROUND
  We present our experience in the reconstruction of these leaks depending on their size and location.
  
  
  METHODS
  Fifty-four patients who underwent advanced skull base surgery (large defects, >20 mm) and 62 patients with CSF leaks of different origin (small, 2-10 mm, and midsize, 11-20 mm, defects) were included in the retrospective study. Large defects were reconstructed with a nasoseptal pedicled flap positioned on fat and fascia lata. In small and midsized leaks. Fascia lata in an underlay position was used for its reconstruction covered with mucoperiosteum of either the middle or the inferior turbinate.
  
  
  RESULTS
  The most frequent etiology for small and midsized defects was spontaneous (48.4%), followed by trauma (24.2%), iatrogenic (5%). The success rate after the first surgical reconstruction was 91% and 98% in large skull base defects and small/midsized, respectively. Rescue surgery achieved 100%.
  
  
  CONCLUSIONS
  Endoscopic surgery for any type of skull base defect is the gold standard. The size of the defects does not seem to play a significant role in the success rate. Fascia lata and mucoperiosteum of the turbinate allow a two-layer reconstruction of small and midsized defects. For larger skull base defects, a combination of fat, fascia lata, and nasoseptal pedicled flaps provides a successful reconstruction.
authors.affiliation: Department of ORL-HNS, Hospital Clinic, University of Barcelona Medical School, 08036 Barcelona, Spain ; Department of ORL-HNS, Rhinology and Skull Base Unit, Hospital Clínic, University of Barcelona Medical School, 08036 Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Bernal-Sprekelsen
authors.affiliation: Department of ORL-HNS, Althaia Xarxa Assistencial de Manresa, 08243 Manresa, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Rioja
authors.affiliation: Department of Neurosurgery, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Enseñat
authors.affiliation: Department of ORL-HNS, Hospital Clinic, University of Barcelona Medical School, 08036 Barcelona, Spain.
authors.forename: Karla
authors.initials: K
authors.lastname: Enriquez
authors.affiliation: Department of ORL-HNS, Hospital Clinic, University of Barcelona Medical School, 08036 Barcelona, Spain.
authors.forename: Liza
authors.initials: L
authors.lastname: Viscovich
authors.affiliation: Department of ORL-HNS, Rhinology and Skull Base Unit, Hospital Clínic, University of Barcelona Medical School, 08036 Barcelona, Spain ; Universidad del Valle, 76000 Cali, Colombia.
authors.forename: Freddy Enrique
authors.initials: FE
authors.lastname: Agredo-Lemos
authors.affiliation: Department of ORL-HNS, Hospital Clinic, University of Barcelona Medical School, 08036 Barcelona, Spain.
authors.forename: Isam
authors.initials: I
authors.lastname: Alobid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis* / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult