Cranial Base Repair Using Suturing Technique Combined with a Mucosal Flap for Cerebrospinal Fluid Leakage During Endoscopic Endonasal Surgery.
OBJECTIVE
To evaluate a cranial base repair method using the dural suturing technique in combination with a mucosal flap in the endoscopic endonasal approach.


METHODS
We analyzed 190 patients (mean age, 52.3 years; age range, 3-86 years) who underwent 194 endoscopic endonasal approaches. The degree of intraoperative cerebrospinal fluid (CSF) leakage was graded based on previously published criteria: grade 0, absent; grade 1, small; grade 2, moderate; and grade 3, large. Cranial base repair using the dural suturing technique was performed according to the grade of CSF leakage: grades 1 and 2, autologous fat graft anchored by dural suturing covered with a sphenoid sinus mucosal flap, and grade 3, multilayered, inlay sutured and onlay nonsutured fascial grafts covered with a nasoseptal flap.


RESULTS
Intraoperative CSF leakage was observed in 125 of 194 cases (64.4%). The degree of CSF leakage was grade 0 in 69 cases, grade 1 in 51 cases, grade 2 in 30 cases, and grade 3 in 44 cases. A postoperative CSF leak was encountered in 2 of 125 repaired cases (1.6%). Both cases with CSF leak involved grade 3 CSF leak (4.5%), and both were successfully treated with lumbar drainage.


CONCLUSIONS
Our graded cranial base repair method using the dural suturing technique is simple and reliable.
Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan.
Takuma
T
Hara
Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan. Electronic address: akutsuh@md.tsukuba.ac.jp.
Hiroyoshi
H
Akutsu
Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan.
Tetsuya
T
Yamamoto
Department of Otolaryngology, University of Tsukuba, Tsukuba, Japan.
Shuho
S
Tanaka
Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan.
Shingo
S
Takano
Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan.
Eiichi
E
Ishikawa
Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan.
Masahide
M
Matsuda
Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan.
Akira
A
Matsumura
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000009:adverse effects; D009666:Nose; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps; D013536:Suture Techniques
Cerebrospinal fluid leak; Endoscopic endonasal surgery; Postoperative complication; Skull base repair