title: Assessment of Abdominal Fat Graft to Repair Anterior Skull Base after Malignant Sinonasal Tumor Extirpation.
abstract: OBJECTIVE
  Adult abdominal fat, which is known to contain pluripotent stem cells, is frequently used to treat cerebrospinal fluid leak. The aim of this study was to assess the efficacy and reliability of abdominal fat graft to close large skull base defects after extirpation of malignant sinonasal tumors.
  
  
  METHODS
  Case series with chart review performed between 2009 and 2014.
  
  
  METHODS
  Twenty-nine cases were included of consecutive patients who were suffering from malignant sinonasal tumors, operated by an endoscopic endonasal approach with anterior skull base extirpation and surgically induced cerebrospinal fluid leak. Skull base was repaired by 1 layer of "en bloc" autologous fat graft used as a plug in the onlay position. Epidemiologic data, medical history, defect size, length of hospitalization, and morbidity were analyzed.
  
  
  RESULTS
  Radiotherapy was given pre- and postoperatively in 4 (13.8%) and 23 (79.3%) patients, respectively. Mean defect size was 4.47 ± 2.9 cm(2) (range, 0.24-9.1 cm(2)). Mean operative time was 210 ± 86 minutes. Mean length of hospitalization was 8.6 ± 3.7 days and 4.9 ± 2 days in the intensive care unit. No lumbar drain was used in this study. There was 1 case of cerebrospinal fluid leak (3.5%) and 2 cases of meningitis (6.9%), which resolved after medical treatment. Mean follow-up was 17 ± 13 months (range, 3-53 months).
  
  
  CONCLUSIONS
  Abdominal fat graft is a safe and reliable material to close the anterior skull base after extirpation of malignant sinonasal tumors.
authors.affiliation: ENT Department, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: David
authors.initials: D
authors.lastname: Fonmarty
authors.affiliation: ENT Department, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Bastier
authors.affiliation: ENT Department, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Lechot
authors.affiliation: Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Gimbert
authors.affiliation: ENT Department, University Hospital of Bordeaux, Bordeaux, France ludovic.de-gabory@chu-bordeaux.fr.
authors.forename: Ludovic
authors.initials: L
authors.lastname: de Gabory
mesh_terms: D050153:Abdominal Fat / Q000637:transplantation*; D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak / Q000601:surgery*; D004724:Endoscopy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D010255:Paranasal Sinus Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D015203:Reproducibility of Results; D019291:Skull Base / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: endoscopic surgery; fat; sinonasal cancer; skull base surgery; stem cell