title: A new multilayer reconstruction using nasal septal flap combined with fascia graft dural suturing for high-flow cerebrospinal fluid leak after endoscopic endonasal surgery.
abstract: This study aimed to evaluate the usefulness and reliability of a new endoscopic multilayer reconstruction using nasal septal flap (NSF) to prevent high-flow cerebrospinal fluid leak after endoscopic endonasal surgery. This study was a retrospective review on 97 patients who underwent multilayer reconstructions using NSF combined with fascia graft dural suturing after endoscopic endonasal surgery between July 2012 and March 2014. Patients were divided into two groups, third ventricle opening group and nonopening group, based on the presence of a direct connection between the third ventricle and the paranasal sinus after tumor removal. Furthermore, we compared this procedure with our previous reconstruction after resection of craniopharyngioma. Finally, we checked the patients who had postoperative prolonged discomfort of the nasal cavity for over a year. Postoperative cerebrospinal fluid (CSF) leak occurred in three patients (3.1 %): one from the third ventricle opening group and the remaining two from the nonopening group. External lumbar drain was performed after surgery in only seven patients (7.2 %). The incidence of postoperative CSF leak was similar in both groups, whereas the rate of craniopharyngioma in the third ventricle opening group was significantly higher. The incidence of postoperative CSF leak after resection of craniopharyngioma was not statistically significant but obviously higher in the previous group (12.2 %) compared with that in the present group (2.3 %). Twelve patients (12.4 %) had postoperative nasal discomfort of the nasal cavity for over a year. Multilayer reconstruction using NSF combined with fascia graft dural suturing is a more reliable method for preventing postoperative high-flow CSF leakage after endoscopic endonasal surgery even if there is a direct connection between the third ventricle and the paranasal sinus. However, we should pay close attention especially to prolonged discomfort of the nasal cavity after harvesting NSF.
authors.affiliation: Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan. ken1977hori@gmail.com.|Department of Neurosurgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. ken1977hori@gmail.com.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Horiguchi
authors.affiliation: Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan.|Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishioka
authors.affiliation: Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Fukuhara
authors.affiliation: Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Yamaguchi-Okada
authors.affiliation: Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan.|Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Yamada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D044583:Neuroendoscopy; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000295:instrumentation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D019292:Skull Base Neoplasms / Q000601:surgery; D013524:Surgical Flaps; D055815:Young Adult
keywords: Dural suturing; High flow; Nasal septal flap; Postoperative cerebrospinal fluid leaks