title: [CLOSURE OF NASOCRANIAL FISTULAS WITH "BATH-PLUG" TECHNIQUE AND MULTILAYER RECONSTRUCTION].
abstract: OBJECTIVE
  In case of dehiscenses developing on the anterior scull base, complete closure resulting in the cessation of the communication between the nasal cavity and the intracranial space is mandatory as soon as possible, in order to prevent serious complications. With the development of the endoscopic techniques, the endonasal management for the reconstruction has become available in recent decades.
  
  
  METHODS
  We aim to present the reconstruction techniques applied in our department in the cases of two patients recently operated at our institute. The choice of methods primarily depends on the size and the localization of the defect. Dehiscenses under 5 mm of diameter can be closed with the so called "bath-plug" technique, while bigger defects, where the required closure of the plug is not possible, can be solved with multilayer reconstruction. We use autogenous fascia, fat and muco-periosteum in both cases.
  
  
  RESULTS
  Our patient, who underwent the aforementioned "bath-plug" procedure, could be discharged after a few days of uneventful postoperative period. During a ten-month follow-up period new fistula formation was not observed. In the case of a patient who underwent multilayer reconstruction, meningitis occurred postoperatively, which was resolved after antibiotic therapy. During a 17-month follow-up period recurrent liquorrhoea did not occur.
  
  
  CONCLUSIONS
  With suitable technical background and appropriate endoscopic skills the surgeries of the anterior skull base cerebrospinal fluid fistulas can be performed efficiently and with low complication rate. These are minimally invasive procedures accompanied by less surgical trauma, morbidity and shorter hospitalization, hence these techniques are considered to be cost-effective and well-tolerated for the patients.
authors.forename: Zalán
authors.initials: Z
authors.lastname: Piski
authors.forename: András
authors.initials: A
authors.lastname: Büki
authors.forename: Nelli
authors.initials: N
authors.lastname: Nepp
authors.forename: Andráas
authors.initials: A
authors.lastname: Burián
authors.forename: Péter
authors.initials: P
authors.lastname: Révész
authors.forename: Imre
authors.initials: I
authors.lastname: Gerlinger
mesh_terms: D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D005402:Fistula / Q000150:complications* / Q000601:surgery*; D006801:Humans; D006814:Hungary; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy; D009666:Nose / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000191:economics / Q000379:methods*; D019291:Skull Base / Q000601:surgery*