Postoperative cerebrospinal fluid leak after microvascular reconstruction of craniofacial defects with orbital exenteration.
To assess risk factors for cerebrospinal fluid (CSF) leak and complications after microvascular reconstruction of cranio-orbitofacial resection with orbital exenteration (CFOE).



Retrospective case series.



Seventy consecutive patients at a tertiary hospital underwent 76 procedures with microvascular reconstruction of CFOE defects. Patients were stratified by extent of skull base exposure and presence or absence of dural resection. Patients with exposure of the orbital apex and roof alone were classified as minimal skull base exposure (MS) (n = 32). Those with skull base exposure beyond the orbital apex and roof were classified as significant skull base exposure (SS) (n = 38) and were subdivided into those with dural exposure (SSe) (n = 15) and those with dural resection (SSr) (n = 23). The main outcome measure was incidence of postoperative CSF leak according to univariate and multivariate analysis of risk factors, including previous radiation, surgery, and location of defect.



Intraoperative leaks occurred in five and four patients in the MS and SSe groups, respectively, with no postoperative leaks. In the SSr group, five patients developed a postoperative CSF leak and three required operative management. Multivariate analysis revealed middle fossa exposure to be the only significant predictor of CSF leak (P = 0.03). The overall complication rate was 31.6%. Major complications were greater in the SS group compared to the MS group (P = 0.05).



In this series, middle fossa resection increased the risk of postoperative CSF leak after microvascular reconstruction of CFOE defects, and complication rates were greater with more complex defects.



4. Laryngoscope, 127:835-841, 2017.
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Kurren S
0000-0003-4370-6110
KS
Gill
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
David
D
Hsu
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Patrick
P
Tassone
Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
John
J
Pluta
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Gurston
G
Nyquist
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Howard
H
Krein
Department of Ophthalmology, Oculoplastics and Orbital Surgery Service, Thomas Jefferson University Hospital and Wills Eye Institute, Philadelphia, Pennsylvania, U.S.A.
Jurij
J
Bilyk
Department of Ophthalmology, Oculoplastics and Orbital Surgery Service, Thomas Jefferson University Hospital and Wills Eye Institute, Philadelphia, Pennsylvania, U.S.A.
Ann P
AP
Murchison
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Alfred
A
Iloreta
Department of Neurological Surgery, Division of Neuro-Oncologic Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
James J
JJ
Evans
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Ryan N
RN
Heffelfinger
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Joseph M
JM
Curry
D017677:Age Distribution; D065634:Cerebrospinal Fluid Leak / Q000209:etiology / Q000601:surgery*; D015331:Cohort Studies; D016001:Confidence Intervals; D005151:Facial Injuries / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008579:Meningioma / Q000473:pathology / Q000601:surgery; D009918:Orbital Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply* / Q000637:transplantation; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods
Orbital exenteration; free tissue transfer; reconstruction; skull base