Skull base reconstruction: A question of flow? A critical analysis of 521 endoscopic endonasal surgeries.
Adenoma
/ pathology
Adolescent
Adult
Aged
Aged, 80 and over
Cerebrospinal Fluid Leak
/ etiology
Endoscopy
/ adverse effects
Female
Humans
Logistic Models
Male
Middle Aged
Neoplasm Grading
Postoperative Complications
Plastic Surgery Procedures
/ adverse effects
Retrospective Studies
Skull Base Neoplasms
/ pathology
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
13
06
2020
accepted:
23
12
2020
entrez:
15
3
2021
pubmed:
16
3
2021
medline:
1
9
2021
Statut:
epublish
Résumé
Post-operative CSF leak still represents the main drawback of Endoscopic Endonasal Approach (EEA), and different reconstructive strategies have been proposed in order to decrease its rate. To critically analyze the effectiveness of different adopted reconstruction strategies in patients that underwent EEA. Adult patients with skull base tumor surgically treated with EEA were retrospectively analyzed. Data recorded for each case concerned patient demographics, type of surgical approach, histotype, anatomical site of surgical approach, intra-operative CSF leak grade (no leak (INL), low flow (ILFL), high flow (IHFL)), reconstructive adopted strategy, Lumbar Drain positioning, post-operative CSF leak rate and intra/post-operative complications. A total number of 521 patients (January 2012-December 2019) was included. Intra-operative CSF leak grade showed to be associated with post-operative CSF leak rate. In particular, the risk to observe a post-operative CSF leak was higher when IHFL was encountered (25,5%; Exp(B) 16.25). In particular, vascularized multilayered reconstruction and fat use showed to be effective in lowering post-operative CSF leaks in IHFL (p 0.02). No differences were found considering INL and ILFL groups. Yearly post-operative CSF leak rate analysis showed a significative decreasing trend. Intra-operative CSF leak grade strongly affected post-operative CSF leak rate. Multilayer reconstruction with fat and naso-septal flap could reduce the rate of CSF leak in high risk patients. Reconstructive strategies should be tailored according also to the type and the anatomical site of the approach.
Identifiants
pubmed: 33720937
doi: 10.1371/journal.pone.0245119
pii: PONE-D-20-18057
pmc: PMC7959384
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0245119Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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