Investigation of the reasons and management of repair failure of high-flow cerebrospinal fluid rhinorrhea after endoscopic removal of skull base tumors

Abstract

Objective To investigate the reasons and management of repair failure of high-flow cerebrospinal fluid rhinorrhea (HFCSFR) after endoscopic resection of skull base tumors. Methods We retrospectively reviewed 5 patients with repair failure of HFCSFR after endoscopic removal of skull base tumors in our center from December 2012 to June 2016. The patients underwent reoperations for skull base repair. The reasons of repair failure and management strategies were analyzed. Results The reconstruction methods of skull base in the reoperation for HFCSFR included autologous fat inlay and autologous pedicled nasal septal flap onlay in one patient, autologous fat inlay and autologous fascia lata onlay in one patient, and autologous fat inlay and autologous fascia lata onlay and autologous pedicled nasal septal flap in 3 patients. The skull base was reconstructed well in 5 patients. The mean follow-up period was 20 months, and no HFCSFR reoccurred in 5 patients. Conclusions Repair of HFCSFR and reconstruction of skull base are the key to endoscopic removal of skull base tumors. The reasons of repair failure included improperly employing synthetic dura mater, failing to obliterate the dead space left behind by removal of tumors with fat grafts or fat liquefaction, non-healing of middle turbinate and dura mater, failing to cover the dural defect onlay with fascia lata, displacement of the repair grafts, ischemia and necrosis of nasal septal flap. The surgeons should pay more attention to the repairment of HFCSFR after endoscopic removal of skull base tumors. Reconstruction with multilayer grafts and vascularized autologous flaps is an effective and safe strategy. Formulating detailed operation plan and strictly following surgical procedure could avoid repair failure. DOI: 10.3969/j.issn.1672-6731.2019.04.005

Keywords

• Skull base neoplasms
• Endoscopes
• Cerebrospinal fluid rhinorrhea
• Neurosurgical procedures
• Reoperation