Over the past decade, the technology of endoscopic transnasal treatment of skull base lesions has evolved. A common complication of transnasal approach to complex skull base lesions is the development of cerebrospinal fluid leakage. Chi-Man Jeon of the Department of Neurosurgery of the Department of Endoscopic Skull Base Surgery at Sungkyunkwan University School of Medicine in Seoul, South Korea, and others studied the effect of postoperative cerebrospinal fluid leakage repair in endoscopic transnasal treatment of skull base tumors and the reasons for the failure of skull base repair, and the results were published online in J Clin Neurosci in July 2017.
The study included 788 patients who underwent endoscopic nasal surgery for skull base lesions between February 2009 and December 2014 who were admitted to the authors' affiliations. Ninety-five patients were non-pituitary tumors; 38 were repaired with multi-layered non-vascular fascia tissue, and 57 patients were repaired with fascial binding with vascular pedicle nasal septum mucosal flap (Figure 1).
Figure 1. A. Multi-layer non-vascular fascia tissue repair; B. Nasal septal mucosal flap repair with vascular peduncle.
The results showed that 95 patients aged 9-77 years, with an average age of 49 years. The postoperative follow-up period was from 6 to 48 months, with an average of 10.7 months. Of the 95 cases, 13 were chordomas involving posterior fossa, 42 were craniopharyngiomas and 17 were meningiomas. Overall, 14 patients (14.7%) developed cerebrospinal fluid leakage after surgery, occurring for 1-66 days postoperatively, with an average of 5.3 days. The main reasons for repair failure are: in patients with multi-layer non-vascular fascial tissue repair, the characteristics of the graft cannot be fixed to the adjacent dura mater; in patients repaired with vascular pedunculated nasal septum mucosal valves, it can be caused by the destruction of mucosal valve integrity or insufficient mucosal valve length; cerebrospinal fluid pressure and gravity lead to mucosal valve displacement. Analysis of the factors of repair failure found that male patients had a higher failure rate of CSF leakage repair. Logistic regression analysis showed that patching failure was not related to age, sex, method of repair and reconstruction, or primary tumor type.
Finally, the authors note that there are still challenges in endoscopic transnasal access to skull base repair, particularly for non-pituitary skull base tumors that require resection into the subarachnoid space. At the same time, the surgeon needs to accumulate experience in skull base reconstruction technology through a lot of exercises to improve the success rate of repair.
Nonpituitary base of the skull with subarachnoid resection. At the same time, the surgeon needs to accumulate experience in skull base reconstruction technology through a lot of exercises to improve the success rate of repair.