Related Experiment Video
Updated: Apr 28, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Management of anterior skull base defect depending on its size and location
Manuel Bernal-Sprekelsen1, Elena Rioja2, Joaquim Enseñat3
1Department of ORL-HNS, Hospital Clinic, University of Barcelona Medical School, 08036 Barcelona, Spain ; Department of ORL-HNS, Rhinology and Skull Base Unit, Hospital Clínic, University of Barcelona Medical School, 08036 Barcelona, Spain.
Introduction:
We present our experience in the reconstruction of these leaks depending on their size and location.
Material And Methods:
Fifty-four patients who underwent advanced skull base surgery (large defects, >20 mm) and 62 patients with CSF leaks of different origin (small, 2-10 mm, and midsize, 11-20 mm, defects) were included in the retrospective study. Large defects were reconstructed with a nasoseptal pedicled flap positioned on fat and fascia lata. In small and midsized leaks. Fascia lata in an underlay position was used for its reconstruction covered with mucoperiosteum of either the middle or the inferior turbinate.
Results:
The most frequent etiology for small and midsized defects was spontaneous (48.4%), followed by trauma (24.2%), iatrogenic (5%). The success rate after the first surgical reconstruction was 91% and 98% in large skull base defects and small/midsized, respectively. Rescue surgery achieved 100%.
Conclusions:
Endoscopic surgery for any type of skull base defect is the gold standard. The size of the defects does not seem to play a significant role in the success rate. Fascia lata and mucoperiosteum of the turbinate allow a two-layer reconstruction of small and midsized defects. For larger skull base defects, a combination of fat, fascia lata, and nasoseptal pedicled flaps provides a successful reconstruction.
