Graded Reconstruction Strategy Using a Multilayer Technique Without Lumbar Drainage After Endoscopic Endonasal...

Area of Science:

• Neurosurgery
• Otolaryngology
• Craniofacial Surgery

Background:

• Sellar reconstruction after endoscopic endonasal surgery (EES) for cerebrospinal fluid (CSF) leaks requires tailored approaches based on leak severity.
• High-flow CSF leaks (grade II-III) typically necessitate lumbar drainage (LD) alongside multilayer closure techniques.
• Lumbar drainage (LD) can lead to complications such as post-dural puncture headache and prolonged hospital stays.

Purpose of the Study:

• To evaluate a graded sellar reconstruction strategy using a multilayer technique with novel biomaterials, specifically avoiding lumbar drainage (LD) for high-flow CSF leaks after EES.
• To assess the efficacy and safety of this approach in preventing postoperative CSF leaks.

Main Methods:

• A retrospective review of 97 patients with grade II or III intraoperative CSF leaks following EES between June 2020 and March 2021.
• Grade II leaks were repaired with fibrin sealant and a nasoseptal flap.
• Grade III leaks utilized a multilayer technique with collagen matrix, acellular dermal graft, injectable hydroxyapatite (HXA), and a nasoseptal flap, without routine postoperative LD.

Main Results:

• The study included 48 grade II and 49 grade III CSF leaks.
• At a mean follow-up of 8.7 months, no postoperative CSF leaks were observed in either group.
• No complications related to the use of injectable hydroxyapatite (HXA) were reported.

Conclusions:

• A graded surgical repair strategy for EES-related CSF leaks can successfully prevent postoperative leakage.
• The combined use of injectable HXA and acellular dermal grafts for high-flow CSF leaks effectively minimizes the need for lumbar drainage (LD) without introducing significant risks.