Collagen Matrix Combined With Hydroxyapatite and Nasoseptal Flap for Skull Base Reconstruction

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Cerebrospinal Fluid Leak Repair

Background:

• Extended endoscopic endonasal transsphenoidal approaches (ExEETSA) frequently cause high-flow cerebrospinal fluid (CSF) leaks.
• Standard nasoseptal flap (NSF) reconstruction may be insufficient for high-flow Grade 3 CSF leaks, necessitating rigid reconstruction.
• This study investigates a novel reconstruction method for these challenging leaks.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of using a collagen matrix combined with hydroxyapatite (HXA) and NSF for rigid skull base reconstruction.
• To assess outcomes without the use of lumbar drains in patients with high-flow Grade 3 CSF leaks following ExEETSA.
• To determine the incidence of postoperative CSF leakage, meningitis, and HXA-related complications.

Main Methods:

• A retrospective cohort study of 100 patients undergoing ExEETSA with intraoperative high-flow Grade 3 CSF leaks.
• Reconstruction involved a collagen matrix for dural repair, followed by HXA and NSF, without lumbar drainage.
• Data collected from January 2016 to December 2023, focusing on primary outcomes of CSF leakage, meningitis, and HXA complications.

Main Results:

• The median skull base defect was 22.9 mm, with tuberculum sellae meningioma being the most common pathology.
• Postoperative CSF leakage occurred in 4% of patients.
• Eight patients (8.0%) experienced HXA exposure with partial NSF necrosis, but 62.5% achieved complete re-mucosalization with a mean healing time of 23.6 months. No meningitis or reoperations for infection were reported.

Conclusions:

• The combined use of collagen matrix, HXA, and NSF is a safe and effective strategy for managing high-flow Grade 3 CSF leaks in ExEETSA.
• This technique demonstrates favorable long-term outcomes with low rates of CSF leakage and manageable complications.
• The absence of lumbar drainage in this cohort did not compromise the reconstructive success.