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Free Fat Grafts in Endoscopic Skull Base Closure: A Clinical Outcome Analysis
Daniel Ilie Rotariu1,2, Bogdan Florin Iliescu1,2, Razvan Buga2
1Department of Neurosurgery, Grigore T. Popa University of Medicine and Pharmacy Iasi, 11 Universitatii St., 700115 Iasi, Romania.
Journal of Clinical Medicine
|May 4, 2026
Summary
Autologous fat grafts for skull base reconstruction significantly resorb over time, losing over 80% volume by 15 months. Resorption varies by surgical approach, impacting imaging interpretation.
Area of Science:
- Neurosurgery
- Radiology
- Biomaterials Science
Background:
- Autologous fat grafting is a common technique for skull base reconstruction after endoscopic endonasal surgery.
- Postoperative volumetric changes in fat grafts can mimic or obscure residual/recurrent disease on imaging.
Purpose of the Study:
- To analyze the volumetric evolution of autologous fat grafts used in skull base reconstruction.
- To identify factors influencing fat graft resorption rates and patterns.
Main Methods:
- Retrospective volumetric imaging analysis of 34 patients undergoing endoscopic endonasal skull base surgery with fat graft reconstruction.
- Fat graft volumes measured using CT (postoperative day 1) and MRI (3, 9, 15 months) with standardized segmentation.
- Correlation of resorption rates with demographic, pathological, surgical, and postoperative variables.
Main Results:
- Mean initial fat graft volume was 3.01 cm³.
- Significant temporal decline in fat graft volume: 56.8% at 3 months, 75.3% at 9 months, and 81.8% at 15 months.
- Higher resorption observed with transsellar compared to transtuberculum approaches (p=0.042), related to graft compartment.
Conclusions:
- Autologous fat grafts exhibit substantial early resorption followed by slower progressive volume loss.
- Anatomical compartment influences resorption patterns, with overlap with surgical approach.
- Findings aid in interpreting postoperative imaging by defining expected fat graft evolution.
