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Composite mucochondral flap for repair of cerebrospinal fluid leaks
M Friedman1, T K Venkatesan, D D Caldarelli
1Department of Otolaryngology and Bronchoesophagology, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
Background:
Cerebrospinal fluid leaks from defects in the anterior cranial fossa present a difficult management problem. Particularly when the defects are large, conventional techniques may not be sufficient to close them. We describe a new technique for treating such CSF leaks using a composite mucochondral flap from the nasal septum.
Methods:
We treated five patients with the composite mucochondral flap. All patients were women aged 29-60 years. Two patients had an encephalocele, one had an esthesioneuroblastoma, and one had adenocarcinoma; one leak was spontaneous.
Results:
The CSF leak was successfully closed in all five patients. No patients have experienced recurrence; the longest follow-up has been 39 months. The donor site on the septum healed without complication in all patients.
Conclusions:
The composite flap is useful for repairing large defects or after radiotherapy or trauma. The advantage of skeletal support to counter the pressure exerted by CSF seems clear.