Comparative analysis of transnasal endoscopic reconstruction techniques for managing cerebrospinal fluid rhinorrhea in skull base defects

Yishuai Tan; Jun Li; Yafeng Liu; Jintao Du

doi:10.1016/j.jocn.2024.05.010

Comparative analysis of transnasal endoscopic reconstruction techniques for managing cerebrospinal fluid rhinorrhea in skull base defects

J Clin Neurosci. 2024 May 13:125:38-42. doi: 10.1016/j.jocn.2024.05.010. Online ahead of print.

Authors

Yishuai Tan¹, Jun Li², Yafeng Liu³, Jintao Du⁴

Affiliations

¹ Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Chengdu 610041, China; West China School of Pharmacy, Sichuan University, No. 17, South Renmin Road, Chengdu 610041, China.
² Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Chengdu 610041, China; Affiliate Hospital of Sichuan Nursing Vocational Collage, The Third People's Hospital of Sichuan Province, Chengdu 610199, China.
³ Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Chengdu 610041, China.
⁴ Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Chengdu 610041, China. Electronic address: dujt@scu.edu.cn.

PMID: 38744121
DOI: 10.1016/j.jocn.2024.05.010

Abstract

The nasal skull base is located into the deep position of nasal cavity and closely related to important nerves and vessels. The complete removal of tumors in this area poses a complex surgical challenge.In order to investigate the clinical efficacy of utilizing free middle turbinate mucosa (FMT), fascia lata, and pedicled nasal septum flap (known as the Hadad-Bassagasteguy flap, HBF) for the treatment of cerebrospinal fluid (CSF) rhinorrhea, a retrospective analysis was conducted on clinical data from 65 patients who underwent skull base reconstruction following endoscopic resection of nasal-skull base tumors. The selection of the repair material was based on the size and location of the defect. For defects less than 1.5 cm (n = 24), FMT was chosen, while for defects greater than or equal to 1.5 cm (n = 16), HBF was preferred. In cases where HBF was not available or not suitable (specifically, when the defect was located on the posterior wall of the frontal sinus), fascia lata was selected (n = 25). The repair outcomes of all 65 patients were summarized, and subsequently, a comparison was made between the use of fascia lata and HBF. The overall success rate for one-time repairs was 93.8 %. Specifically, the success rates for repairs using FMT, fascia lata, and HBF were 91.7 %, 96.0 %, and 93.8 %, respectively. Throughout the follow-up period, there were 2 cases of postoperative CSF leakage out of 24 patients who underwent FMT reconstruction, 1 case out of 25 patients who underwent fascia lata reconstruction, and 1 case out of 16 patients who underwent HBF reconstruction. The occurrence of postoperative complications, such as intracranial infection, lung infection, and epistaxis, was observed in both the fascia lata group and the HBF group. However, there were no statistically significant differences between the two groups. The transnasal endoscopic reconstruction of skull base defect using HBF, fascia lata, and FMT demonstrated satisfactory repair effects in managing CSF rhinorrhea. Generally, FMT has been found to be a dependable repair material for small defects measuring less than 1.5 cm, while in the case of larger defects equal to or exceeding 1.5 cm, both HBF and fascia lata can be utilized with comparable repair outcomes. The selection of fascia lata becomes a viable option when HBF is unavailable or not suitable.

Keywords: Cerebrospinal fluid rhinorrhea; Fascia lata; Free middle turbinate mucosa; Hadad-Bassagasteguy flap; Nasal skull base; Skull base defect; Transnasal endoscopic reconstruction.