Graded reconstruction strategy using a multi-layer technique without lumbar drainage after endoscopic endonasal surgery

xlomafota13 shared this article with you from Inoreader Graded reconstruction strategy using a multi-layer technique without lumbar drainage after endoscopic endonasal surgery Via leak of cerebrospinal fluid World Neurosurg. 2021 Nov 9:S1878-8750(21)01704-6. doi: 10.1016/j.wneu.2021.11.003. Online ahead of print. ABSTRACT OBJECTIVE: Sellar reconstruction following endoscopic endonasal surgery (EES) requires modification based on the degree of cerebrospinal fluid (CSF) leak. For high-flow (grade II or III according to Esposito et al., 2007) intraoperative CSF leak, lumbar drainage (LD), in addition to the multi-layer closing technique, is generally recommended. However, LD has complications occasionally, including post-puncture headache, over-drainage symptoms, and increased length of stay (LOS). We retrospectively evaluated the outcome of our graded reconstruction strategy using a multi-layer technique with a novel material, without LD, after EES. METHODS: Ninety-seven patients who underwent EES with grade II or III intraoperative CSF leak between June 2020 and March 2021 were retrospectively reviewed. For grade II CSF leak, fibrin sealant and a nasoseptal flap (NSF) were placed; for grade III CSF leak, a multi-layer technique was utilized in combination with collagen matrix, an acellular dermal graft, injectable hydroxyapatite (HXA), and an NSF. Postoperatively, routine LD was not performed. RESULTS: This study included 48 (49.5%) grade II and 49 (50.5%) grade III CSF leaks. Upon follow-up period (mean, 8.7 months), no patient showed postoperative CSF leak in either group. No HXA-associated complications occurred. CONCLUSIONS: A graded surgical repair strategy after EES could avoid postoperative CSF leak. Combined use of injectable HXA and acellular dermal grafts for high-flow CSF leak can limit LD requirement, without significant risks. PMID:34767991< /a> | DOI:10.1016/j.wneu.2021.11.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.