Synthetic polyurethane foam for sphenoid packing after endonasal skull base surgery: propensity-matched trends in cerebrospinal fluid leakage and sphenoid mucosal changes.

BACKGROUND

Postoperative cerebrospinal fluid (CSF) leakage and sphenoid sinusitis remain major concerns after endoscopic endonasal approaches (EEAs) for midline skull base tumors. To our knowledge, this study is among the first to directly compare synthetic polyurethane foam (SPF) with balloon catheters (BCs) for sphenoid sinus packing, assessing efficacy and safety, including in high‑flow CSF leaks.

METHODS

This retrospective, single-center, observational study included 116 patients who underwent EEAs between April 2016 and March 2025. Since May 2021, SPF has replaced BCs for sphenoid sinus packing. Propensity score matching (PSM) generated 43 matched pairs based on age, body mass index, and intraoperative CSF leak grade (Esposito classification). Outcomes were postoperative CSF leakage and magnetic resonance imaging-detected sphenoid mucosal changes.

RESULTS

Among 116 patients (median age, 50 years), 57 received SPF and 59 BCs. Postoperative CSF rhinorrhea occurred in 10 patients (8.6% overall), including 3.5% in the SPF group. All three reclosures occurred in the BC group. Post-matching, baseline variables were well balanced. Postoperative CSF leakage did not differ significantly between SPF and BCs (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.049–1.14 pre-PSM; OR 0.25, 95% CI 0.049–1.29 post-PSM). Postoperative radiologic sphenoid mucosal changes were significantly less frequent with SPF both before and after PSM (ORs 0.13 and 0.14; P < 0.001). Two SPF-group leaks resolved with conservative spinal drainage.

CONCLUSION

SPF achieved CSF leak rates comparable to BCs and consistent with recent reports (3.4–6.1%), along with fewer postoperative sphenoid mucosal changes on MRI.