Comparison of the Lumbar Drain and the Hydroxyapatite Methods for Cerebrospinal Fluid Leakage after Endoscopic Skull Base Surgery.

OBJECTIVE

This study aimed to compare the clinical outcomes and risk of two skull base reconstruction methods after expanded expanded endoscopic approach (EEA), viz. postoperative cerebrospinal fluid (CSF) lumbar drainage (L-method) and injectable hydroxyapatite cement without lumbar drainage (H-method).

METHODS

We enrolled 211 consecutive patients with grade 2 or 3 intraoperative CSF leakage during EEA. The most common preoperative diagnoses were pituitary adenoma (n=62, 29%), meningioma (n=50, 24%), and craniopharyngioma (n=28, 13%). Vascularized nasoseptal flaps were used in most cases (98%). We used the L-method and H-method in 83 (39%) and 103 patients (49%), respectively.

RESULTS

The overall reconstruction-related complication and postoperative CSF leakage rates were 8% (18/211) and 6% (12/211), respectively. The complications included postoperative CSF leakage (n=12), infection (n=4), postoperative optic nerve compression (n=1), and brain herniation (n=1). The postoperative complication and CSF leakage rates did not differ significantly between the L-method (12% and 10%, respectively) and H-method (8% and 4%, respectively) (p=0.326 and 0.112, respectively). Postoperative hospital stay was significantly shorter with the H-method (6.9 days) compared to the L-method (10.0 days) (p<0.001). However, the postoperative infection rate of the H-method (n=4) was higher than that of the L-method (n=0; p=0.070).

CONCLUSION

Skull base reconstruction using hydroxyapatite effectively prevented postoperative CSF leakage and ensured patient comfort and shorter hospitalization without postoperative lumbar drainage, although postoperative infection requires consideration.