Complications and donor site morbidity of 3‐layer reconstruction with iliotibial tract of the anterior skull base: Retrospective analysis of 186 patients

Mattavelli, Davide; Schreiber, Alberto; Villaret, Andrea Bolzoni; Accorona, Remo; Turri‐Zanoni, Mario; Lambertoni, Alessia; Ferrari, Marco; Castelnuovo, Paolo; Nicolai, Piero

doi:10.1002/hed.24931

Cited by 24 publications

(21 citation statements)

References 18 publications

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“…23,26 Earlier studies on fascia lata complications for ptosis surgery, which is obviously achieved with smaller graft size, found lower satisfaction in the first week, which improved with time. 21,22 In our cohort of patients, 21.8% (n ¼ 26) had early, and 12.6% (n ¼ 15) had late CNS complications, and these rates are also similar to large published studies. 10,11 In an effort to identify the patients who had early CNS complications after fascia lata reconstruction, our univariate and multivariate analyses found that malignant histology and the use of continuous lumbar drainage were predictors for CNS complications.…”

Section: Discussionsupporting

confidence: 89%

Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience

Ringel

Abergel

Horowitz

et al. 2020

J Neurol Surg B Skull Base

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Objectives Reconstruction after open surgery of anterior skull base lesions is challenging. The fascia lata graft is our workhorse for achieving dural sealing and preventing cerebrospinal fluid leak and meningitis. This study seeks to analyze the donor and recipient site complication rates after fascia lata reconstruction. Methods This is a retrospective review of all open anterior skull base operations in which a double-layer fascia lata graft was used for the reconstruction of the defect from 2000 to 2016 at the Tel-Aviv Sourasky Medical Center, a tertiary referral center in Israel. Results Of the 369 patients operated for skull base lesions, 119 underwent open anterior skull base surgery and were reconstructed with a fascia lata graft. The patients' mean age was 47.1 years, and 68 (57.1%) were males. The overall postoperative early and late donor site complication rates were 6.7% (n = 8) and 5.9% (n = 7), respectively. Multivariate analysis found minor comorbidities and persistent/recurrent disease as being predictors for early-term complications. The overall postoperative early central nervous system (CNS) complication rate was 21.8% (n = 26), while 12.6% (n = 15) of the patients had late postoperative CNS complications. Conclusion Reconstruction of open anterior skull base lesions with fascia lata grafting is a safe procedure with acceptable complication and donor site morbidity rates.

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Section: Discussionsupporting

confidence: 89%

Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience

Ringel

Abergel

Horowitz

et al. 2020

J Neurol Surg B Skull Base

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“…More convincing evidence of the potential efficacy of free graft reconstruction techniques is provided by a recent study published by Matavelli et al, wherein the authors describe the results following the resection of 186 sinonasal malignancies, resulting in large anterior cranial fossa defects. Using autologous iliotibial tract and fat tissue in a three-layer reconstruction protocol, the authors reported a post-operative CSF leak rate of 5.8% (47). Although these studies do suggest that acceptable results can be obtained with the use of free graft techniques, in the absence of a trial comparing both techniques, the weight of the evidence suggests that lower rates of CSF leak are obtained with the use of local vascularized flaps, and this view is supported by the results of a systematic review comparing the efficacy of skull base reconstruction methods following EEA (48).…”

Section: Alternative Optionsmentioning

confidence: 99%

Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

2020

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Following the introduction of fully endoscopic techniques for the resection of pituitary tumors, there was a rapid expansion of the indications for endonasal endoscopic surgery to include extrasellar tumors of the skull base. These techniques offer significant advantages over traditional open surgical approaches to the skull base, including improved tumor resection, and better post-operative neurological outcomes. Following their introduction, however, the initial rate of post-operative CSF leak was unacceptably high. Post-operative CSF leak following skull base surgery is a major source of morbidity, and can lead to the development of life-threatening intracranial infection. The use of vascularized naso-septal flaps transformed the management of these patients, significantly reducing the rate of post-operative CSF leak and increasing the number of patients that could benefit from this less invasive treatment modality. Adequate repair of iatrogenic defects in the skull base is of crucial importance for patients with skull base tumors, as the development of a post-operative CSF leak, and the associated complications can significantly delay the administration of the adjunctive oncological therapies these patients require. In this review, we provide an overview of the latest evidence regarding skull base reconstruction following endoscopic skull base surgery, and describe the skull base repair technique in use at our institution.

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“…An I 2 value of 0% indicated no heterogeneity, while values less than 50% indicated low heterogeneity, values less than 75% indicated moderate heterogeneity and values above 75% indicated substantial heterogeneity. Egger's test and funnel plots were used to view (14) Flap Retrospective 7 8 238 2009-2017 Zwagerman (4) LD RCT Low 25 170 2011-2015 Kuan (15) Flap Retrospective 6 7 300 2013-2016 Caggiano (16) Obesity, LD , RTx Retrospective 8 18 811 2008-2017 Conger (10) Flap Retrospective 7 9 551 2010-2017 Turri-Zanoni (6) Flap, RTx, size Retrospective 9 26 513 1998-2017 Ben-Ari (17) LD, sella Retrospective 7 1 12 2011-2016 Patel (18) Flap, RTx Retrospective 8 38 806 2004-2016 Kutlay (19) TC Retrospective 5 9 106 2010-2017 Mattavelli (20) RTx Retrospective 9 11 186 2007-2015 Jeon (21) Flap, TC Retrospective 8 14 95 2009-2014 Patel (22) Obesity, flap Retrospective 7 3 16 1995-2016 Fraser (3) Obesity, flap, LD, Retrospective 8 103 615 1997-2012 Stapleton (9) Obesity, flap, sella, TC Retrospective 7 11 47 1999-2014 Shahangian (23) Flap, LD, RTx Retrospective, multicenter 9 112 2097 2002-2014 Fathalla (24) Size, sella, TC, FR Retrospective 7 4 84 1999-2014 Dolci (25) FR, sella Retrospective 7 3 40 2012-2014 Karnezis (26) Flap, LD, RTx, sella, FR Retrospective 8 68 1161 2002-2014 Roxbury (27) Obesity, FR Retrospective 6 5 73 2008-2014 Thomas (28) FR, sella Retrospective 7 6 43 2011-2015 Dehdashti (29) FR Retrospective 8 11 180 2009-2013 Nix (30) FR, sella, TC Retrospective 8 10 51 2009-2015 Horiguchi …”

Section: Statisticsmentioning

confidence: 99%

Risk factors for postoperative CSF leakage after endonasal endoscopic skull base surgery: a meta-analysis and systematic review

Kim¹,

Hong²

2020

Rhin

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Background: Cerebrospinal fluid (CSF) leakage is a complication that any surgeon working in the field of skull base surgery does not wish to encounter. The surgical approach to the skull base often varies, and the various sizes and locations of skull base lesions make it difficult to determine the cause of CSF leakage. However, it is useful to investigate which factors contribute to postoperative CSF leakage. Methods: Related studies were identified by searching the following databases: PubMed/Medline, Embase, and Web of Sciences through December 2019. Random-effects models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). The Newcastle-Ottawa scale was used to evaluate the quality of observational studies. Results: Our search yielded 56 retrospective cohort studies involving a total of 11,826 skull base surgical procedures. The overall rate of postoperative CSF leakage was 7.2%. The effect of obesity on postoperative CSF leakage had an OR of 1.88, and the effect of perioperative radiotherapy on postoperative CSF leakage yielded an OR of 1.87. High intraoperative CSF flow rate also had a significant OR of 2.98. On the other hand, a pedicled vascularized flap efficiently reduced the risk of postoperative CSF leakage. Defect size and the presence or absence of a lumbar drain had no effect on postoperative CSF leakage. Conclusions: This comprehensive quantitative assessment of postoperative CSF leakage showed that obesity, perioperative radiotherapy, and high intraoperative CSF flow rate raised the risk of CSF leakage; however, a pedicled vascularized flap can effectively reduce the risk of postoperative CSF leakage.

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Complications and donor site morbidity of 3‐layer reconstruction with iliotibial tract of the anterior skull base: Retrospective analysis of 186 patients

Cited by 24 publications

References 18 publications

Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience

Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience

Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

Risk factors for postoperative CSF leakage after endonasal endoscopic skull base surgery: a meta-analysis and systematic review

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