Background
Materials and methods
Patients and group
Surgical technique
Inlay procedures
Partial dural suturing
Onlay of the fascia lata
Embedding of bone flap graft
PNSF application
Postoperative management
Collection of intraoperative and postoperative data
Statistical analysis
Results
Baseline characteristics
Characteristics | CEFB | PNSF |
---|---|---|
No. of patients | 110 | 65 |
Age at surgery | 50.12 (± 10.96) | 49.60 (± 9.14) |
(years, mean ± SD) | ||
Gender | ||
Male (%) | 62 (56.4%) | 36 (55.4%) |
Female (%) | 48 (43.6%) | 29 (44.6%) |
BMI (kg/m2, mean ± SD) | 23.09 (± 3.35) | 23.27(± 2.66) |
Diabetes (%) | 10 (9.1%) | 7 (10.8%) |
Smoking (%) | 52 (47.3%) | 31 (47.7%) |
Hypertension (%) | 36 (32.7%) | 24 (36.9%) |
Surgical approach | ||
EEA (%) | 72 (64.5%) | 39 (60.0%) |
EEEA (%) | 38 (34.5%) | 26 (40.0%) |
Lesion volume (cm3, mean ± SD) | 7.83 (± 2.04) | 7.75(± 2.47) |
Pathology | ||
Pituitary adenoma (%) | 70 (63.6%) | 41 (63.1%) |
Craniopharyngioma (%) | 20 (18.2%) | 15 (23.1%) |
Rathke Cyst (%) | 8 (7.3%) | 3 (4.6%) |
Arachnoid Cyst (%) | 4 (3.6%) | 1 (1.5%) |
Meningioma (%) | 8 (7.3%) | 5 (7.7%) |
Intraoperative and postoperative conditions
Characteristics | CEFB | PNSF |
---|---|---|
No. of patients | 110 | 65 |
Leak grade | ||
Grade II (%) | 69 (62.7%) | 33 (50.8%) |
Grade III (%) | 41 (37.3%) | 32 (49.2%) |
Leak size | 18.55 (± 2.41) | 18.38 (± 3.09) |
(mm2,mean ± SD) | ||
Gross total resection (%) | 100 (90.9%) | 58 (89.2) |
Surgery duration | 2.62 (± 0.56) | 2.26 (± 0.62) |
(hours, mean ± SD) | ||
Postoperative CSF leak (%) | 3 (2.7%) | 2 (3.1%) |
Infection (%) | 5 (4.5%) | 2 (3.1%) |
LD placement (%) | 6 (6.5%) | 4 (6.2%) |
LD duration (days, mean ± SD) | 6.67 (± 2.16) | 10.50(± 2.38) |
Epistaxis (%) | 0 (0) | 4 (6.2%) |
Dysosmia (%) | 1 (0.9%) | 3 (4.6%) |
Nasal discomforts (%) | 0 (0) | 5 (7.7%) |
Bed stay time | 5.74 (± 1.58) | 8.83(± 3.79) |
(days, mean SD) | ||
Hospitalization time | 10.49 (± 5.51) | 13.58(± 5.50) |
(days, mean ± SD) |
Subdivided comparisons
Subdivided characteristics | CEFB | PNSF | |
---|---|---|---|
Grade II leakage | No. of patients | 69 | 33 |
Postoperative CSF leak (%) | 2 (2.9%) | 1 (3.0%) | |
Infection (%) | 3 (4.3%) | 1 (3.0%) | |
LD placement (%) | 3 (4.3%) | 2 (6.1%) | |
Grade III leakage | No. of patients | 41 | 32 |
Postoperative CSF leak (%) | 1 (2.4%) | 1 (3.1%) | |
Infection (%) | 2 (4.9%) | 1 (3.1%) | |
LD placement (%) | 3 (7.3%) | 2 (6.3%) | |
Preoperative hydrocephalus | No. of patients | 5 | 3 |
Postoperative CSF leak (%) | 0 (0) | 1 (33.3%) | |
Infection | 1 (20.0%) | 0 (0) | |
LD placement (%) | 1 (20.0%) | 1 (33.3%) |
Additional supplementary cases
Discussion
Benefits of inlay and partial dural suturing in the CEFB technique
Comparison between the CEFB procedure and gasket-seal
Resistance of the CEFB construct against counteracting forces
Considerations regarding the application of PNSF
Authors and Year | Repair technique | Postoperative CSF leak rate | ||
---|---|---|---|---|
Overall | Grade 2 | Grade 3 | ||
Garcia-Navarro et al. (2013) [6] | Gasket seal closure ± LD, ± PNSF | 4.3% (2/46) | Data NA | 4.3% (2/46) |
Takayuki Ishikawa et al. (2018) [9] | Continuous dural suturing + fat graft + lactate plate ± PNSF | 3.9% (3/76) | 2.9%(1/34) | 4.7% (2/42) |
Andrew Conger et al. (2018) [19] | Fat + Collagen sponge + bone/ synthetic buttress + PNSF /sphenoid sinus mucosa | 3.9% (7/181) | 3.1%(3/98) | 4.8% (4/83) |
Biao Jin et al. (2020) [18] | ADM + ISBF ± fascia lata + PNSFs | 2.1% (1/47) | Data NA | 2.1% (1/47) |
Present study | ADM + fat + partial dural sturing + BFFE | 2.7% (3/110) | 2.9% (2/69) | 2.4% (1/41) |