J Neurol Surg B Skull Base 2020; 81(02): 128-135
DOI: 10.1055/s-0039-1677705
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Impact of Multilayer Vascularized Reconstruction after Skull Base Endoscopic Endonasal Approaches

Juan Antonio Simal-Julián
1  Neurosurgical Department HUiP La Fe Valencia, Valencia, Spain
Pablo Miranda-Lloret
1  Neurosurgical Department HUiP La Fe Valencia, Valencia, Spain
Laila Pérez de San Román Mena
1  Neurosurgical Department HUiP La Fe Valencia, Valencia, Spain
Pablo Sanromán-Álvarez
1  Neurosurgical Department HUiP La Fe Valencia, Valencia, Spain
2  Neurosurgical Department H Álvaro Cunqueiro Vigo, Spain
Alfonso García-Piñero
3  ENT Department HUiP La Fe, Valencia, Pontevedra, Spain
Rosa Sanchis-Martín
4  Anaesthesiology Department H General Universitario de Valencia, Valencia, Spain
Carlos Botella-Asunción
1  Neurosurgical Department HUiP La Fe Valencia, Valencia, Spain
Amin Kassam
5  Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, United States
› Author Affiliations
Funding No funding was received for this research.
Further Information

Publication History

02 October 2018

15 December 2018

Publication Date:
28 February 2019 (online)


Background The use of vascularized flap to reconstruct the skull base defects has dramatically changed the postoperative cerebrospinal fluid (CSF) leak rates allowing the expansion of endoscopic skull base procedures. At present, there is insufficient scientific evidence to permit identification of the optimal reconstruction technique after the endoscopic endonasal approach (EEA).

Objective The main purpose of this article is to establish the risk factors for failure in the reconstruction after EEA and whether the use of a surgical reconstruction protocol can improve the surgical results.

Material and Methods A retrospective cohort study was conducted in our institution, selecting patients that underwent EEA with intraoperative CSF leak. Two reconstructive protocols were defined based on different reconstructive techniques; both were vascularized but one monolayer and the other multilayer. A multivariate analysis was performed with outcome variable presentation of postoperative leak.

Results One hundred one patients were included in the study. Patients reconstructed with protocol 1, with the diagnosis different to the pituitary adenoma and older than 45 years old had higher risk of presenting postoperative leak, and with statistically significant differences when we adjusted for the remaining variables.

Conclusion The vascularized reconstructions after endoscopic endonasal skull base approaches have demonstrated to be able to obtain a low rate of postoperative CSF leak. The multilayer vascularized technique may provide a more evolved technique, even reducing the postoperative leak rates comparing with the monolayer vascularized one. The reconstructive protocol employed in each case, as well as age and histological diagnosis, is independent risk factor for presenting postoperative leak.

Ethical approval

For this type of study formal consent is not required.

Informed consent: Informed consent was obtained from all individual participants included in the study.