Endoscopic Skull Base Surgery Program Development at Roswell Park

Introduction: Recently our institution created a multidisciplinary endoscopic skull base program. Our skull base reconstruction evolved from using various grafts in our initial cases to exclusive use of vascularized septal mucoperichondrial flaps. This reconstructive paradigm change resulted in lower rates of postoperative CSF rhinorrhea. Interim evaluation suggests improved prevention of postoperative CSF rhinorrhea following skull base repair with a vascularized pedicled nasal septal flap.

Methods: Consecutive expanded endoscopic endonasal skull base procedures performed from April 2006 to March 2008 were reviewed. Patient demographics, final pathology, skull base reconstruction techniques, and complications were collected from clinical notes.

Results: Eighteen patients were treated over a 2-year period. Eight patients had fat autograft or AlloDerm (LifeCell Co., Branchburg, NJ) skull base reconstruction. Three of eight patients (38%) without nasoseptal flap closure experienced a CSF leak postoperatively. None of the 10 patients reconstructed with a posteriorly based septal mucoperichondrial flap experienced a CSF leak postoperatively. Lumbar drainage did not account for the difference observed.

Conclusions: Sellar floor reconstruction with a vascularized pedicle flap is a good option for skull base reconstruction. Beginning skull base programs may avoid postoperative complications by instituting this technique from their inception.