Comparing the Effects of Absorbable versus Nonabsorbable Nasal Packing on Postoperative Outcomes Following Endoscopic Ventral Skull Base Surgery

Abstract

Background

Advances in endoscopic endonasal approaches in ventral skull base surgery have led to increasingly complex resections and reconstructions. This study investigates differences in postoperative outcomes, including postoperative cerebrospinal fluid (CSF) leak and infection, following anterior skull base surgery and reconstruction, as a function of the type of nasal packing (absorbable vs. nonabsorbable) used to bolster the skull base reconstruction.

Methods

A retrospective chart review was performed at a single tertiary care institution. Patients who underwent ventral skull base surgery with placement of nasal packing between January 1, 2020, and December 1, 2023, were included. We included only patients of a single rhinologist (S.L.) involved. Outcome measures included postoperative CSF leaks and postoperative infection.

Results

Of the 179 patients meeting inclusion criteria, 105 patients (58.7%) received absorbable nasal packing (Nasopore), and 72 patients (40.2%) received nonabsorbable nasal packing (Merocel). Fifteen postoperative leaks occurred overall, with six CSF leaks reported in patients with absorbable nasal packing (5.7%) and nine CSF leaks reported in patients with Merocel packing (12.5%). Fifteen cases of postoperative infection were recorded, with nine cases in patients with absorbable nasal packing (8.6%) and six cases in patients with nonabsorbable nasal packing (8.3%). Overall, no statistically significant difference was found for the rate of postoperative CSF leak (p = 0.168) or infection (p = 0.309) between these two cohorts of patients.

Conclusion

While no significant differences were found in the rate of postoperative CSF leak or infection, additional patient factors should be taken into consideration when choosing between absorbable and nonabsorbable nasal packing for ventral skull base reconstruction.

Level of Evidence

4.

Keywords

nasal packing - anterior skull base - skull base surgery - skull base reconstruction - endoscopic endonasal approach

Publikationsverlauf

Eingereicht: 30. Januar 2025

Angenommen: 28. Juni 2025

Artikel online veröffentlicht:
14. Juli 2025

• References

• 1 Soudry E, Turner JH, Nayak JV, Hwang PH. Endoscopic reconstruction of surgically created skull base defects: a systematic review. Otolaryngol Head Neck Surg 2014; 150 (05) 730-738
• 2 Prickett KK, Wise SK, Delgaudio JM. Choice of graft material and postoperative healing in endoscopic repair of cerebrospinal fluid leak. Arch Otolaryngol Head Neck Surg 2011; 137 (05) 457-461
• 3 Patel MR, Stadler ME, Snyderman CH. et al. How to choose? Endoscopic skull base reconstructive options and limitations. Skull Base 2010; 20 (06) 397-404
• 4 Liu JK, Schmidt RF, Choudhry OJ, Shukla PA, Eloy JA. Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgery. Neurosurg Focus 2012; 32 (06) E7
• 5 Pang JC, Bitner BF, Nottoli MM. et al. Tissue sealant impact on skull base reconstruction outcomes: A systematic review and meta-analysis. Laryngoscope 2024; 134 (08) 3425-3436
• 6 Coucke B, Van Gerven L, De Vleeschouwer S, Van Calenbergh F, van Loon J, Theys T. The incidence of postoperative cerebrospinal fluid leakage after elective cranial surgery: a systematic review. Neurosurg Rev 2022; 45 (03) 1827-1845
• 7 Fraser S, Gardner PA, Koutourousiou M. et al. Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery. J Neurosurg 2018; 128 (04) 1066-1071
• 8 Ozawa H, Sekimizu M, Saito S. et al. Risk factor for cerebrospinal fluid leak after endoscopic endonasal skull base surgery: A single-center experience. Acta Otolaryngol 2021; 141 (06) 621-625
• 9 Stapleton AL, Tyler-Kabara EC, Gardner PA, Snyderman CH, Wang EW. Risk factors for cerebrospinal fluid leak in pediatric patients undergoing endoscopic endonasal skull base surgery. Int J Pediatr Otorhinolaryngol 2017; 93: 163-166
• 10 Papagiannopoulos P, Batra PS, Tajudeen BA. Postoperative management following skull base reconstruction. In: Kuan EC, Tajudeen BA, Djalilian HR, Lin HW. (eds). Skull Base Reconstruction. Cham: Springer; 2023. . Accessed July 2, 2025 at: https://doi.org/10.1007/978-3-031-27937-9_28
• 11 Ceraudo M, Cavallo LM, Rossi DC. et al. Role of anterior nasal packing in endoscopic skull base surgery: Italian survey. World Neurosurg 2021; 154: e406-e415
• 12 Jeon C, Hong SD, Seol HJ. et al. Corrigendum to “Reconstructive outcome of intraoperative cerebrospinal fluid leak after endoscopic endonasal surgery for tumors involving skull base” [J. Clin. Neurosci. 45 (2017) 227–231]. J Clin Neurosci 2018; 58: 235
• 13 Abiri A, Patel TR, Nguyen E. et al. Postoperative protocols following endoscopic skull base surgery: An evidence-based review with recommendations. Int Forum Allergy Rhinol 2023; 13 (01) 42-71
• 14 Asmaro K, Yoo F, Yassin-Kassab A. et al. Sinonasal packing is not a requisite for successful cerebrospinal fluid leak repair. J Neurol Surg B Skull Base 2021; 83 (05) 476-484
• 15 Zhou Z, Zuo F, Chen X. et al. Risk factors for postoperative cerebrospinal fluid leakage after transsphenoidal surgery for pituitary adenoma: a meta-analysis and systematic review. BMC Neurol 2021; 21 (01) 417
• 16 Douglas JE, Adappa ND, Choby G. et al. American Rhinologic Society expert practice statement part 2: Postoperative precautions and management principles following endoscopic skull base surgery. Int Forum Allergy Rhinol 2024; 14 (11) 1724-1738
• 17 Zoli M, Guaraldi F, Pasquini E, Frank G, Mazzatenta D. The endoscopic endonasal management of anterior skull base meningiomas. J Neurol Surg B Skull Base 2018; 79 (Suppl. 04) S300-S310