Comparative Analysis of Autograft and Xenograft Based Multilayer Lateral Skull Base Reconstruction for Encephalocele And CSF Leaks

Nauman F. Manzoor; Douglas J. Totten; Kristen Yancey; Alexander D. Sherry; Marc L. Bennett; David S. Haynes; Alejandro Rivas

doi:10.1055/s-0040-1702729

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2020; 81(S 01): S1-S272
DOI: 10.1055/s-0040-1702729

Poster Presentations

Georg Thieme Verlag KG Stuttgart · New York

Comparative Analysis of Autograft and Xenograft Based Multilayer Lateral Skull Base Reconstruction for Encephalocele And CSF Leaks

Authors

Nauman F. Manzoor

¹Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Douglas J. Totten

²Vanderbilt University School of Medicine, Nashville, Tennessee, United States
Kristen Yancey

¹Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Alexander D. Sherry

²Vanderbilt University School of Medicine, Nashville, Tennessee, United States
Marc L. Bennett

¹Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
David S. Haynes

¹Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Alejandro Rivas

¹Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Abstract

Full Text

Objective: To compare the use of porcine small intestine submucosal grafts (PSISG, Biodesign) and standard autologous material (fascia) as a reconstructive material in multilayer repair of lateral skull base (LSB) defects.

Setting: Tertiary skull base center

Methods: Retrospective chart review. After IRB approval, a retrospective cohort study was performed including patients who underwent LSB defect repair in a multilayer fashion using either fascia autograft or porcine small intestinal submucosal grafts (PSISG, Biodesign). Demographics were summarized with descriptive statistics. The Kruskal-Wallis and Fisher's exact tests compared the cohorts. Single-predictor binary logistic regression evaluated the association of covariates with outcomes.

Results: 45 patients (mean age = 56 years (range 26–73) and female= 30 (67%) underwent LSB defect repair in a multilayer fashion using either fascia autograft (26 patients; 58%) or porcine small intestine submucosal grafts (Biodesign) (19 patients; 42%) from 2016–2019. Patients were followed for a minimum of six months after surgery. The mean BMI across all cohorts was 36 kg/m2 (range 22–57). BMI did not differ significantly between the Biodesign and fascia autograft cohort (p = 0.2232). The most common location of defect was the tegmen mastoideum (39, 87%) followed by the tegmen tympani (19, 42%) and posterior fossa plate (2, 4%). Intraoperatively, 21 patients (47%) were noted to have dural defects, 41 patients (91%) were noted to have encephalocele present and 34 (76%) were noted to have an active CSF leak. Intra-operative lumbar drains were used in 5 (26%) Biodesign cases and 13 (50%) fascia autograft cases (Biodesign vs. autograft: OR 0.357, 95% CI 0.099–1.282, p = 0.114).

There was no significant difference in defect location or intraoperative findings between the fascia autograft and Biodesign groups. There were no primary operative failures and recurrent CSF leaks in either cohort (0.0%).

Conclusion: Porcine small intestinal submucosal grafts (Biodesign) appear to provide an effective barrier as a component of multilayer reconstruction after surgical repair of LSB defects. Biodesign performs well in preventing recurrent CSF leaks and appears non-inferior to fascial autografts in LSB reconstruction.