No2(1) 2018
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DOI 10.37219/2528-8253-2018-2-18 |
Zabolotny DI, Zabolotna DD, Ismagilov ER
The advantages of using auto-fat tissue in the reconstruction of defects of
the skull base in patients with CSF leak |
Zabolotny Dmitry I
State Institution “Institute of otolaryngology named after Prof. O.S.
Kolomiychenko of the National Academy of Medical Sciences of Ukraine”; Kyiv,
Ukraine. Director
Doctor of Medical Sciences, Professor, Academician of the National Academy
of Medical Sciences of Ukraine
E-mail: amtc@kndio.kiev.ua
Zabolotnaya Diana D
State Institution “Institute of otolaryngology named after Prof. O.S.
Kolomiychenko of the National Academy of Medical Sciences of Ukraine”; Kyiv,
Ukraine.
Clinical Allergology Department, Leading Researcher, MD
E-mail: dianazab@ukr.net
Ismagilov Eldar R.
State Institution “Institute of otolaryngology named after Prof. O.S.
Kolomiychenko of the National Academy of Medical Sciences of Ukraine”; Kyiv,
Ukraine.
Graduate student
Email: ismagilovaldar08@gmail.com |
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Abstract
Relevance: At present, the method of repair of the cerebrospinal
fluid fistula using mucous flaps according to the “overlay” technique is
widely used in the reconstruction of the skull base and is generally
accepted. We have developed an original method for reconstructing defects of
the skull base in the presence of a cerebrospinal fluid fistula, using an
auto-fat tissue and placing it in two layers.
Objectives: To conduct a comparative assessment of methods for the
reconstruction of the skull base defect in patients with CSF leak using
endoscopic endonasal approach.
Materials and methods: Under our supervision there were 46 patients
with CSF leak. Depending on the technique of cerebrospinal fluid fistula
repair, all patients were divided into 2 groups. The first group of 20
patients consisted of patients who underwent surgery with auto-fat tissue
according to our proposed technique. The second group - 26 patients were
patients who underwent repair of the skull base defect using the standard
overlay technique - a mucous flap on the feeding vascular pedicle. The
criterion for evaluating the effectiveness of surgical treatment was patient
complaints and data from objective research methods (endoscopic examination
of the nasal cavity).
Results: After 3 months after surgical treatment, a patient of group
1 had a recurrence of liquorrhea, patients of group 2 after 3 months had a
recurrence of liquorrhea in 3 patients, after 6 months in 2 patients of
group 2 there was a recurrence of liquorrhea.
Findings: When the size of the bone defect of the base of the skull
is up to 0.6 cm, the original technique proposed by us for plastics of the
cerebrospinal fluid fistula with an auto-fat tissue in two layers provides a
tight closure of the bone defect and the defect of the dura mater. When
using this method of plastics, the risk of the development of a recurrence
of CSF leak is significantly reduced in comparison with the plastics of the
cerebrospinal fluid fistula with the use of overlay grafts. |
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Keywords
CSF leak, CSF leak repair. |
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