CSF leak after endoscopic skull base surgery in children: A single institution experience.

Abstract

INTRODUCTION\nThe endoscopic expanded endonasal approach (EEA) has been shown to be a safe and effective surgical technique in the resection of pediatric skull base lesions. Cerebrospinal fluid (CSF) leaks are among the most common complications of this approach. Here we review skull base resections using EEA in pediatric patients at our single institution, to identify potential risk factors for this surgical complication.\n\n\nMETHODS\nA retrospective chart review was conducted on pediatric patients at our single institution for patients 19 years-old and under, who underwent an EEA for resection of a skull base tumor.\n\n\nRESULTS\nThirty-nine pediatric patients (ages 1-19 years) with 8 different tumor pathologies underwent an EEA for resection of their skull base tumors. 21 patients experienced an intraoperative CSF leak, of which 10 (48%) were high-flow leaks and 11 (52%) were low-flow leaks. Nasoseptal flaps were only used to repair the intraoperative high flow leaks (n\u202f=\u202f10), and low flow and no leaks were repaired with allograft and fat. No patients experienced a post-operative CSF leak.\n\n\nCONCLUSION\nIn our pediatric series, the skull base repair algorithm of using an NSF only in cases of high flow intraoperative leaks was effective, and no post-operative CSF leaks occurred. Not using an NSF in cases of low-flow or no leak cases allows for decreased anatomical disruption in the growing patient.