Comparison of the Lumbar Drain and the Hydroxyapatite Methods for Cerebrospinal Fluid Leakage after Endoscopic Skull Base Surgery

초록

Objective : This study aimed to compare the clinical outcomes and risk of two skull base reconstruction methods after expanded expanded endoscopic approach (EEA), viz. postoperative cerebrospinal fluid (CSF) lumbar drainage (L-method) and injectable hydroxyapatite cement without lumbar drainage (H-method). Methods : We enrolled 211 consecutive patients with grade 2 or 3 intraoperative CSF leakage during EEA. The most common preoperative diagnoses were pituitary adenoma (n=62, 29%), meningioma (n=50, 24%), and craniopharyngioma (n=28, 13%). Vascularized nasoseptal flaps were used in most cases (98%). We used the L-method and H-method in 83 (39%) and 103 patients (49%), respectively. Results : The overall reconstruction-related complication and postoperative CSF leakage rates were 8% (18/211) and 6% (12/211), respectively. The complications included postoperative CSF leakage (n=12), infection (n=4), postoperative optic nerve compression (n=1), and brain herniation (n=1). The postoperative complication and CSF leakage rates did not differ significantly between the L-method (12% and 10%, respectively) and H-method (8% and 4%, respectively) (p=0.326 and 0.112, respectively). Postoperative hospital stay was significantly shorter with the H-method (6.9 days) compared to the L-method (10.0 days) (p<0.001). However, the postoperative infection rate of the H-method (n=4) was higher than that of the L-method (n=0; p=0.070). Conclusion : Skull base reconstruction using hydroxyapatite effectively prevented postoperative CSF leakage and ensured patient comfort and shorter hospitalization without postoperative lumbar drainage, although postoperative infection requires consideration.

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