Effects Of Cruciate Embedding Fascia-bone Flap Technique On Grade Ⅱ-Ⅲ Cerebral Spinal Fluid Leak In Endoscopic Endonasal Surgery

[Background]Cerebral spinal fluid(CSF)leak remains an important issue of endoscopic endonasal surgery(EES),and no standard protocol of skull base reconstruction has been established yet.In this article,we introduce the cruciate embedding fascia-bone flap(CEFB)as a skull base reconstruction technique using autologous bone flap graft to buttress fascia lata attaching to partially sutured skull base dural defect,and evaluate its efficacy on a consecutive case series of intraoperative grade Ⅱ-Ⅲ CSF leak in EES.[Method]Data of consecutive patients with grade Ⅱ-Ⅲ CSF leak during EES were collected between May 2015 and May 2020.Skull base reconstructions were performed either with the CEFB,conventional PNSF,or combination of 2 methods.Related clinical data were compared and analyzed respectively.[Results]There are 110,65,and 23 patients included in CEFB,PNSF,and combination group respectively.CEFB demonstrated statistically similar effects on postoperative CSF leak(2.7%)and intracranial infection(4.5%)compared to PNSF(3.1%,3.1%),but with less morbidity of epistaxis(CEFB: 0%,PNSF: 6.2%)and nasal discomforts(CEFB: 0%,PNSF: 7.7%).The bed stay time(CEFB: 5.74 d,PNSF: 8.83d)and hospitalization time(CEFB: 10.49 d,PNSF: 13.58d)were shortened in CEFB group.Combination of CEFB and PNSF achieved 0 postoperative CSF leak in 23 highly susceptible patients with grade III leak and multiple high risk factors.[Conclusion]The CEFB technique is reliable and feasible to prevent postoperative CSF leak in EES.It can be used safely without PNSF in suitable cases,or applied in association with PNSF with high compatibility and security when necessary.