Diagnosis And Treatment Of Cerebrospinal Fluid Nasal Leakage After Endoscopic Transnasal Skull Base Surgery And Analysis Of Risk Factors

Objective:We introduce the diagnosis and treatment of cerebrospinal fluid nasal leakage after transnasal endoscopic skull base surgery,the causes of cerebrospinal fluid nasal leakage after endoscopic exploration and analysis,and discuss the risk factors affecting cerebrospinal fluid(CSF)nasal leakage after endoscopic transnasal skull base surgery,in order to identify high-risk patients and further improve the shortcomings of the endoscopic transnasal surgical reconstruction process.Methods:The clinical data of 446 patients who underwent neuroendoscopic transnasal skull base treatment at the First Affiliated Hospital of Nanchang University from January 2018 to June 2021 were retrospectively analyzed.Postoperatively,they were divided into cerebrospinal fluid nasal leakage group(19 cases)and non-cerebrospinal fluid nasal leakage group(427 cases)according to whether cerebrospinal fluid nasal leakage occurred or not.Firstly,the causes leading to cerebrospinal fluid nasal leakage in patients with cerebrospinal fluid nasal leakage after endoscopic transnasal surgery were analyzed by transnasal endoscopic exploration.Secondly,gender,age,presence of underlying disease,preoperative gamma knife,recurrence,tumor size,tumor growth location,presence of intraoperative cerebrospinal fluid leak and grade of cerebrospinal fluid leak,use of bony reconstruction,use of balloon or iodoform gauze support,and presence of postoperative lumbar cistern drainage(LD)were included in the study,and the risk factors affecting the occurrence of postoperative cerebrospinal fluid leak in patients treated with transnasal endoscopic skull base surgery were analyzed by single-and multi-factor logistic regression analysis.Results:After 446 patients were treated by nasal endoscopy,postoperative cerebrospinal fluid nasal leakage occurred in 19 cases.Among these 19 patients with postoperative cerebrospinal fluid nasal leakage,all but 2 patients were cured by LD,and the remaining 17 patients were endoscopically explored and repaired.Except for 4patients who had 2 successful repairs of cerebrospinal fluid leaks,the remaining 13 patients had 1 successful repair.The causes of postoperative cerebrospinal fluid nasal leak during nasal endoscopic exploration and cerebrospinal fluid leak repair were insufficient embedded fat in one case,rupture of the inner dura in 10 cases,perforation of the vascularized pedicle nasoseptal flap(VP-NSF)in two cases,failure of the VP-NSF to fit the skull base in three cases,displacement of the VP-NSF in five cases,and inactivation of the VP-NSF in five cases.There were 12 cases of intracranial infection among the 19 patients with postoperative cerebrospinal fluid leakage,and all of them were discharged with no significant sequelae,except for one case of death due to intracranial infection.Univariate and multifactorial logistic analyses showed that lesion invasion of the suprasellar area and intraoperative high-flow cerebrospinal fluid leakage were risk factors affecting the occurrence of postoperative cerebrospinal fluid nasal leakage,while bony reconstruction was a protective factor.Conclusion:In case of cerebrospinal fluid nasal leakage after endoscopic transnasal skull base surgery,early endoscopic exploration and repair are recommended.The cause of cerebrospinal fluid nasal leakage after endoscopic transnasal skull base surgery was found to be irregularities in the multilayer skull base reconstruction process,so the multilayer skull base reconstruction technique should be given high priority.For patients with lesions invading the suprasellar area and high risk of intraoperative cerebrospinal fluid leakage,intraoperative skull base reconstruction techniques and postoperative management should be emphasized,while bony reconstruction combined with VP-NSF multi-layer skull base reconstruction can reduce the incidence of cerebrospinal fluid nasal leakage after endoscopic transnasal skull base surgery.