Which factors affect the postoperative CSF leak following endoscopic skull base surgery?
Reviewed by Sangeeta Maini and Bhaskar Ram

Endoscopic skull base surgery is being increasingly performed worldwide for skull base tumours. Common indications include pituitary tumours, rathke cleft cysts, chordomas, craniopharyngiomas and olfactory neuroblastomas. The most common and important complication following endoscopic skull base surgery is postoperative CSF leak. The senior author in this retrospective study had looked at 230 endoscopic skull base surgery cases in his institution. Key clinical factors assessed included patient’s co-existing morbidities such as diabetes mellitus (DM), preoperative radiotherapy, number of previous surgeries, tumour pathology, location of the pathology, the extent of the tumour, and the reconstruction method of the skull base defect. The team in their study had used different reconstructive techniques depending on which suited best for that case. Techniques commonly used included reconstruction of skull base defects with either pedicled flaps such as nasoseptal flaps (NSF), pericranial flaps, middle turbinate flaps, or use of free tissues such as fat tissue, fascia, and artificial materials. The most common technique used in their institution was the rescue flap with fat tissue or the nasoseptal flap. They report low complication rates in their series. They identified intraoperative CSF leak, tumour pathology and revision surgery as the main factors influencing the postoperative CSF leak. I found this paper interesting as it looked at the various co-morbid factors which could affect the outcome of skull base surgery. This helps when consenting patients for skull base surgery. We also liked the different reconstructive techniques used for closing the skull base defect, as suits the case.

Risk factor for cerebrospinal fluid leak after endoscopic endonasal skull base surgery: a single-center experience.
Hiroyuki Ozawa, Mariko Sekimizu, Shin Saito, et al.
ACTA OTOLARYNGOL
2021:141(6):621-5.