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Continuous dural suturing for closure of grade 3 leaks after tumor removal via an endoscopic endonasal approach

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Abstract

Cerebrospinal fluid (CSF) leakage is a major complication after extended endonasal transsphenoidal surgery (EETSS), which is commonly used in the treatment of anterior skull base tumors. Dural suturing and graded reconstruction are promising techniques to further decrease the incidence of postoperative CSF (poCSF) leakage. The effect of continuous dural suturing in endoscopic surgery was investigated in this retrospective study. A total of 79 EETSS patients were included; the procedures were performed for subdural tumor removal by a single endoscopic neurosurgical team. Comparisons were applied between patients who did and did not undergo endoscopic dural suturing after tumor removal. Multivariate logistic regression analysis was performed to identify variables that significantly influenced the incidence of poCSF leakage. In all, 79 adult patients developed Esposito’s grade 3 intraoperative high-flow CSF leakage. Ten patients (12.7%) experienced poCSF leakage. One of the 36 patients who underwent intraoperative dural suturing developed poCSF leakage, compared with nine of 43 patients who did not undergo dural suturing (p = 0.016). Regression analysis showed that dural suturing could significantly decrease the incidence of poCSF leakage (p = 0.049, OR 0.108, 95% CI 0.013–0.899). Prophylactic lumbar drainage could also help decrease the CSF leakage rate. Dural suturing under endoscopy is a promising and effective method for application in skull base reconstruction after subdural skull base tumor removal. With future progress, lumbar drainage and even nasoseptal flap placement could be replaced in certain groups of patients undergoing EETSS.

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Hai Xue, Zhijun Yang, Jian Liu, Xingchao Wang, Zhiyong Bi & Pinan Liu

  2. China National Clinical Research Center for Neurological Disease, Beijing, China

    Hai Xue, Zhijun Yang, Xingchao Wang, Zhiyong Bi & Pinan Liu

  3. Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University,, Beijing, China

    Zhijun Yang, Xingchao Wang & Pinan Liu

  4. Department of Neurosurgery, The Second Hospital of Dalian Medical University, Dalian, China

    Jian Liu

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  1. Hai Xue
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Correspondence to Pinan Liu.

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All procedures performed in studies involving human participants were in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards and approved by the ethics committee of Beijing Tiantan Hospital.

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Consent was obtained from all patients for information collection and analysis.

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Xue, H., Yang, Z., Liu, J. et al. Continuous dural suturing for closure of grade 3 leaks after tumor removal via an endoscopic endonasal approach. Neurosurg Rev 44, 373–380 (2021). https://doi.org/10.1007/s10143-019-01199-w

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  • DOI: https://doi.org/10.1007/s10143-019-01199-w

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