No2-3(2) 2019
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DOI 10.37219/2528-8253-2019-2-14 |
Zabolotna DD, Ismagilov ER
The advantages of using a fragment of the fascia lata and autobone in the
reconstruction of defects in the base of the skull in patients with CSF leak |
Zabolotnaya Diana D
State Institution “Institute of otolaryngology named after Prof. O.S.
Kolomiychenko of the National Academy of Medical Sciences of Ukraine”; Kyiv,
Ukraine.
Clinical Allergology Department
Leading Researcher
Doctor of Medical Sciences
E-mail: dianazab@ukr.net
Ismagilov Eldar R.
State Institution “Institute of otolaryngology named after Prof. O.S.
Kolomiychenko of the National Academy of Medical Sciences of Ukraine”; Kyiv,
Ukraine
Graduate student
E-mail: ismagilovaldar08@gmail.com |
Abstract
Relevance: Diagnosis and treatment of patients with CSF leak, today,
is not a fully resolved problem. With small defects in the base of the
skull, the overlay technique has worked relatively well. However, when the
size of the bone defect is more than 0.6 cm, the surgeon has to resort to
the underlay technique of transplant placement.
Thus, the search for the optimal technique for reconstruction surgery of the
cerebrospinal fluid fistula, especially with large defects of the skull
base, is a complex and urgent problem.
Purpose of the study: To conduct a comparative assessment of the
techniques for reconstruction of the skull base defect lager than 0,6 cm in
the anterior cranial fossa in patients with CSF leak using endoscopic
endonasal approach.
Materials and methods: We observed 44 patients with CSF leak.
Depending on the technique of cerebrospinal fluid fistula repair, all
patients were divided into 2 groups. The first group of 21 patients was
patients who underwent reconstruction surgery of the skull base defect using
a generally accepted technique using a fragment of the fascia lata and
nasoseptal flap. The second group – 23 patients, consisted of patients who
underwent reconstruction surgery with a fragment o fascia lata with fixation
of it by a fragment of an autobone according to our technique, followed by
the use of a nasoseptal flap. The criterion for evaluating the effectiveness
of the surgical treatment was lack of relapse of CSF leak and data from
objective research methods (endoscopic examination of the nasal cavity).
Results: 1 month after surgical treatment, 3 (14,28%)patients of the
1st group experienced a recurrence of CSF leak, and 1(4,34%) patient of the
2nd group had a recurrence of CSF leak. In 2 patients of the 1st group there
was a relapse of CSF leak in the 3rd month of observation, there was no
recurrence of CSF leak in patients of the 2nd group, after 6 months in 1
patient of the 1st group there was a relapse of liquorrhea.
Conclusions: In patients with CSF leak with a bone defect greater
than 0.6 cm, it is appropriate to use the sandwich technique.
The technique of reconstruction CSF fistula using a fascia lata with its
fixation by autologous bone can significantly reduce the risk of CSF
recurrence in comparison with the use of generally accepted techniques for
CSF leak.
The use of autobone in reconstruction of the cerebrospinal fluid fistula
does not affect the change in the architectonics of the nose compared to the
generally accepted technique. |
Keywords
CSF leak, base of the skull, reconstruction of the cerebrospinal fluid
fistula.. |
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