In-situ suture based on a nasoseptal mucosal flap for repair of grade 3 leaks associated with an expanded endoscopic endonasal approach

Abstract

Abstract Background To investigate the reliability and efficacy of a modified technique for preventing postoperative grade 3 leaks associated with an expanded endoscopic endonasal approach (EEEA). Method This study was a retrospective review of 33 patients who presented with intraoperative grade 3 leaks after the use of an EEEA for resection of skull base lesions from January 2017 to February 2022. Patients who received the conventional method from January 2017 to December 2019 were included in Group A. Patients who received the modified in-situ suture technique from 2020 onward were included in Group B. The Whitney test and chi-square test or Fisher's exact test were conducted to analyze the differences in several postoperative outcomes between the two groups. Result Five cases of postoperative CSF leaks and a single intracranial infection occurred in Group A. No postoperative CSF leaks or intracranial infection occurred in Group B. The in-situ suture technique avoided the need to take autologous fat and fascia lata from the thigh (p < 0.001), reduced postoperative bed rest (p < 0.001), and decreased the incidence of postoperative CSF leaks (p = 0.049) and the total hospital stay (p = 0.011). No significant differences in re-repair, hospitalization costs or postoperative intracranial infection were noted between the two groups. Conclusion This modified technique could represent an effective and safe option for repairing grade 3 leaks associated with the EEEA. In the future, the focus should be on increasing the number of surgeries and continuing follow-up to monitor and evaluate the long-term efficacy of this approach.