Efficacy of hydroxyapatite-based skull base reconstruction for intraoperative high-flow cerebrospinal fluid leakage performed by less-experienced surgeons

Cerebrospinal fluid (CSF) leakage after endoscopic skull base surgery remains a challenge despite multilayer reconstruction including nasoseptal flap (NSF) has become a standard technique. Injectable hydroxyapatite (HXA) has shown promising results to prevent CSF leakage. This study aimed to validat...

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Bibliographic Details
Published in:Scientific reports 2023-09, Vol.13 (1), p.14886-14886, Article 14886
Main Authors: Hong, Inseo, Kim, Kyung Hwan, Seo, Youngbeom, Choo, Yoon-Hee, Lee, Han-Joo, Kim, Seon-Hwan
Format: Article
Language:English
Subjects:
692/4028
692/617
Cerebrospinal fluid
Endoscopy
Fluid flow
Humanities and Social Sciences
Hydroxyapatite
Leakage
multidisciplinary
Neoplasia
Patients
Pituitary
Reconstructive surgery
Science
Science (multidisciplinary)
Skull
Surgeons
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Summary:Cerebrospinal fluid (CSF) leakage after endoscopic skull base surgery remains a challenge despite multilayer reconstruction including nasoseptal flap (NSF) has become a standard technique. Injectable hydroxyapatite (HXA) has shown promising results to prevent CSF leakage. This study aimed to validate the efficacy of HXA-based skull base reconstruction performed by less-experienced neurosurgeons who had short-term clinical experiences as independent surgeons. Between March 2018 and November 2022, 41 patients who experienced intraoperative high-flow CSF leakage following endoscopic endonasal surgery at two independent tertiary institutions were enrolled. Skull base reconstruction was performed using conventional multilayer techniques combined with or without HXA. The primary outcome was postoperative CSF leakage. The surgical steps and nuances were described in detail. The most common pathology was craniopharyngioma. Injectable HXA was used in 22 patients (HXA group) and conventional techniques were performed in 19 patients (control group). The HXA group achieved a significantly lower incidence of postoperative CSF leakage than the control group (0% vs. 26.3%, p = 0.016). No HXA-related complications were observed. The use of injectable HXA in skull base reconstruction was highly effective and safe. This technique and its favorable results might be readily reproduced by less-experienced neurosurgeons.
ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-023-42097-y