Anterior Skull Base Reconstruction: Does Fat Preparation Matter?

Abstract

Objectives This article aims (1) to determine whether there is any difference in cerebrospinal fluid (CSF) leak rate after anterior skull base autologous fat reconstruction based on how the fat is prepared, and (2) to measure impact on surgical times by reconstruction type. Design Translational animal model surgical technique 3-arm trial, comparing two different methods of autologous fat skull base reconstruction versus a nonreconstructed control group. Setting Animal study. Subjects Adult Sprague-Dawley rats. Main Outcome Measures Resolution of CSF rhinorrhea after repair of a surgically created anterior skull base defect. Results Both wet (uncompressed) and dry (compressed) fat reconstruction of an anterior skull base defect demonstrated lower CSF leak rates than nonreconstructed defects. Dry fat reconstruction achieved significance in superiority of controlling CSF leak over no reconstruction (64% success vs. 31%); while wet fat reconstruction trended toward significance (50% vs. 31%). Reconstruction procedure time was longer than nonreconstructed controls, but there was no significant difference between type of fat preparation in surgical time. Conclusions This study demonstrates that drying and compressing the fat graft improves autologous fat reconstruction success for anterior skull base defects, and does not add significantly to surgical time over nonprepared fat.

Advances in Pituitary Surgery

“…It usually occurs following an extended transsphenoidal approach or in cases of revision surgery of the recurred pituitary adenoma. Various reconstruction techniques to repair these CSF leaks using different autologous (fat, fascia, cartilage, bone), allogenic and artificial materials (fibrin sealants) have been explored [44][45][46]. Although there is no consensus on what grafts and materials to use, a "multilayered" reconstruction method is important, especially for high-flow CSF leaks.…”

“…Low-flow CSF leaks can usually be repaired by sealing the defect with fibrin sealants, spraying tissue glue on top and positioning a temporary soft buttress in the nostrils to hold the repair construct in position. Some groups prefer to use autologous fat grafts to fill the sellar dead space [45,47] before sealing the defect with fibrin sealants; however, this does not seem necessary in most cases. Reconstruction for high-flow CSF leaks usually requires more layers to provide a more secure repair construct.…”