Clinical outcomes of intraoperative skull base reconstruction in endoscopic endonasal skull base tumor resection

Objective To summarize the reconstruction strategy and efficacy for skull base defect in endoscopic endonasal skull base tumor resection. Methods The clinical outcomes of 202 patients with skull base defect who underwent endoscopic tumor resection at Department of Neurosurgery, Huashan Hospital, Fudan University from April 2011 to February 2016 were retrospectively analyzed. Skull base defects were intraoperatively classified into Ⅰ-Ⅲ grades based on the diameter of dura defect and flow of cerebrospinal fluid (CSF), and corresponding reconstruction strategies were adopted. Results The classification result of 202 skull base defects was 15.8%(32 cases) in Grade Ⅰ, 24.3%(49 cases) in Grade Ⅱ and 59.9%(121 cases) in Grade Ⅲ. Six patients (3.0%) had postoperative CSF rhinorrhea, which resolved following secondary endoscopic repair surgery. Four patients (2.0%) had intracranial infection which was finally cured by antibiotics medication. One elderly patient (0.5%) died of pulmonary infection after prolonged bed rest after surgery. Conclusions Endoscopic surgery seems safe and effective for the reconstruction of skull base defect. The occurrence of postoperative CSF leakage could be effectively avoided when specific reconstruction strategy is adopted according to the classification of skull base defect. Key words: Natural orifice endoscopic surgery; Skull base neoplasms; Reconstructive surgical procedures; Skull base defect