Endoscopic Endonasal Reconstruction of Anterior Skull Base Defects: What Factors Really Affect the Outcomes?

Related Articles

Endoscopic Endonasal Reconstruction of Anterior Skull Base Defects: What Factors Really Affect the Outcomes?

World Neurosurg. 2018 May 09;:

Authors: Turri-Zanoni M, Zocchi J, Lambertoni A, Giovannardi M, Karligkiotis A, Battaglia P, Locatelli D, Castelnuovo P

Abstract
OBJECTIVES: Endoscopic endonasal surgery has evolved considerably over the last few decades, requiring comparable advances in reconstructive techniques. The objectives of this study were to retrospectively review the outcomes of endoscopic anterior skull base (ASB) reconstruction and to analyze factors that might be associated with failures.
METHODS: Data from patients who underwent endoscopic endonasal ASB reconstruction in a single Institution between 1998 and 2017 were collected. Patients were stratified according to selected risk factors: sex, age, previous surgery, disease treated (cerebro-spinal fluid leaks, benign tumors, malignant tumors), single or multiple defects, defect dimension (<1cm2, 1-2cm2, 2-6 cm2, >6 cm2) and site (olfactory cleft, ethmoidal roof, planum sphenoidalis, posterior wall of frontal sinus), reconstruction technique (overlay graft, multilayer grafts, pedicled flap) and materials used, post-operative radiotherapy, and year of surgery. Statistical significance was assessed using Fisher's exact tests. A univariate logistic regression was implemented to analyze the association between risk factors and failures.
RESULTS: 513 cases met the inclusion criteria with a median follow-up of 96 months (range,12-257). There was a 95%(487/513) success rate for initial repair, with 100% for secondary closure after revision surgery. Failures were not significantly related to sex(p=.54), reconstruction technique(p=.28), location of the defect(p=.65), dimension(p=.69), disease(p=.83), and post-operative radiotherapy(p=.83). The year of surgery, considered as a continuous variable, was associated with a statistically significant reduction of failures (Odd-Ratio= 0.89,p.005).
CONCLUSION: Endoscopic surgery is safe and effective for ASB reconstruction. Refinements in surgical technique and increasing experience have contributed to improving success rates over the years.

PMID: 29753077 [PubMed - as supplied by publisher]

https://ift.tt/2IyaR2F