The Use of the Temporoparietal Fascial Flap in Preventing CSF Leak after Lateral Skull Base Surgery

Abstract

Objective Determine the effectiveness of the temporoparietal fascia flap (TPFF) with adipose tissue in preventing cerebrospinal fluid (CSF) leaks for lateral skull base tumor reconstruction.

Design A retrospective chart review from 2005 to 2010 was conducted of patients undergoing skull base tumor resection. Patients with TPFF reconstruction were compared with those with adipose packing alone based on lumbar drain placement, tumor size, extent of dissection, and incidence of CSF leak. Data was analyzed with a Fisher exact test at p < 0.05.

Setting Tertiary care institution.

Main Outcome Measures Incidence of CSF leak.

Results A total of 16 patients had a TPFF reconstruction; 20 had adipose only. Four TPFF patients had lumbar drain placement, as did six in the adipose-only group. Six patients had a CSF leak, all in the adipose-only group (p = 0.02). Patients with a lumbar drain were more likely to have larger tumors (p = 0.01) and to have a CSF leak if they had adipose-only reconstruction (p = 0.07).

Conclusions Lateral skull base reconstruction using TPFF with adipose tissue is easily performed and has a low operative morbidity. Early results show a significant decrease in the rate of CSF leak using TPFF, particularly in high-risk patients.

Keywords

cerebrospinal fluid leak - skull base surgery - skull base reconstruction - paraganglioma

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