J Neurol Surg B Skull Base 2020; 81(S 01): S1-S272
DOI: 10.1055/s-0040-1702471
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Operative Strategy in Lateral Skull Base Reconstruction: Comparative of Rigid and Nonrigid Techniques

Kristen Yancey
1   Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Nauman F. Manzoor
1   Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Douglas J. Totten
2   Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Alexander D. Sherry
2   Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Alejandro Rivas
1   Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
David S. Haynes
1   Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Publikationsdatum:
05. Februar 2020 (online)

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Objective: To evaluate the use of rigid and soft-tissue reconstruction in lateral skull base (LSB) repair to prevent cerebrospinal fluid (CSF) leak after resection of spontaneous encephalocele or chronic middle ear disease–related middle fossa defect.

Setting: Tertiary skull base center.

Methods: Retrospective chart review. After IRB approval, a retrospective cohort study evaluating patients who underwent repair of LSB from spontaneous or chronic ear disease–related defects using either rigid or soft-tissue repair. Demographics were summarized with descriptive statistics. The Kruskal–Wallis and Fisher’s exact tests compared the cohorts. Single-predictor binary logistic regressions evaluated the association of covariates with outcomes.

Results: Forty-five patients (mean age = 56 years; range: 26–73; and female = 30 [67%]) who underwent LSB defect repair using multilayer rigid repair involving bone (32 patients; 71%) or soft-tissue repair (13 patients; 29%) from 2016 to 2019 were evaluated. Patients were followed up for a minimum of 6 months after surgery. The mean BMI across all cohorts was 36 (range: 22–57). BMI did not differ significantly between the rigid and soft-tissue cohorts (p = 0.7830). The most common location of defect was the tegmen mastoideum (39, 87%) followed by the tegmen tympani (19, 42%) and posterior fossa plate (2, 4%). Intraoperatively, 21 patients (47%) were noted to have dural defects, 41 patients (91%) were noted to have encephalocele, and 34 (76%) were noted to have an active CSF leak. There was no significant difference in defect location or intraoperative findings between the rigid and soft-tissue repair groups. There were no postoperative leaks in either cohort (0.0%). Lumbar drains were used in 10 (31%) rigid repair cases and 8 (62%) soft-tissue repair cases (rigid vs. soft tissue: OR, 0.284; 95% CI, 0.0874–1.090, p = 0.0666).

Conclusion: Both rigid and soft-tissue repair strategies provide an effective LSB reconstruction done for spontaneous as well as chronic ear disease–related defects. Choice of repair (rigid vs. nonrigid) is based on intraoperative determination of defect size and surgeon preference.