Closure of dural defects in trans-nasal, extended, endoscopic techniques remains a challenge, and published cerebrospinal fluid (CSF) leak rates are higher than rates for trans-cranial approaches. Development of a technique that used a vascularized, nasoseptal flap (NSF) significantly reduced the rate of CSF leak, and several groups have developed ways to buttress the NSF. A closure technique developed at our institution uses a bilayer “button” of fascia lata. The initial series of twenty patients repaired with this method from 2007 to July 1, 2009 were presented, with a CSF leak rate of 10% (Luginbuhl et al 2010).
Luminais, Chris; Otten, M. L.; Farag, A. A.; Soni, P.; Mohiuddin, W.; Ziegler, N.; Nyquist, G. G.; Farrell, C.; Rosen, M. R.; and Evans, J. J., "Bilayer Button Graft for Endoscopic Repair of High-Flow Cranial Base Defects" (2015). Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds. Presentation 38.