Cerebrospinal fluid leak after microvascular reconstruction of large craniofacial defects with orbital exenteration

Authors

Kurren Gill, BA, Thomas Jefferson University – Dept of Otolaryngology-Head & Neck SurgeryFollow
David Hsu, MD, Thomas Jefferson University – Dept of Otolaryngology-Head & Neck SurgeryFollow
Patrick Tassone, MD,, Thomas Jefferson University – Dept of Otolaryngology-Head & Neck SurgeryFollow
John Pluta, MD, University of Pennsylvania – Dept of Radiology
Gurston G. Nyquist, MD, Thomas Jefferson University – Dept of Otolaryngology-Head & Neck SurgeryFollow
Howard Krein, MD, PhD, Thomas Jefferson University – Dept of Otolaryngology-Head & Neck SurgeryFollow
Jurij Bilyk, MD, Thomas Jefferson University and Wills Eye Institute - Dept of OculoplasticsFollow
Ann P. Murchison, MD, Thomas Jefferson University and Wills Eye Institute - Dept of OculoplasticsFollow
Alfred Iloreta, MD, Thomas Jefferson University – Dept of Otolaryngology-Head & Neck SurgeryFollow
James J. Evans, MD, Thomas Jefferson University – Dept of Neurological SurgeryFollow
Ryan N. Heffelfinger, MD, Thomas Jefferson University – Dept of Otolaryngology-Head & Neck SurgeryFollow
Joseph M. Curry, MD, Thomas Jefferson University – Dept of Otolaryngology-Head & Neck SurgeryFollow

Files

Description

Abstract

Objectives: To assess risk factors for cerebrospinal fluid (CSF) leak after microvascular reconstruction of extensive cranio-orbitofacial resection with orbital exenteration (CFOE).

Study Design: Retrospective Case Series

Methods: 70 consecutive patients at a tertiary hospital underwent 76 procedures with microvascular reconstruction of CFOE defects. Patients were stratified by extent of skull base exposure and presence or absence of dural resection. Patients with exposure of the orbital apex and roof alone were classified as minimal skullbase exposure (MSE, n=32). Those with exposure beyond the orbital apex and roof were classified as significant skullbase exposure (SSE, n=38), including those with dural resection (n=23). The main outcome measure was incidence of postoperative CSF leak according to univariate and multivariate analysis of risk factors.

Results: Five patients developed a postoperative CSF leak, and 3 required operative management. All 5 were SSE with dural resection and had middle fossa exposure, previous radiation and 4 had previous surgery. None of the MSE group or SSE without dural resection or SSE with anterior fossa exposure alone developed a CSF leak. Multivariate analysis revealed middle fossa exposure to be the only significant predictor of CSF leak (p=0.03). The overall complication rate was 31.6%. Major complications were greater in the SSE group (p=0.05).

Conclusion: Middle fossa exposure increases the risk of CSF leak in microvascular reconstruction of CFOE defects.

Publication Date

3-26-2016

Keywords

Cerebrospinal fluid leak after microvascular reconstruction of large craniofacial defects with orbital exenteration, Department of Otolaryngology, Thomas Jefferson University

Disciplines

Otolaryngology

Comments

Poster presented at: 2016 Philadelphia Surgery Symposium

Recommended Citation

Gill, BA, Kurren; Hsu, MD, David; Tassone, MD,, Patrick; Pluta, MD, John; Nyquist, MD, Gurston G.; Krein, MD, PhD, Howard; Bilyk, MD, Jurij; Murchison, MD, Ann P.; Iloreta, MD, Alfred; Evans, MD, James J.; Heffelfinger, MD, Ryan N.; and Curry, MD, Joseph M., "Cerebrospinal fluid leak after microvascular reconstruction of large craniofacial defects with orbital exenteration" (2016). Department of Otolaryngology - Head and Neck Surgery Posters. 3.
https://jdc.jefferson.edu/otoposters/3