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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2018; 79(02): e31-e35
DOI: 10.1055/s-0038-1645886
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Anterior Skull Base Reconstruction: Does Fat Preparation Matter?

Joshua Wood
1   Department of Otolaryngology, Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Jaron Densky
2   Department of Otolaryngology, Head and Neck Surgery, Ohio State University, Columbus, Ohio, United States
,
John Boughter
3   Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Merry Sebelik
4   Department of Otolaryngology, Head and Neck Surgery, Emory University, Atlanta, Georgia, United States
,
Courtney Shires
1   Department of Otolaryngology, Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
› Author Affiliations
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Publication History

10 October 2017

12 March 2018

Publication Date:
11 May 2018 (online)

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Abstract

Objectives This article aims (1) to determine whether there is any difference in cerebrospinal fluid (CSF) leak rate after anterior skull base autologous fat reconstruction based on how the fat is prepared, and (2) to measure impact on surgical times by reconstruction type.

Design Translational animal model surgical technique 3-arm trial, comparing two different methods of autologous fat skull base reconstruction versus a nonreconstructed control group.

Setting Animal study.

Subjects Adult Sprague-Dawley rats.

Main Outcome Measures Resolution of CSF rhinorrhea after repair of a surgically created anterior skull base defect.

Results Both wet (uncompressed) and dry (compressed) fat reconstruction of an anterior skull base defect demonstrated lower CSF leak rates than nonreconstructed defects. Dry fat reconstruction achieved significance in superiority of controlling CSF leak over no reconstruction (64% success vs. 31%); while wet fat reconstruction trended toward significance (50% vs. 31%). Reconstruction procedure time was longer than nonreconstructed controls, but there was no significant difference between type of fat preparation in surgical time.

Conclusions This study demonstrates that drying and compressing the fat graft improves autologous fat reconstruction success for anterior skull base defects, and does not add significantly to surgical time over nonprepared fat.

Keywords

autologous fat graft - cerebrospinal fluid leak - anterior skull base - skull base reconstruction

Note

This was presented as an oral presentation at the North American Skull Base Society Annual Meeting in February 20–22, 2015.


 

  • References

  • 1 Montgomery WW, Ojemann RG, Weiss AD. Suboccipital-translabyrinthine approach for acoustic neuroma. Arch Otolaryngol 1966; 83 (06) 566-569
    CrossrefPubMedGoogle Scholar
  • 2 Montgomery WW. Translabyrinthine resection of the small acoustic neuroma. Arch Otolaryngol 1969; 89 (02) 319-325
    CrossrefPubMedGoogle Scholar
  • 3 Collins WF. Hypophysectomy: historical and personal perspective. Clin Neurosurg 1974; 21: 68-78
    CrossrefPubMedGoogle Scholar
  • 4 Ziu M, Jimenez DF. The history of autologous fat graft use for prevention of cerebrospinal fluid rhinorrhea after transsphenoidal approaches. World Neurosurg 2013; 80 (05) 554-562
    CrossrefPubMedGoogle Scholar
  • 5 Wigand ME. Transnasal ethmoidectomy under endoscopical control. Rhinology 1981; 19 (01) 7-15
    PubMedGoogle Scholar
  • 6 Schmalbach CE, Webb DE, Weitzel EK. Anterior skull base reconstruction: a review of current techniques. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (04) 238-243
    CrossrefPubMedGoogle Scholar
  • 7 Schlosser RJ, Bolger WE. Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope 2004; 114 (02) 255-265
    CrossrefPubMedGoogle Scholar
  • 8 Soudry E, Turner JH, Nayak JV, Hwang PH. Endoscopic reconstruction of surgically created skull base defects: a systematic review. Otolaryngol Head Neck Surg 2014; 150 (05) 730-738
    CrossrefPubMedGoogle Scholar
  • 9 Zanation AM, Thorp BD, Parmar P, Harvey RJ. Reconstructive options for endoscopic skull base surgery. Otolaryngol Clin North Am 2011; 44 (05) 1201-1222
    CrossrefPubMedGoogle Scholar
  • 10 Dusick JR, Mattozo CA, Esposito F, Kelly DF. BioGlue for prevention of postoperative cerebrospinal fluid leaks in transsphenoidal surgery: a case series. Surg Neurol 2006; 66 (04) 371-376 , discussion 376
    CrossrefPubMedGoogle Scholar
  • 11 Seda L, Camara RB, Cukiert A, Burattini JA, Mariani PP. Sellar floor reconstruction after transsphenoidal surgery using fibrin glue without grafting or implants: technical note. Surg Neurol 2006; 66 (01) 46-49 , discussion 49
    CrossrefPubMedGoogle Scholar
  • 12 Germani RM, Vivero R, Herzallah IR, Casiano RR. Endoscopic reconstruction of large anterior skull base defects using acellular dermal allograft. Am J Rhinol 2007; 21 (05) 615-618
    CrossrefPubMedGoogle Scholar
  • 13 Eloy JA, Choudhry OJ, Friedel ME, Kuperan AB, Liu JK. Endoscopic nasoseptal flap repair of skull base defects: is addition of a dural sealant necessary?. Otolaryngol Head Neck Surg 2012; 147 (01) 161-166
    CrossrefPubMedGoogle Scholar
  • 14 Kakagia D, Pallua N. Autologous fat grafting: in search of the optimal technique. Surg Innov 2014; 21 (03) 327-336
    CrossrefPubMedGoogle Scholar
  • 15 Bucky LP, Percec I. The science of autologous fat grafting: views on current and future approaches to neoadipogenesis. Aesthet Surg J 2008; 28 (03) 313-321 , quiz 322–324
    CrossrefPubMedGoogle Scholar
  • 16 Pu LL. Towards more rationalized approach to autologous fat grafting. J Plast Reconstr Aesthet Surg 2012; 65 (04) 413-419
    CrossrefPubMedGoogle Scholar
  • 17 Gir P, Brown SA, Oni G, Kashefi N, Mojallal A, Rohrich RJ. Fat grafting: evidence-based review on autologous fat harvesting, processing, reinjection, and storage. Plast Reconstr Surg 2012; 130 (01) 249-258
    CrossrefPubMedGoogle Scholar
  • 18 Fonmarty D, Bastier PL, Lechot A, Gimbert E, de Gabory L. Assessment of abdominal fat graft to repair anterior skull base after malignant sinonasal tumor extirpation. Otolaryngol Head Neck Surg 2016; 154 (03) 540-546
    CrossrefPubMedGoogle Scholar
  • 19 Minn KW, Min KH, Chang H, Kim S, Heo EJ. Effects of fat preparation methods on the viabilities of autologous fat grafts. Aesthetic Plast Surg 2010; 34 (05) 626-631
    CrossrefPubMedGoogle Scholar
  • 20 Ramon Y, Shoshani O, Peled IJ. , et al. Enhancing the take of injected adipose tissue by a simple method for concentrating fat cells. Plast Reconstr Surg 2005; 115 (01) 197-201 , 202–203
    PubMedGoogle Scholar
  • 21 Nishihira S, McCaffrey TV. The use of fibrin glue for the repair of experimental CSF rhinorrhea. Laryngoscope 1988; 98 (6 Pt 1): 625-627
    PubMedGoogle Scholar
  • 22 Mashiko T, Yoshimura K. How does fat survive and remodel after grafting?. Clin Plast Surg 2015; 42 (02) 181-190
    CrossrefPubMedGoogle Scholar