Analysis of risk factors for the failure of endoscopic endonasal skull base reconstruction
10.3760/cma.j.cn115330-20240314-00140
- VernacularTitle:内镜经鼻颅底重建失败的影响因素分析
- Author:
Xudong YAN
1
;
Lin WANG
;
Ruifeng TAN
;
Longgang YU
;
Jisheng ZHANG
;
Lin HAN
;
Shengnan ZHANG
;
Yan JIANG
Author Information
1. 青岛大学附属医院耳鼻咽喉头颈外科，青岛 266000
- Keywords:
Otorhinolaryngologic surgical procedures;
Skull base reconstruction;
Postoperative cerebrospinal fluid leakage
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2024;59(11):1159-1164
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the influencing factors of skull base reconstruction failure after endoscopic endonasal skull base surgery (EESBS).Methods:A retrospective analysis was performed on 228 EESBS cases at the Affiliated Hospital of Qingdao University from 2018 to 2023. The clinical features associated with skull base reconstruction and postoperative cerebrospinal fluid leakage were collected and analyzed. Lasso regression was initially used for exploratory analysis, and risk factors for reconstruction failure were subsequently evaluated using multifactorial logistic regression.Results:A total of 157 cases of EESBS were included, with an overall reconstruction failure rate of 11.5% (18/157). No patients who underwent second-stage reconstruction with a tipped mucosal flap or multilayered free mucosal and fascial repair experienced further postoperative cerebrospinal fluid leakage. Variables identified through Lasso regression included history of surgery, history of radiotherapy, and site of leakage. Multifactorial logistic analysis showed that history of radiotherapy ( OR=5.96, P=0.021) and site of leakage in the posterior skull base ( OR=8.70, P=0.003) were significant risk factors for failure of skull base reconstruction. Conclusion:In cases with a history of radiotherapy and/or posterior skull base lesions in the operative area, reconstruction strategies should be strengthened to improve the success rate of one-stage repair, in particular, when intraoperative cerebrospinal fluid leakage occurs.
