Abstract：
OBJECTIVE: Risk factors for a postoperative cerebrospinal fluid leak (CSF) after surgery include an intraoperative high flow of CSF, elevated body mass index, defect size, and defect site. In our prior series, a high postoperative CSF leak rate for tumors of the central skull base (planum, sella, and clivus) appeared to be due to graft migration. We changed our closure technique from a single layer of collagen +/- fat graft to a novel graft, termed a \"Bow tie\" (a tri-layer fat graft with two pieces of collagen matrix), and report our results in this study.
METHODS: Retrospective temporal epoch study of a single otolaryngologist\'s experience of closing skull base defects in our skull base center from 2005 to 2017.
RESULTS: One hundred and forty-nine patients met inclusion criteria in two time periods, pre- and post-introduction of the Bow tie technique. In epoch I, from 2005 to 2013, 79 patients had reconstruction with a single layer of dural graft (25 had additional free fat graft). In epoch II, from 2014 to 2017, 70 patients had reconstruction with the Bow tie.
RESULTS: CSF leak rates were 8.7% overall: 15.2% in epoch I and 1.4% in epoch II (p = 0.01). After controlling the procedure, defects with a size greater than 2 cm had a 5.7 greater likelihood of failure. Epoch II had a lower incidence of major complications.
CONCLUSIONS: Using a single surgeon\'s experience, the multilayer Bow tie has a significant reduction in postoperative CSF leak and associated major complications for defects of the central skull base.
METHODS: 3 Laryngoscope, 133:1568-1575, 2023.
METHODS: Retrospective temporal epoch study of a single otolaryngologist\'s experience of closing skull base defects in our skull base center from 2005 to 2017.
RESULTS: One hundred and forty-nine patients met inclusion criteria in two time periods, pre- and post-introduction of the Bow tie technique. In epoch I, from 2005 to 2013, 79 patients had reconstruction with a single layer of dural graft (25 had additional free fat graft). In epoch II, from 2014 to 2017, 70 patients had reconstruction with the Bow tie.
RESULTS: CSF leak rates were 8.7% overall: 15.2% in epoch I and 1.4% in epoch II (p = 0.01). After controlling the procedure, defects with a size greater than 2 cm had a 5.7 greater likelihood of failure. Epoch II had a lower incidence of major complications.
CONCLUSIONS: Using a single surgeon\'s experience, the multilayer Bow tie has a significant reduction in postoperative CSF leak and associated major complications for defects of the central skull base.
METHODS: 3 Laryngoscope, 133:1568-1575, 2023.
摘要：
目的：术后脑脊液漏（CSF）的危险因素包括术中脑脊液高流量，身体质量指数升高,缺陷尺寸,和缺陷部位。在我们之前的系列中,中央颅底肿瘤的术后脑脊液渗漏率高(平面，塞拉,和clivus）似乎是由于移植物迁移。我们将闭合技术从单层胶原+/-脂肪移植物改为新型移植物，称为“蝴蝶结”（三层脂肪移植物，带有两块胶原蛋白基质），并报告我们在这项研究中的结果。
方法：回顾性研究了2005年至2017年在我们的颅底中心进行的单耳鼻喉科医生闭合性颅底缺损的经历。
结果：在两个时间段内，有一百四十九名患者符合纳入标准，蝴蝶结技术的前后介绍。在时代I,从2005年至2013年,79例患者接受了单层硬脑膜移植重建(25例接受了额外的游离脂肪移植).在第二时代，从2014年到2017年，有70名患者使用蝴蝶结进行了重建。
结果：CSF泄漏率总体为8.7％：I期15.2％，II期1.4％（p=0.01）。控制程序后,尺寸大于2厘米的缺陷有5.7更大的失败可能性.EpochII的主要并发症发生率较低。
结论：使用单个外科医生的经验，多层蝴蝶结显著减少了术后脑脊液渗漏和与中央颅底缺损相关的主要并发症。
方法：III喉镜，2022年。
方法：回顾性研究了2005年至2017年在我们的颅底中心进行的单耳鼻喉科医生闭合性颅底缺损的经历。
结果：在两个时间段内，有一百四十九名患者符合纳入标准，蝴蝶结技术的前后介绍。在时代I,从2005年至2013年,79例患者接受了单层硬脑膜移植重建(25例接受了额外的游离脂肪移植).在第二时代，从2014年到2017年，有70名患者使用蝴蝶结进行了重建。
结果：CSF泄漏率总体为8.7％：I期15.2％，II期1.4％（p=0.01）。控制程序后,尺寸大于2厘米的缺陷有5.7更大的失败可能性.EpochII的主要并发症发生率较低。
结论：使用单个外科医生的经验，多层蝴蝶结显著减少了术后脑脊液渗漏和与中央颅底缺损相关的主要并发症。
方法：III喉镜，2022年。
