Endoscopic anterior skull base reconstruction exclusively with autologous fat graft - a multicentric retrospective case series study

Introduction: The reconstruction of the anterior skull base defects reaching the cerebrospinal fluid (CSF) space during surgery, and the closure of nasal liquorrhea of any other origin are essential to prevent meningitis. Several techniques and grafting materials have been proposed for this reason.

Objective: To evaluate our cases where autologous fat graft was exclusively used to reconstruct the anterior skull base defect, regarding the success rate of closure and complications. Method: Retrospective case record review of patients treated between April 2019 and October 2023 was performed. We included all patients who underwent endoscopic anterior skull base surgery with autologous fat graft reconstruction. Primary outcome was the success rate regarding the closure of the CSF leak.

Results: 13 patients, 6 women and 7 men (average age: 53.8 yrs [32–75 yrs]) were included, with the following etiologies of CSF leak: spontaneous CSF leak (4 cases), intraoperative iatrogenic defect (1 case), encephalocele (2 cases), hamartoma (1 case), and malignant tumour (5 cases). The defect and CSF leak were localized on the cribriform plate in 10 cases, on the orbital apex and rhinobase in 1 case, and in the sphenoid sinus in 2 cases. The sizes of the medium and larger defects were 12–34 mm, according to the postoperative CT scan. All the malignant tumors underwent postoperative radiotherapy, and with a median of 32 months follow-up, we couldn’t detect recurrent disease in any of them. The CSF closure was successful in all patients in the short term, and we found CSF leak recurrence only in 1 case in the long term follow-up (92% success rate). 2 patients developed meningitis, 1 of them died due to pneumonia.

Conclusion: Reconstructing with autologous fat graft is a safe and reliable technique for closing even medium and large size anterior skull base defects and CSF leaks. Orv Hetil. 2024; 165(38): 1509–1515.