Anterior kafa tabanı BOS rinoresinin endoskopik tedavisinde fasya lata grefti ile temporal kas fasya greftinin başarı oranlarının karşılaştırılması

Year 2025, Volume: 16 Issue: 1, 100 - 105, 25.03.2025

Görkem Dündar , Serdar Özer

https://doi.org/10.18663/tjcl.1626813

Abstract

Amaç: Bu retrospektif çalışmanın amacı, beyin omurilik sıvısı (BOS) rinoresi olan kafa tabanı defektlerinin onarımında fasya
lata ve temporal fasyanın başarı oranını değerlendirmektir.
Gereç ve Yöntemler: 2007-2021 yılları arasında kulak burun boğaz kliniği tarafından tedavi edilen BOS rinoreli hastalar çalışmaya dahil edildi. Hastaların demografik bilgileri, sızıntının yeri, etiyolojisi, vücut kitle indeksi (VKİ), cerrahi yaklaşım, greft materyali ve herhangi bir sızıntı rekürrensi toplandı.
Bulgular: Çalışmaya 25'i erkek, 41'i kadın 66 hasta dahil edildi. Ortanca yaş 43.7 (19 - 72) olarak bulundu. Median Vücut Kitle İndeksi (VKİ) 27.5 (19-46) olarak bulunmuştur. Endoskopik yöntemin BOS rinoresini onarmadaki başarı oranı %90,4 olarak bulunmuştur. Greft materyali olarak 35 hastada fasya lata kullanılırken, 31 hastada temporal kas fasyası kullanıldı. Temporal kas fasyası kullanılan 31 hastanın 5'inde (%16,1) rekürren rinore saptanırken, fasya lata grefti kullanılan 35 hastanın 2'sinde (%5,7) rekürrens saptandı (p=0,170). Obez 27 hastanın 6'sında (%22,2) rinore nüksü saptanırken, obez olmayan sadece 1 (%2,6) hastada revizyon cerrahisi gerekmiştir (p=0,011). Ameliyat edilen 4 hastada greft bölgesine bağlı hematom, alopesi ve bacak ağrısı gibi komplikasyonlar görüldü.
Sonuç: BOS rinoresi ile başvuran hastalar endoskopik sinüs cerrahisi ile başarılı bir şekilde tedavi edilebilir. Defekt onarımında temporal fasya grefti ve fasya lata grefti kullanımının rinore onarımındaki başarı oranı benzerdir. Çalışmamızda tedavi başarısını etkileyen tek faktörün yüksek VKİ olduğu tespit edilmiştir.

Keywords

beyin omurilik sıvısı, endoskopik, rinore, kafa tabanı

Comparison of the success rate of fascia lata graft and temporal muscle fascia graft in endoscopic treatment of anterior skull base cerebrospinal fluid rhinorrhea

Abstract

Aim: The aim of this retrospective study is to describe our experiences of cerebrospinal fluid (CSF) rhinorrhea and assess
success rate of fascia lata and temporal fascia of repairing the skull base defects
Material and Methods: Patients with CSF rhinorrhea managed by department of otolaryngology from 2007 to 2021 were included. Demographic information, site of leak, etiology, body mass index (BMI), surgical approach, graft material, and any recurrence of leak of the patients was collected.
Results: Out of the 66 patients included in the study, 25 were male and 41 were female and the median age was found to be 43.7 (ranging from 19 to 72). The median Body Mass Index (BMI) was found to be 27.5 (ranging from 19 to 46). The success rate of endoscopic method in repairing CSF rhinorrhea was found to be 90.4%. Fascia lata was used as graft material in 35 patients, while temporal muscle fascia was used in 31 patients. Recurrent rhinorrhea was detected in 5 of 31 patients (16.1%) in whom temporal muscle fascia was used as a graft, while recurrence was detected in 2 of 35 patients (5.7%) in whom fascia lata graft was used (p=0.170). While rhinorrhea recurrence was detected in 6 of 27 obese patients (22.2%), revision surgery was required in only 1 (2.6%) non-obese patient (p=0.011). Complications such as hematoma, alopecia and leg pain related to the graft site were seen in 4 operated patients.
Conclusion: Patients presenting with CSF rhinorrhea can be successfully treated with endoscopic sinus surgery. The success rate of using temporal fascia graft and fascia lata graft in defect repair is similar in rhinorrhea repair. In our study, it was determined that the only factor affecting treatment success was high BMI.

Keywords

cerebrospinal fluid, endoscopic, rhinorrhea, skull base

Ethical Statement

Our study was carried out on receiving the approval of Hacettepe University Hospital Ethical Board, no. 2021/04-65.

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