Dural suturing for the resolution of high-flow cerebrospinal fluid leakage after extended endoscopic endonasal approach surgery.

Abstract

High-flow cerebrospinal fluid (CSF) leakage is a major complication after surgery via the extended endoscopic endonasal approach (EEA). Thus, surgeons are still searching for techniques to avoid postoperative cerebrospinal fluid (poCSF) leakage. Recently, several surgeons have attempted dural suturing to prevent poCSF leakage. This study was performed to evaluate the efficacy of dural suturing for preventing poCSF leakage and presents a description of our operative technique. A total of 167 patients who underwent surgery via the extended EEA were enrolled in this study from January 2020 to May 2024. Among them, 75 patients underwent multilayered reconstruction only before May 2022. 92 patients underwent multilayered reconstruction combined with dural suturing after May 2022. The clinical data of the dural suturing group were compared with those of the no dural suturing group. All surgeries were performed by an experienced endoscopic neurosurgical team. Eighteen of 75 (24.0%) patients in the no dural suturing group and 2 of 92 patients (2.2%) in the dural suturing group developed poCSF leakage (p < 0.001). This finding indicates that dural suturing helps prevent poCSF leakage after lesion resection via the extended EEA.