Choice of graft material and postoperative healing in endoscopic repair of cerebrospinal fluid leak

Abstract

Objective: To compare the postoperative healing profiles of graft materials used for endoscopic repair of cerebrospinal fluid (CSF) leak.

Design: Retrospective cohort study with 1 to 21 months of follow-up.

Setting: Tertiary referral, academic medical center.

Patients: Consecutive sample of patients undergoing endoscopic repair of CSF leak from March 2007 through May 2009.

Intervention: Endoscopic repair of CSF leak with acellular dermis, collagen matrix, or sinonasal mucosal grafts. Graft success, time to full graft mucosalization, and duration of graft or donor site crusting were assessed during the postoperative period.

Results: Forty repairs were performed on 37 patients: 17 with mucosal grafts, 10 with acellular dermis, and 13 with collagen matrix grafts. The mean follow-up time was 5.3 months (range, 0.5-21.0 months). Two patients had partial graft loss; none had a recurrence of CSF leak. There was a significant difference in time to mucosalization with acellular dermis (11.7 weeks) when compared with collagen matrices (6.6 weeks) or mucosa (4.9 weeks) (P < .001). Graft crusting was more prolonged with acellular dermis (9.4 weeks) than with collagen matrices (5.1 weeks) (P = .04). No patients with mucosal grafts had graft crusting. Donor site crusting was present only in the mucosal group, with an average duration of 6.5 weeks (range, 1.0-20.0 weeks).

Conclusions: Mucosal grafts, acellular dermis, and collagen matrices have similar success rates in endoscopic repair of CSF leak. Acellular dermis grafts have longer time to mucosalization and more weeks of crusting than mucosal or collagen matrix grafts.