Outcome of closure of Skull Base Defect after Endonasal Endoscopic Resection of Skull Base Tumours- A Retrospective Longitudinal Study

Abstract

Background: Effective closure of skull base defects is vital in preventing postoperative complications such as cerebrospinal fluid (CSF) leak, infection, and structural herniation following endoscopic skull base surgery. This study aims to assess the clinical and radiological outcomes of skull base defect closure in patients who underwent endoscopic repair.
Methods: Fifty patients who underwent endoscopic skull base surgery for various benign pathologies were evaluated. Patient demographics, diagnosis,and postoperative findings (including flap uptake, crusting, nasal bleeding, CSF leak, and infection) were recorded. Follow-up assessments were done on the 3rd day, 3rd week, 3rd month, and 6th month postoperatively. Radiological assessment (CT scan) was performed on day 1 post-surgery and MRI scan at 6 months.
Results: The cohort had a mean age of 52.7±15.97 years; 34% were male and 66% female. The most common diagnosis was pituitary macroadenoma (72%). Flap uptake was 100% at all follow-up points with no flap rejections. Crusting peaked at the 3rd week (100%), decreased by the 3rd month (86%), and resolved in most cases by 6 months (14% persistence). Nasal bleeding was reported in 20% on the 3rd day, which declined to 4% by 6 months. No cases of postoperative CSF leak or infection were observed at any follow-up. CT imaging confirmed complete closure of the skull base defect in all patients, with no brain herniation and only one case of compression of optic nerve,with decrease in visual acuity where patient was taken to theatre and decompression done followed by reconstruction.
Conclusion: Endoscopic skull base defect closure demonstrates excellent clinical and radiological outcomes, with no postoperative CSF leaks or infections observed. Most cases of crusting and nasal bleeding resolved within 6 months. The employed repair technique is both safe and effective for the management of skull base pathologies