Comparing the Effects of Absorbable versus Nonabsorbable Nasal Packing on Postoperative Outcomes Following Endoscopic Ventral Skull Base Surgery

Abstract Advances in endoscopic endonasal approaches in ventral skull base surgery have led to increasingly complex resections and reconstructions. This study investigates differences in postoperative outcomes, including postoperative cerebrospinal fluid (CSF) leak and infection, following anterior skull base surgery and reconstruction, as a function of the type of nasal packing (absorbable vs. nonabsorbable) used to bolster the skull base reconstruction. A retrospective chart review was performed at a single tertiary care institution. Patients who underwent ventral skull base surgery with placement of nasal packing between January 1, 2020, and December 1, 2023, were included. We included only patients of a single rhinologist (S.L.) involved. Outcome measures included postoperative CSF leaks and postoperative infection. Of the 179 patients meeting inclusion criteria, 105 patients (58.7%) received absorbable nasal packing (Nasopore), and 72 patients (40.2%) received nonabsorbable nasal packing (Merocel). Fifteen postoperative leaks occurred overall, with six CSF leaks reported in patients with absorbable nasal packing (5.7%) and nine CSF leaks reported in patients with Merocel packing (12.5%). Fifteen cases of postoperative infection were recorded, with nine cases in patients with absorbable nasal packing (8.6%) and six cases in patients with nonabsorbable nasal packing (8.3%). Overall, no statistically significant difference was found for the rate of postoperative CSF leak (p = 0.168) or infection (p = 0.309) between these two cohorts of patients. While no significant differences were found in the rate of postoperative CSF leak or infection, additional patient factors should be taken into consideration when choosing between absorbable and nonabsorbable nasal packing for ventral skull base reconstruction. 4.