Skull base reconstruction strategy for high-flow CSF leaks during EEA surgery based on the quality of pedicled nasoseptal flap

This study aimed to evaluate the efficacy of a skull base reconstruction strategy for treating intraoperative high-flow cerebrospinal fluid (CSF) leaks during endoscopic endonasal approach (EEA) in the sellar region. This single-institution prospective study included patients who underwent EEA with multi-layer reconstruction between May 2023 and April 2025. Patients were divided into groups 1, 2, & 3, based on the quality of the pedicled nasoseptal flap (PNSF): high-quality, low-quality, and unavailable PNSF, respectively. We analyzed postoperative complications (failed skull base reconstruction and meningitis), time in bed, and length of hospital stay. Of 86 patients enrolled, we encountered three cases of failed skull base reconstruction (3.5%) and four cases of meningitis (4.7%), indicating a reduction in the postoperative complication rate. There were no significant differences in postoperative complications between the three groups (P > 0.05). There was no significant difference in lengths of hospital stay (10.82 ± 3.80 vs. 12.41 ± 2.26, P > 0.05) and time in bed (9.00 ± 4.06 vs. 10.00 ± 2.36, P > 0.05) between Groups 1 and 2, respectively. Group 3 had longer lengths of hospital stay and time in bed than the other groups (P < 0.001). The modified multi-layer skull base reconstruction based on the quality of PNSF is a reliable method for treating intraoperative high-flow CSF leak during EEA surgeries and was associated with low complications rates in this cohort.