Cranial bone grafts in cerebrospinal fluid leak and encephalocele repair: a preliminary report.

BACKGROUND: With the introduction and subsequent widespread acceptance of endoscopic surgery, otolaryngologists are increasingly being called on to care for patients with cerebrospinal fluid rhinorrhea and meningoencephaloceles. Patients with large encephaloceles and skull base defects present a special challenge. We present our experience with cranial bone grafts in treating this important entity.

METHODS: Our clinical experience was reviewed from 1998 to 2001. Review parameters included defect size, cranial bone graft harvest site and size, and graft appearance on postoperative follow-up.

RESULTS: Results revealed that 20 patients underwent defect repair with cranial bone graft. The average defect was approximately 0.92 x 0.7 cm; nine defects were located in the ethmoid roof, eight defects were in the sphenoid, and three defects were in the posterior table of the frontal sinus. Donor sites included 2 parietal, 3 frontal, and 15 temporal (mastoid). Grafts healed well and all defects remained closed on endoscopic and computerized tomographic follow-up. All donor sites healed well.

CONCLUSION: Our experience indicates that cranial bone graft is an excellent material for endoscopic reconstruction of skull base defects. It confers special advantages in large defects, in defects with complex three-dimensional characteristics, and in patients with cerebrospinal fluid leaks associated with an elevated intracranial pressure.