Repair of high-flow cerebrospinal fluid leak by combined artificial dura plug and free mucosal flap in 15 cases.

Background: In the endoscopic endonasal approach skull base surgery repair and reconstruction of the base of the skull is a critical step. Free mucosal flaps are primarily used to repair low-flow cerebrospinal fluid (CSF) leaks, whereas they are not adequate in the face of high-flow CSF leaks. We propose a modified approach-termed the "Fishing method"-which utilizes free mucosal flaps in combination with absorbable sutures and an artificial dura to reverse-plug the defect, to repair high-flow CSF leaks with a clear point of origin. Objective: To investigate the application of the "Fishing method" to repair high-flow CSF leaks caused by large diaphragma sellae rupture and small dura leak that occur unexpectedly during endoscopic endonasal sellae area surgery. Methods: A retrospective analysis was conducted including 15 patients with unexpected intraoperative high-flow cerebrospinal fluid leaks. The "Fishing method" was applied to reconstruct and repair the skull base in these patients, and the results were evaluated. Results: In 10 cases of large diaphragma sellae rupture that occurred during pituitary adenomas resection, all 10 patients were successfully repaired in a single operation using the "Fishing method", with no cerebrospinal fluid nasal leakage (100%); in 5 cases of small dura ruptures that occurred during chordoma resection, 4 patients underwent successful repair in a single operation, with no cerebrospinal fluid nasal leakage occurring in 80% of cases, resulting in an overall success rate of 93.3%. Conclusion: The "Fishing method" is a reliable technique for skull base reconstruction and serves as an effective solution for high-flow CSF leaks caused by unexpected large diaphragma sellae rupture or a small dura leak occurring intraoperatively.