You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Extracranial Radial Forearm Free Flap Closure of Refractory Cerebrospinal Fluid Leaks: A Novel Hybrid Transantral-Endoscopic Approach

Sinha, Parul MBBS, MS*; Desai, Shaun C. MD*; Ha, Dun H. MD, PhD; Chicoine, Michael R. MD§; Haughey, Bruce H. MBChB, FACS, FRACS*

doi: 10.1227/NEU.0b013e3182684ac8
Operative Technique

BACKGROUND: Although rare, recalcitrant cerebrospinal fluid (CSF) leak after skull base tumor resection or major head trauma is a difficult therapeutic challenge, often complicated by lack of local vascularized tissue in a scarred, radiated field. Craniotomy with a free tissue transfer has been described for CSF leak repair from these complicated skull base defects.

OBJECTIVE: We present our experience with a novel extracranial approach to manage refractory CSF leaks with a radial forearm free flap set in through a transantral and ethmoid sinus approach.

METHODS: Five patients with recalcitrant CSF leaks in the anterior skull base underwent radial forearm free tissue transfer via a hybrid transantral-endoscopic approach.

RESULTS: There were 4 female patients and 1 male patient. Average age was 58 years (range, 30-72 years). Four patients had previous neurosurgical anterior skull base tumor resections, and 1 patient had significant head trauma leading to a recalcitrant CSF leak. All 5 patients had undergone multiple prior endoscopic and/or open repairs. All 5 patients had successful resolution of their leak after undergoing radial forearm free tissue transfer. Two of 5 patients required a second minor endoscopic procedure. No patients required a craniotomy.

CONCLUSION: An extracranial transantral-endoscopic approach for the inset of radial forearm free flap is a safe treatment technique that precludes the need for a craniotomy and promotes effective repair of CSF leaks refractory to traditional endoscopic procedures.

ABBREVIATION: RFFF, radial forearm free flap

Author Information

*Department of Otolaryngology – Head & Neck Surgery, Washington University School of Medicine, St. Louis, Missouri

Department of Otolaryngology – Head & Neck Surgery, Magan Medical Clinic, Corvina, California

§Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri

Correspondence: Bruce H. Haughey, MBChB, FACS, FRACS, Department of Otolaryngology – Head & Neck Surgery, Washington University School of Medicine, 600 S Euclid Ave, St. Louis, MO 63110. E-mail:

Received November 10, 2011

Accepted June 20, 2012

Copyright © by the Congress of Neurological Surgeons