A Comparative Study of Endoscopic Skull Base Repair Using Pedicled Flap, Fascia Lata Graft, and Fat Graft

Background: Endoscopic endonasal techniques have become the preferred approach for repair of skull base defects and cerebrospinal fluid (CSF) leaks. Various reconstruction methods including vascularized pedicled flaps, fascia grafts, and fat grafts are used to achieve watertight closure. The choice of material depends on defect size, CSF flow, and surgeon preference.

Objective: To compare the effectiveness and outcomes of pedicled flap, fascia lata graft, and autologous fat graft in endoscopic skull base defect repair.

Methods: A prospective comparative study was conducted on patients undergoing endoscopic skull base repair for CSF rhinorrhea. Patients were divided into three groups based on reconstruction technique: pedicled flap, fascia lata graft, and fat graft. Outcomes assessed included postoperative CSF leak, complications, operative time, and hospital stay.

Results: Pedicled flap reconstruction showed the highest success rate with the lowest postoperative CSF leak rate. Fascia lata graft provided reliable closure but had donor-site morbidity. Fat graft was effective for small defects but had slightly higher recurrence rates.

Conclusion: Pedicled vascularized flaps provide superior outcomes in large skull base defects, while fascia and fat grafts remain effective options for smaller defects. Selection of repair material should be individualized based on defect characteristics.