Autologous versus synthesis materials used in the surgical closure of CSF leak

The evolution of the endoscopic skull base surgery in the last ten years had led to the development of new surgical reconstructive techniques. In the endoscopic reconstructive surgery of the CSF leaks both synthesis and natural materials. The advancement of the endoscopic reconstructive surgery was closely linked with the production of new synthesis materials. The aim of the paper is to compare the efficacy of synthesis versus natural materials in the closure of CSF leaks and to point out certain rules of when and where to use a synthesis or natural material. INTRODUCTION In the reconstructive surgery of the skull base, the surgeon can use both natural and synthesis materials. The developments of the endoscopic surgery of the skull base had led to removing bigger tumors from high-risk areas that were not suitable for endoscopic surgical approach up to now. The endoscopic surgical approaches tend to replace the external approaches even in malignant tumors of the skull base in selected cases. Because of that, the surgeon started to encounter more defects at the level of the skull base with or without CSF leaks. New surgical reconstructive techniques started to be developed in close connection with the production of new surgical reconstructive materials and adhesives. [1] The materials used in the reconstruction of the skull Corresponding author: Silviu Pițuru piturus@yahoo.com base defect can be divided in autologous tissue and synthesis reconstructive materials. Autologous tissues that are used in the reconstructive skull base surgery are: fascia, cartilage, bone, fat, free mucosal grafts, vascularize flaps and free flaps with micro anastomosis. Fat can be used to obliterate dead space or to plug a CSF leak.[1] Fascia lata or fascia temporalis can be placed in an underlay technique between the dura and the skull base or overlay technique in the sinus cavities. Multilayered fascia lata was the effective especially management of open cisterns or in cases of another type of high-pressure CSF leak.[2] in Bone or septal cartilage are placed in the underlying tech- 1 The “Carol Davila” University of Medicine and Pharmacy Bucharest, Romania 2 “Prof. Dr. Dorin Hociotă” Institute of Phonoaudiology and Functional ENT surgery, Bucharest, Romania 29