Composite mucochondral flap for repair of cerebrospinal fluid leaks

BACKGROUND: Cerebrospinal fluid leaks from defects in the anterior cranial fossa present a difficult management problem. Particularly when the defects are large, conventional techniques may not be sufficient to close them. We describe a new technique for treating such CSF leaks using a composite mucochondral flap from the nasal septum. METHODS: We treated five patients with the composite mucochondral flap. All patients were women aged 29-60 years. Two patients had an encephalocele, one had an esthesioneuroblastoma, and one had adenocarcinoma; one leak was spontaneous. RESULTS: The CSF leak was successfully closed in all five patients. No patients have experienced recurrence; the longest follow-up has been 39 months. The donor site on the septum healed without complication in all patients. CONCLUSIONS: The composite flap is useful for repairing large defects or after radiotherapy or trauma. The advantage of skeletal support to counter the pressure exerted by CSF seems clear.