Rigid Autologous Bone Reconstruction after Endoscopic Endonasal Olfactory Neuroblastoma Resection

Background: For endoscopic endonasal reconstruction of skull base defects, minimizing the sequelae of Cerebrospinal Fluid (CSF) leakage, graft migration, and infection is challenging.This study aims to evaluate the outcomes of endoscopic multilayer autologous rigid buttress reconstruction in patients with olfactory neuroblastoma.Methods: This study retrospectively reviews the records of olfactory neuroblastoma patients who underwent endoscopic endonasal surgery and reconstruction with a rigid buttress at one institution between May 2015 and December 2021.After tumor resection, reconstruction was performed using a multilayered fascia lata and autologous rigid buttress, and the defect was covered with a vascularized nasoseptal flap.Autologous bone chips or septal cartilage was placed between the dura and bone of the skull base.We reviewed demographic data, postoperative complications, body mass index, the follow-up time, and tumor Kadish stage and Hyams grade.Results: Reconstruction was performed in 12 patients (4 males; 8 females).The median follow-up period was 24.8 months.3 patients with Kadish stage D tumors with lymph node invasion underwent neck dissection surgery.Hyams tumor grade classification showed 5 patients with tumor grade II, 6 with grade III, and 1 with grade IV.Lumbar drainage was placed in one patient for monitoring (patient #1). 4 patients underwent radiotherapy, and 4 underwent chemoradiotherapy.No postoperative CSF leakage occurred in any patient.Conclusions: Reconstruction of skull base defects using a multilayered anatomical approach with an autologous rigid buttress and vascularized flap is effective and can prevent complications in patients after endoscopic endonasal surgery for olfactory neuroblastoma.