{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T12:36:10Z","timestamp":1772109370562,"version":"3.50.1"},"reference-count":16,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,5,3]],"date-time":"2020-05-03T00:00:00Z","timestamp":1588464000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Delayed postoperative cerebrospinal fluid (CSF) leaks are uncommon and largely unstudied complications. In this study we aim to identify their etiology and understand the efficacy of various reconstruction strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective chart analysis of 1017 endonasal skull base surgeries performed by a single neurosurgeon was completed identifying delayed CSF leaks (occurring &gt;1 week after surgery).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventeen cases of early (1\u20102 weeks after surgery) or delayed (&gt;2 weeks after surgery) postoperative CSF leak were identified. The most common reconstruction during the initial surgery consisted of an inlay or gasket seal collagen matrix (82.4% of patients) with an onlay pedicled flap (76.5% of patients). Presenting symptoms of delayed CSF leak included rhinorrhea (82.4%), headache (41.2%), and meningitis (23.5%). The most common causes included flap dehiscence (17.6%); provoking events such as emesis, sneezing, or fall (17.6%); flap necrosis (11.8%); flap displacement (11.8%); and inadequate apposition of the flap, that is, folded flap (11.8%). Reconstructive techniques of the delayed CSF leak included fortification of the initial reconstruction with free fat grafts (29.4% of patients), combined collagen matrix with a fat graft (23.5% of patients), repositioning of the previous flap (11.8% of patients), and repair with a new flap (11.8% of patients). CSF diversion (spinal\/ventricular drain or shunt) was used in 17.6% of patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study identifies the most common etiologic factors leading to a delayed CSF leak and its initial symptoms. Furthermore, it serves as the foundation for a reconstructive algorithm based on reinforcement of the initial repair with free abdominal fat graft with or without collagen matrix.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22544","type":"journal-article","created":{"date-parts":[[2020,5,3]],"date-time":"2020-05-03T14:50:33Z","timestamp":1588517433000},"page":"779-784","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Contributing factors for delayed postoperative cerebrospinal fluid leaks and suggested treatment algorithm"],"prefix":"10.1002","volume":"10","author":[{"suffix":"Jr","given":"Nyall R.","family":"London","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2012Head and Neck Surgery The Ohio State University  Columbus OH"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins University  Baltimore MD"},{"name":"National Institute on Deafness and Other Communication Disorders National Institutes of Health  Bethesda MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Mohyeldin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery The Ohio State University  Columbus OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alla S.","family":"Montaser","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Ain Shams University Faculty of Medicine  Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kangsadarn","family":"Tanjararak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Ramathibodi Hospital Faculty of Medicine Mahidol University  Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel M.","family":"Prevedello","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2012Head and Neck Surgery The Ohio State University  Columbus OH"},{"name":"Department of Neurosurgery The Ohio State University  Columbus OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley A.","family":"Otto","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2012Head and Neck Surgery The Ohio State University  Columbus OH"},{"name":"Department of Neurosurgery The Ohio State University  Columbus OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo L.","family":"Carrau","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2012Head and Neck Surgery The Ohio State University  Columbus OH"},{"name":"Department of Neurosurgery The Ohio State University  Columbus OH"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,5,3]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1266763"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000234933.37779.e4"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S002221511500167X"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2016.12.019"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818756272"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21783"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.3171\/2016.12.JNS1694"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2014.08.009"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1549308"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2011.09.016"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.01.001"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2019.08.067"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.3171\/2012.2.JNS111837"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1584229"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22187"},{"key":"e_1_2_6_17_1","first-page":"1","article-title":"Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial","volume":"1","author":"Zwagerman NT","year":"2018","journal-title":"J Neurosurg"}],"container-title":["International Forum of Allergy &amp; Rhinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Falr.22544","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alr.22544","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/alr.22544","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alr.22544","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T02:11:53Z","timestamp":1693966313000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/alr.22544"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,3]]},"references-count":16,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1002\/alr.22544"],"URL":"https:\/\/doi.org\/10.1002\/alr.22544","archive":["Portico"],"relation":{},"ISSN":["2042-6976","2042-6984"],"issn-type":[{"value":"2042-6976","type":"print"},{"value":"2042-6984","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,3]]},"assertion":[{"value":"2019-09-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}