{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:03:00Z","timestamp":1793325780680,"version":"4.5.0"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Extended endoscopic endonasal transsphenoidal approaches (ExEETSA) commonly result in high\u2010flow cerebrospinal fluid (CSF) leaks that demand robust reconstruction strategies. Although nasoseptal flap (NSF) is a standard reconstructive technique, high\u2010flow grade 3 CSF leaks require additional rigid reconstruction. This study evaluated the long\u2010term outcomes of collagen matrix\u2010hydroxyapatite (HXA)\u2010NSF for rigid skull base reconstruction without lumbar drain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study was conducted on 100 patients undergoing ExEETSA involved intraoperative high\u2010flow grade 3 CSF leak that were managed using a collagen matrix for dural repair followed by HXA and NSF reconstruction without lumbar drainage between January 2016 and December 2023. The primary outcomes assessed were postoperative CSF leakage, meningitis, and HXA\u2010related complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median skull base defect diameter was 22.9\u2009mm. Tuberculum sellae meningioma represented the predominant pathology (39.0%), with the transplanum\/transtuberculum region being the most commonly affected area (77.0%). Postoperative CSF leakage occurred in 4% of cases. HXA exposure accompanied by partial NSF necrosis was observed in eight patients (8.0%). Of these, complete re\u2010mucosalization of the exposed HXA surface was achieved in five patients (62.5%), with a mean healing time of 23.6\u2009months. There were no cases of meningitis or local infection requiring reoperation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The combination of collagen matrix, HXA, and NSF without lumbar drainage represents a safe and effective reconstruction strategy for managing intraoperative high\u2010flow Grade 3 CSF leaks in ExEETSA. This reconstructive technique yielded favorable outcomes, characterized by a low incidence of postoperative CSF leakage, manageable complications, and sustained long\u2010term effectiveness.<\/jats:p><jats:p><jats:bold>Level of Evidence<\/jats:bold>: IV.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lio2.70192","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T13:05:38Z","timestamp":1753707938000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Collagen Matrix Combined With Hydroxyapatite and Nasoseptal Flap for Skull Base Reconstruction"],"prefix":"10.1002","volume":"10","author":[{"given":"Maithrea Suresh","family":"Narayanan","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"},{"name":"Department of Otolaryngology and Head \u2010Neck Surgery Hospital Kuala Lumpur  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5861-7386","authenticated-orcid":false,"given":"Sung Seok","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jang Wook","family":"Gwak","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young\u2010Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9215-6867","authenticated-orcid":false,"given":"Ji Heui","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3171\/2020.11.Jns202494"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40136\u2010013\u20100027\u20104"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599814520685"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000234933.37779.e4"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/01455613221099483"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.Neu.0000255354.64077.66"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010020\u201005911\u20101"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/scs.0000000000003170"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.06.090"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.23041"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2021.11.003"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3205\/cto000059"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2020.0231"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/02688697.2012.741739"},{"key":"e_1_2_8_16_1","volume-title":"Endoscopic Sinus Surgery: Anatomy, Three\u2010Dimensional Reconstruction, and Surgical Technique","author":"Wormald P. J.","year":"2018"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100039\u20101693124"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.3.Jns131521"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.3171\/2013.6.Jns122259"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.906162"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0245119"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin23.127"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30501"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2011.08.034"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2014.07.004"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010023\u201042097\u2010y"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.3171\/2016.12.Jns1694"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2009.23.3378"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20861"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/194589240201600610"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2005.09.001"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002341\u2010200301000\u201000006"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2022.02.006"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.3171\/2018.4.Jns172447"}],"container-title":["Laryngoscope Investigative Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lio2.70192","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T04:45:07Z","timestamp":1756442707000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lio2.70192"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,28]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1002\/lio2.70192"],"URL":"https:\/\/doi.org\/10.1002\/lio2.70192","archive":["Portico"],"relation":{},"ISSN":["2378-8038","2378-8038"],"issn-type":[{"value":"2378-8038","type":"print"},{"value":"2378-8038","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,28]]},"assertion":[{"value":"2025-05-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70192"}}