{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T21:09:05Z","timestamp":1776805745633,"version":"3.51.2"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>In the endoscopic endonasal approach skull base surgery repair and reconstruction of the base of the skull is a critical step. Free mucosal flaps are primarily used to repair low-flow cerebrospinal fluid (CSF) leaks, whereas they are not adequate in the face of high-flow CSF leaks. We propose a modified approach-termed the \u201cFishing method\u201d-which utilizes free mucosal flaps in combination with absorbable sutures and an artificial dura to reverse-plug the defect, to repair high-flow CSF leaks with a clear point of origin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the application of the \u201cFishing method\u201d to repair high-flow CSF leaks caused by large diaphragma sellae rupture and small dura leak that occur unexpectedly during endoscopic endonasal sellae area surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted including 15 patients with unexpected intraoperative high-flow cerebrospinal fluid leaks. The \u201cFishing method\u201d was applied to reconstruct and repair the skull base in these patients, and the results were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 10 cases of large diaphragma sellae rupture that occurred during pituitary adenomas resection, all 10 patients were successfully repaired in a single operation using the \u201cFishing method\u201d, with no cerebrospinal fluid nasal leakage (100%); in 5 cases of small dura ruptures that occurred during chordoma resection, 4 patients underwent successful repair in a single operation, with no cerebrospinal fluid nasal leakage occurring in 80% of cases, resulting in an overall success rate of 93.3%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The \u201cFishing method\u201d is a reliable technique for skull base reconstruction and serves as an effective solution for high-flow CSF leaks caused by unexpected large diaphragma sellae rupture or a small dura leak occurring intraoperatively.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1422524","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T05:26:50Z","timestamp":1745299610000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Repair of high-flow cerebrospinal fluid leak by combined artificial dura plug and free mucosal flap in 15 cases"],"prefix":"10.3389","volume":"12","author":[{"given":"Hengsen","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duoduo","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhitong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pasut","family":"Limchoopornwikul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yibao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e506","DOI":"10.1016\/j.wneu.2018.10.090","article-title":"Implementation of free mucosal graft technique for sellar reconstruction after pituitary surgery: outcomes of 158 consecutive patients","volume":"122","author":"Scagnelli","year":"2019","journal-title":"World Neurosurg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e513","DOI":"10.1016\/j.wneu.2013.06.005","article-title":"Incidence and significance of intraoperative cerebrospinal fluid leak in endoscopic pituitary surgery using intrathecal fluorescein","volume":"82","author":"Jakimovski","year":"2014","journal-title":"World Neurosurg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1544","DOI":"10.3171\/2010.10.JNS09406","article-title":"Endoscopic endonasal skull base surgery: analysis of complications in the Authors\u2019 initial 800 patients","volume":"114","author":"Kassam","year":"2011","journal-title":"J. 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