Failure of anterior skull base reconstruction for sinonasal carcinoma: consequence on the postoperative follow up. A multicentre evaluation of management.

Background: Numerous techniques for closure of the anterior skull base in cancer patients have a high success rate but management of failure is poorly documented.
Objectives: To standardize the post-operative follow-up after reconstruction surgery of the anterior skull base after removal for sinonasal carcinoma.
Materials and Methods: Retrospective review of failure of anterior skull base reconstruction between 2005 and 2018 in a multicenter setting.
Results: Twenty four patients were included. Reconstruction failure was detected by a cerebrospinal (CSF) leak in 79.2%, by an infectious complication without CSF leak (i.e. meningitis) in 12.5%, and in 8.3% by extensive pneumocephalus. Failure was observed during the first week after surgery in 75% of patients, in the second week in 21%, and in 4% after day 15. The delay in discovery of the failure was associated with multilayer reconstruction ( p =.03). Failure was treated surgically in 54% of the patients and medically in 46%, with a similar success rate (85 vs. 100%).
Conclusion and Significance: After carcinologic resection of the anterior skull base, monitoring should be systematic during the first postoperative week. Surgical management of failure is not always necessary.