Abstract

Background: The endoscopic endonasal approach (EEA) is a minimally invasive technique widely used for skull base tumor removal. Elderly patients present unique challenges due to age-related physiological changes and comorbidities. This study evaluates the impact of reconstruction techniques on postoperative cerebrospinal fluid (CSF) leaks in elderly (≥ 65 years) and non-elderly (< 65 years) patients.

Methods: This retrospective cohort study, conducted at MacKay Memorial Hospital, included 132 patients who underwent EEA with skull base reconstruction between October 2020 and September 2024. Patients were stratified into elderly and non-elderly groups. Data on demographics, tumor characteristics, surgical variables, and postoperative complication of CSF leakage were analyzed.

Results: No statistically significant differences were observed between the two groups in intraoperative CSF leak grading or nasoseptal flap (NSF) usage. Postoperative CSF leaks requiring revision surgery occurred in 3.1% of non-elderly patients and none in the elderly group (p = 0.569). Key contributors to CSF leaks included delayed mucosal recovery, residual tumor bleeding, and inadequate patient education.

Conclusion: Advanced age was not associated with increased postoperative CSF leak risk, supporting the safety and efficacy of EEA in elderly patients. Tailored surgical planning and perioperative care remain essential for optimizing outcomes.