Predicting post-operative cerebrospinal fluid (CSF) leak following endoscopic transnasal pituitary and anterior skull base surgery: a multivariate analysis

Hannan, Cathal John; Almhanedi, Hamad; Al-Mahfoudh, Rafid; Bhojak, Maneesh; Looby, Seamus; Javadpour, Mohsen

doi:10.1007/s00701-020-04334-5

Cited by 38 publications

(45 citation statements)

References 28 publications

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“…There is also evidence to suggest that posterior fossa defects have a higher proclivity for post-operative CSF leak, which may not be surprising given their dependent location and the requirement for any vascularized nasoseptal flap to be transposed to a greater extent than if they were being used for an anterior fossa or sellar defect (69,70). The rate of post-operative CSF leak has been shown to decrease as the experience of the operating surgeon increases, with data from our series of 270 endoscopic cases identifying a CSF leak rate of 21% in the first 90 cases, as compared to 1% in the last 90 cases (66).…”

Section: Post-operative Csf Leak: Risk Factorsmentioning

confidence: 84%

“…In the latter third of a series of 270 patients (operated between July 2006 and June 2016) undergoing endoscopic surgery for resection of pituitary and skull base tumors, 1/90 (1%) patients experienced a post-operative CSF leak. When only EEA with high flow intra-operative CSF leaks were repaired using the following technique, 1/28 (4%) of patients experienced a post-operative CSF leak (66).…”

Section: Skull Base Repair: the Dublin Techniquementioning

confidence: 99%

“…Prior to the adoption of this technique in 2013, we utilized a fat graft, covered with an onlay graft of dural substitute/fascia lata secured with dural sealant. In the setting of a high flow intra-operative CSF leak, a post-operative CSF leak was noted in 7 of 20 cases (35%) (66).…”

Section: Skull Base Repair: the Dublin Techniquementioning

confidence: 99%

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Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

2020

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Following the introduction of fully endoscopic techniques for the resection of pituitary tumors, there was a rapid expansion of the indications for endonasal endoscopic surgery to include extrasellar tumors of the skull base. These techniques offer significant advantages over traditional open surgical approaches to the skull base, including improved tumor resection, and better post-operative neurological outcomes. Following their introduction, however, the initial rate of post-operative CSF leak was unacceptably high. Post-operative CSF leak following skull base surgery is a major source of morbidity, and can lead to the development of life-threatening intracranial infection. The use of vascularized naso-septal flaps transformed the management of these patients, significantly reducing the rate of post-operative CSF leak and increasing the number of patients that could benefit from this less invasive treatment modality. Adequate repair of iatrogenic defects in the skull base is of crucial importance for patients with skull base tumors, as the development of a post-operative CSF leak, and the associated complications can significantly delay the administration of the adjunctive oncological therapies these patients require. In this review, we provide an overview of the latest evidence regarding skull base reconstruction following endoscopic skull base surgery, and describe the skull base repair technique in use at our institution.

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Section: Post-operative Csf Leak: Risk Factorsmentioning

confidence: 84%

Section: Skull Base Repair: the Dublin Techniquementioning

confidence: 99%

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Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

2020

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“…Patient-related factors considered in planning repair strategy included age (e.g. poor wound healing in the elderly), elevated body mass index, previous endonasal surgery and concomitant radiotherapy [ 10 , 28 , 35 – 41 ]. Tumour-related factors included pathology type [ 28 , 31 , 33 , 35 , 42 , 43 ], size, extension (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…poor wound healing in the elderly), elevated body mass index, previous endonasal surgery and concomitant radiotherapy [ 10 , 28 , 35 – 41 ]. Tumour-related factors included pathology type [ 28 , 31 , 33 , 35 , 42 , 43 ], size, extension (e.g. suprasellar extension) [ 31 ] and consistency [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

et al. 2021

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Purpose Postoperative cerebrospinal fluid rhinorrhoea (CSFR) remains a frequent complication of endonasal approaches to pituitary and skull base tumours. Watertight skull base reconstruction is important in preventing CSFR. We sought to systematically review the current literature of available skull base repair techniques. Methods Pubmed and Embase databases were searched for studies (2000–2020) that (a) reported on the endonasal resection of pituitary and skull base tumours, (b) focussed on skull base repair techniques and/or postoperative CSFR risk factors, and (c) included CSFR data. Roles, advantages and disadvantages of each repair method were detailed. Random-effects meta-analyses were performed where possible. Results 193 studies were included. Repair methods were categorised based on function and anatomical level. There was absolute heterogeneity in repair methods used, with no independent studies sharing the same repair protocol. Techniques most commonly used for low CSFR risk cases were fat grafts, fascia lata grafts and synthetic grafts. For cases with higher CSFR risk, multilayer regimes were utilized with vascularized flaps, gasket sealing and lumbar drains. Lumbar drain use for high CSFR risk cases was supported by a randomised study (Oxford CEBM: Grade B recommendation), but otherwise there was limited high-level evidence. Pooled CSFR incidence by approach was 3.7% (CI 3–4.5%) for transsphenoidal, 9% (CI 7.2–11.3%) for expanded endonasal, and 5.3% (CI 3.4–7%) for studies describing both. Further meaningful meta-analyses of repair methods were not performed due to significant repair protocol heterogeneity. Conclusions Modern reconstructive protocols are heterogeneous and there is limited evidence to suggest the optimal repair technique after pituitary and skull base tumour resection. Further studies are needed to guide practice.

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Craniopharyngioma

Karsy

Evans

2022

Contemporary Skull Base Surgery

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Predicting post-operative cerebrospinal fluid (CSF) leak following endoscopic transnasal pituitary and anterior skull base surgery: a multivariate analysis

Cited by 38 publications

References 28 publications

Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

Craniopharyngioma

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