Trends in cerebrospinal fluid leak rates following the extended endoscopic endonasal approach for anterior skull base me
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REVIEW ARTICLE - TUMOR - MENINGIOMA
Trends in cerebrospinal fluid leak rates following the extended endoscopic endonasal approach for anterior skull base meningioma: a meta-analysis over the last 20 years Amir H. Zamanipoor Najafabadi 1 & Danyal Z. Khan 2,3 & Ivo S Muskens 1 Neil L. Dorward 2 & Wouter R. van Furth 1 & Hani J. Marcus 2,3
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Marike L. D. Broekman 1
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Received: 18 August 2020 / Accepted: 3 November 2020 # The Author(s) 2020
Abstract Objective The extended endoscopic approach provides unimpaired visualization and direct access to ventral skull base pathology, but is associated with cerebrospinal fluid (CSF) leak in up to 25% of patients. To evaluate the impact of improved surgical techniques and devices to better repair skull base defects, we assessed published surgical outcomes of the extended endoscopic endonasal approach in the last two decades for a well-defined homogenous group of tuberculum sellae and olfactory groove meningioma patients. Methods Random-effects meta-analyses were performed for studies published between 2004 (first publications) and April 2020. We evaluated CSF leak as primary outcome. Secondary outcomes were gross total resection, improvement in visual outcomes in those presenting with a deficit, intraoperative arterial injury, and 30-day mortality. For the main analyses, publications were pragmatically grouped based on publication year in three categories: 2004–2010, 2011–2015, and 2016–2020. Results We included 29 studies describing 540 patients with tuberculum sellae and 115 with olfactory groove meningioma. The percentage patients with CSF leak dropped over time from 22% (95% CI: 6–43%) in studies published between 2004 and 2010, to 16% (95% CI: 11–23%) between 2011 and 2015, and 4% (95% CI: 1–9%) between 2016 and 2020. Outcomes of gross total resection, visual improvement, intraoperative arterial injury, and 30-day mortality remained stable over time Conclusions We report a noticeable decrease in CSF leak over time, which might be attributed to the development and improvement of new closure techniques (e.g., Hadad-Bassagasteguy flap, and gasket seal), refined multilayer repair protocols, and lumbar drain usage. Keywords Meningioma . Endoscopic surgery . Skull base . Cerebrospinal fluid leak
Introduction Prior presentations The results of this manuscript have not been presented in any form at any conferences. This article is part of the Topical Collection on Tumor—Meningioma * Amir H. Zamanipoor Najafabadi [email protected] 1
Department of Neurosurgery, University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
2
Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
3
Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
In the last two decades, the limits of endoscopic endonasal skull base surgery have been investigated. Current extended approaches allow exposure of the area betwe
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