Abstract
Abstract Introduction The extended endoscopic approach (EEA) provides direct access for resection of tuberculum sellae (TSM) and olfactory groove meningiomas (OGM) but is associated with cerebrospinal fluid (CSF) leak in up to 25% of patients. To evaluate the impact of improved skull base reconstructive techniques, we assessed published CSF leak percentages in EEA over the last two decades. Method Random-effects meta-analyses were performed for studies published between 2004-2020. Outcomes assessed were CSF leak, gross total resection, visual improvement, 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 TSM and 115 OGM patients. CSF leak incidence 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 of reconstructive techniques (e.g., hadad bassagasteguy flap, and gasket seal), refined multilayer repair protocols, and selected lumbar drain usage.
Highlights
In the last two decades, the limits of endoscopic endonasal skull base surgery have been investigated
The percentage patients with a cerebrospinal fluid (CSF) leak dropped over time from 22% in studies published between 2004 and 2010, to 16% between 2011 and 2015, and 4% between 2016 and 2020 (Fig. 2)
Results of the main meta-analyses indicate that the percentage patients suffering from a CSF leak after extended endoscopic endonasal surgery for a tuberculum sellae or olfactory groove meningioma has decreased from 22% since publication of the first described case series to 4% in recent case series
Summary
In the last two decades, the limits of endoscopic endonasal skull base surgery have been investigated. Acta Neurochir with tuberculum sellae and olfactory groove meningioma, there is evidence that in selected patients the endoscopic approach results in better visual outcomes compared with the transcranial approach with overall low complication rates [22]. These extended approaches result in large dural defects and an increased risk of cerebrospinal fluid (CSF) leak in up to 25% of patients [22]. As these extended approached are still relatively new and are used for uncommon pathologies, a learning curve has been described by multiple groups [17, 33]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
