CSF rhinorrhoea after endonasal intervention to the anterior skull base (CRANIAL): proposal for a prospective multicentre observational cohort study

Danyal Z Khan ,Claire Nicholson,Kismet Hossain-Ibrahim,Jonathan Hempenstall,Jonathan Pollock,David Bennett ,Angelos Kolias ,Andrew F Alalade ,Bhaskar Ram,Daniel M Fountain ,Pragnesh Bhatt,Mahmoud Kamel ,Raj Bhalla,Anastasios Giamouriadis,Mohammad Habibullah Khan ,Catherine Gilkes,Patrick Statham,Philip Weir,Rafid Al-Mahfoudh,Peter Ross ,Vikesh Patel,Neil Dorward ,Showkat Mirza,Joan Grieve,Alireza Shoakazemi,Thomas Santarius,James R Tysome,Anuj Bahl,Caroline Hayhurst,Sinan Al-Barazi,Shahzada Ahmed,Georgios Solomou,Simon Stapleton ,Simon Shaw,Dimitris Paraskevopoulos,Alex Paluzzi,Benjamin E Schroeder ,Sam Muquit,Georgios Tsermoulas,Hani J Marcus,Rory J Piper ,Richard Mannion ,Omar Pathmanaban ,Simon Cudlip ,Benjamin Stew,Nick Phillips,Soham Bandyopadhyay,Rishi Sharma,Brendan Hanna,Mark Hughes,Nick Thomas ,Bhavna Ramachandran,Alice O’Donnell,Kanna Gnanalingham ,Parag Sayal,Iain Robertson ,Nigel Mendoza,Graham Dow ,Saurabh Sinha,Mohsen Javadpour,Ivan Cabrilo,Ramesh Nair,Andrew Martin ,Jane Halliday,Eleni Maratos,Alistair Jenkins,Peter D Lacy ,Nijaguna Mathad,David Choi,Neil Donnelly ,Adam Williams

doi:10.1080/02688697.2020.1795622

Abstract

Background The endonasal transsphenoidal approach (TSA) has emerged as the preferred approach in order to treat pituitary adenoma and related sellar pathologies. The recently adopted expanded endonasal approach (EEA) has improved access to the ventral skull base whilst retaining the principles of minimally invasive surgery. Despite the advantages these approaches offer, cerebrospinal fluid (CSF) rhinorrhoea remains a common complication. There is currently a lack of comparative evidence to guide the best choice of skull base reconstruction, resulting in considerable heterogeneity of current practice. This study aims to determine: (1) the scope of the methods of skull base repair; and (2) the corresponding rates of postoperative CSF rhinorrhoea in contemporary neurosurgical practice in the UK and Ireland. Methods We will adopt a multicentre, prospective, observational cohort design. All neurosurgical units in the UK and Ireland performing the relevant surgeries (TSA and EEA) will be eligible to participate. Eligible cases will be prospectively recruited over 6 months with 6 months of postoperative follow-up. Data points collected will include: demographics, tumour characteristics, operative data), and postoperative outcomes. Primary outcomes include skull base repair technique and CSF rhinorrhoea (biochemically confirmed and/or requiring intervention) rates. Pooled data will be analysed using descriptive statistics. All skull base repair methods used and CSF leak rates for TSA and EEA will be compared against rates listed in the literature. Ethics and dissemination Formal institutional ethical board review was not required owing to the nature of the study – this was confirmed with the Health Research Authority, UK. Conclusions The need for this multicentre, prospective, observational study is highlighted by the relative paucity of literature and the resultant lack of consensus on the topic. It is hoped that the results will give insight into contemporary practice in the UK and Ireland and will inform future studies.

Highlights

The endonasal transsphenoidal approach (TSA) has emerged as the preferred approach in order to resect pituitary adenoma and related sellar pathologies owing to its superior effectiveness and safety profile when compared to transcranial approaches
This study aims to determine: [1] the scope of the methods of skull base repair; and [2] the corresponding rates of postoperative cerebrospinal fluid (CSF) rhinorrhoea in contemporary neurosurgical practice in the UK and Ireland
The project will be run through the Neurology and Neurosurgery Interest Group (NANSIG; https://nansig.org/) and British Neurosurgical Trainee Collaborative (BNTRC; https:// www.bntrc.org.uk/) networks

Summary

Introduction

The endonasal transsphenoidal approach (TSA) has emerged as the preferred approach in order to resect pituitary adenoma and related sellar pathologies owing to its superior effectiveness and safety profile when compared to transcranial approaches. This approach is defined by its purpose of accessing the sella turcica through the sphenoid bone. The endonasal transsphenoidal approach (TSA) has emerged as the preferred approach in order to resect pituitary adenoma and related sellar pathologies owing to its superior effectiveness and safety profile when compared to transcranial approaches.. Recent technological advances have allowed the TSA to be performed with success endoscopically.1,3 Building on these endoscopic techniques, the development of the expanded endonasal approach (EEA) has further improved access to the anterior skull base.. The recently adopted expanded endonasal approach (EEA) has improved access to the ventral skull base whilst retaining the principles of minimally invasive surgery. Despite the advantages these approaches offer, cerebrospinal fluid (CSF) rhinorrhoea remains a common complication. It is hoped that the results will give insight into contemporary practice in the UK and Ireland and will inform future studies

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