Abstract
ObjectiveThe 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.MethodsRandom-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.ResultsWe 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 timeConclusionsWe 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.
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 (2021) 163:711–719 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 
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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
