Abstract
Background Repair of anterior skull base cerebrospinal fluid (CSF) leaks, encephaloceles, and meningoceles can prevent meningitis, intracranial abscess, and pneumocephalus. Various surgical techniques have been employed for repair, including open transcranial and transfacial methods. The endoscopic endonasal approach represents a minimal access but equally aggressive alternative. We conducted a systematic review of case series and case reports to assess the role of endoscopy in the management of these lesions. Methods We performed a MEDLINE search of the literature (1950-2010) to identify open and endoscopic surgical series for repair of anterior skull base CSF leaks, encephaloceles, and meningoceles. Comparisons were made for patient and defect characteristics as well as success of repair, morbidity, and outcome. Results Seventy-one studies, involving 1178 patients, were included. There was no significant difference in the rate of successful repair (∼90%) between the open and endoscopic cohorts. Compared with open approaches, complications were significantly lower in the endoscopic group, including meningitis (3.9% versus 1.1%, p = 0.034), abscess/wound infection (6.8% versus 0.7%, p < 0.001), and sepsis (3.8% versus 0%, p = 0.003). Perioperative mortality was also lower in the endoscopic group (0%) compared with the open group (1.4%) (p < 0.001). Conclusion Our systematic review supports the endoscopic endonasal approach as a safe and effective alternative for the treatment of anterior skull base defects, which may be preferable in select patients.
| Original language | English |
|---|---|
| Pages (from-to) | 239-250 |
| Number of pages | 12 |
| Journal | Journal of Neurological Surgery, Part A: Central European Neurosurgery |
| Volume | 74 |
| Issue number | 4 |
| DOIs | |
| State | Published - Jul 8 2013 |
| Externally published | Yes |
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Keywords
- CSF leak
- encephalocele
- endoscopic
- meningocele
- skull base
- systematic review
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
Endoscopic endonasal versus open repair of anterior skull base CSF leak, meningocele, and encephalocele : A systematic review of outcomes. / Komotar, Ricardo J; Starke, Robert M.; Raper, Daniel M S; Anand, Vijay K.; Schwartz, Theodore H.
In: Journal of Neurological Surgery, Part A: Central European Neurosurgery, Vol. 74, No. 4, 08.07.2013, p. 239-250.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Endoscopic endonasal versus open repair of anterior skull base CSF leak, meningocele, and encephalocele
T2 - A systematic review of outcomes
AU - Komotar, Ricardo J
AU - Starke, Robert M.
AU - Raper, Daniel M S
AU - Anand, Vijay K.
AU - Schwartz, Theodore H.
PY - 2013/7/8
Y1 - 2013/7/8
N2 - Background Repair of anterior skull base cerebrospinal fluid (CSF) leaks, encephaloceles, and meningoceles can prevent meningitis, intracranial abscess, and pneumocephalus. Various surgical techniques have been employed for repair, including open transcranial and transfacial methods. The endoscopic endonasal approach represents a minimal access but equally aggressive alternative. We conducted a systematic review of case series and case reports to assess the role of endoscopy in the management of these lesions. Methods We performed a MEDLINE search of the literature (1950-2010) to identify open and endoscopic surgical series for repair of anterior skull base CSF leaks, encephaloceles, and meningoceles. Comparisons were made for patient and defect characteristics as well as success of repair, morbidity, and outcome. Results Seventy-one studies, involving 1178 patients, were included. There was no significant difference in the rate of successful repair (∼90%) between the open and endoscopic cohorts. Compared with open approaches, complications were significantly lower in the endoscopic group, including meningitis (3.9% versus 1.1%, p = 0.034), abscess/wound infection (6.8% versus 0.7%, p < 0.001), and sepsis (3.8% versus 0%, p = 0.003). Perioperative mortality was also lower in the endoscopic group (0%) compared with the open group (1.4%) (p < 0.001). Conclusion Our systematic review supports the endoscopic endonasal approach as a safe and effective alternative for the treatment of anterior skull base defects, which may be preferable in select patients.
AB - Background Repair of anterior skull base cerebrospinal fluid (CSF) leaks, encephaloceles, and meningoceles can prevent meningitis, intracranial abscess, and pneumocephalus. Various surgical techniques have been employed for repair, including open transcranial and transfacial methods. The endoscopic endonasal approach represents a minimal access but equally aggressive alternative. We conducted a systematic review of case series and case reports to assess the role of endoscopy in the management of these lesions. Methods We performed a MEDLINE search of the literature (1950-2010) to identify open and endoscopic surgical series for repair of anterior skull base CSF leaks, encephaloceles, and meningoceles. Comparisons were made for patient and defect characteristics as well as success of repair, morbidity, and outcome. Results Seventy-one studies, involving 1178 patients, were included. There was no significant difference in the rate of successful repair (∼90%) between the open and endoscopic cohorts. Compared with open approaches, complications were significantly lower in the endoscopic group, including meningitis (3.9% versus 1.1%, p = 0.034), abscess/wound infection (6.8% versus 0.7%, p < 0.001), and sepsis (3.8% versus 0%, p = 0.003). Perioperative mortality was also lower in the endoscopic group (0%) compared with the open group (1.4%) (p < 0.001). Conclusion Our systematic review supports the endoscopic endonasal approach as a safe and effective alternative for the treatment of anterior skull base defects, which may be preferable in select patients.
KW - CSF leak
KW - encephalocele
KW - endoscopic
KW - meningocele
KW - skull base
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=84879657548&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84879657548&partnerID=8YFLogxK
U2 - 10.1055/s-0032-1325636
DO - 10.1055/s-0032-1325636
M3 - Article
C2 - 23027433
AN - SCOPUS:84879657548
VL - 74
SP - 239
EP - 250
JO - Journal of Neurological Surgery, Part A: Central European Neurosurgery
JF - Journal of Neurological Surgery, Part A: Central European Neurosurgery
SN - 2193-6315
IS - 4
ER -