Endoscopic endonasal versus open repair of anterior skull base CSF leak, meningocele, and encephalocele: A systematic review of outcomes

Ricardo J Komotar, Robert M. Starke, Daniel M S Raper, Vijay K. Anand, Theodore H. Schwartz

Research output: Contribution to journalArticle

43 Citations (Scopus)

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 languageEnglish
Pages (from-to)239-250
Number of pages12
JournalJournal of Neurological Surgery, Part A: Central European Neurosurgery
Volume74
Issue number4
DOIs
StatePublished - Jul 8 2013
Externally publishedYes

Fingerprint

Meningocele
Encephalocele
Skull Base
Meningitis
Abscess
Pneumocephalus
Wound Infection
MEDLINE
Endoscopy
Sepsis
Morbidity
Mortality
Cerebrospinal Fluid Leak
Therapeutics

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 journalArticle

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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.",
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