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Open Access 01-03-2021 | Meningioma | Review Article - Tumor - Meningioma

Trends in cerebrospinal fluid leak rates following the extended endoscopic endonasal approach for anterior skull base meningioma: a meta-analysis over the last 20 years

Authors: Amir H. Zamanipoor Najafabadi, Danyal Z. Khan, Ivo S Muskens, Marike L. D. Broekman, Neil L. Dorward, Wouter R. van Furth, Hani J. Marcus

Published in: Acta Neurochirurgica | Issue 3/2021

Abstract

Objective

The 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.

Methods

Random-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.

Results

We 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 time

Conclusions

We 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.

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Bander ED, Singh H, Ogilvie CB, Cusic RC, Pisapia DJ, Tsiouris AJ, Anand VK, Schwartz TH (2018) Endoscopic endonasal versus transcranial approach to tuberculum sellae and planum sphenoidale meningiomas in a similar cohort of patients. J Neurosurg 128(1):40–48CrossRef

Banu MA, Mehta A, Ottenhausen M, Fraser JF, Patel KS, Szentirmai O, Anand VK, Tsiouris AJ, Schwartz TH (2016) Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches. J Neurosurg 124(3):605–620CrossRef

Banu MA, Szentirmai O, Mascarenhas L, Salek AA, Anand VK, Schwartz TH (2014) Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks. J Neurosurg 121(4):961–975CrossRef

Ceylan S, Anik I, Koc K, Cabuk B (2015) Extended endoscopic transsphenoidal approach infrachiasmatic corridor. Neurosurg Rev 38(1):137–147CrossRef

Clark AJ, Jahangiri A, Garcia RM, George JR, Sughrue ME, McDermott MW, El-Sayed IH, Aghi MK (2013) Endoscopic surgery for tuberculum sellae meningiomas: a systematic review and meta-analysis. Neurosurg Rev 36(3):349–359CrossRef

Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T (2004) Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55(3):539–547CrossRef

Dehdashti AR, Stofko D, Okun J, Obourn C, Kennedy T (2016) Endoscopic endonasal reconstruction of skull base: repair protocol. J Neurol Surgery, Part B Skull Base 77(3):271–278

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188CrossRef

Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method. Biometrics 56(June):455–463CrossRef

10.

Egger M, Schneider M (1998) Meta-analysis spurious precision? Meta-analysis of observational studies. Bmj 316(7125):140CrossRef

11.

Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116(10):1882–1886CrossRef

12.

Hughes-Hallett A, Mayer EK, Marcus HJ, Cundy TP, Pratt PJ, Parston G, Vale JA, Darzi AW (2014) Quantifying innovation in surgery. Ann Surg 260(2):205–211CrossRef

13.

Jho HD, Ha HG (2004) Endoscopic endonasal skull base surgery: Part 1 - the midline anterior fossa skull base. Minim Invasive Neurosurg 47(1):1–8CrossRef

14.

Kassam A, Carrau RL, Snyderman CH, Gardner P, Mintz A (2005) Evolution of reconstructive techniques following endoscopic expanded endonasal approaches. Neurosurg Focus 19(1):1–7

15.

Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 19(1):1–12

16.

Khan DZ, Patel V, Schroeder BE, Cabrilo I, Choi D, Cudlip SA, Donnelly N (2020) CSF rhinorrhoea after endonasal intervention to the anterior skull base (CRANIAL): proposal for a prospective multicentre observational cohort study. Br J Neurosurg. https://doi.org/10.1080/02688697.2020.179562

17.

Koutourousiou M, Gardner PA, Tormenti MJ, Henry SL, Stefko ST, Kassam AB, Fernandez-Miranda JC, Snyderman CH (2012) Endoscopic endonasal approach for resection of cranial base chordomas: Outcomes and learning curve. Neurosurgery 71(3):614–624CrossRef

18.

Leng LZ, Brown S, Anand VK, Schwarz TH (2008) “Gasket-seal” watertight closure in minimal-access endoscopic cranial base surgery. Oper Neurosurgery. 62(5 Suppl 2):ONSE342-3 https://doi.org/10.1227/01.neu.0000326017.84315.1f.

19.

Liu JK, Schmidt RF, Choudhry OJ, Shukla PA, Eloy JA (2012) Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgery. Neurosurg Focus 32(6):1–3CrossRef

20.

Lobatto DJ, de Vries F, Zamanipoor Najafabadi AH, Pereira AM, Peul WC, Vliet Vlieland TPM, Biermasz NR, van Furth WR (2018) Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review. Pituitary 21(1):84–97. https://doi.org/10.1007/s11102-017-0839-1CrossRefPubMed

21.

Lu VM, Goyal A, Rovin RA (2018) Olfactory groove and tuberculum sellae meningioma resection by endoscopic endonasal approach versus transcranial approach: a systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg 174(August):13–20CrossRef

22.

Muskens IS, Briceno V, Ouwehand TL et al (2018) The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis. Acta Neurochir 160(1):59–75CrossRef

23.

Nix P, Alavi SA, Tyagi A, Phillips N (2018) Endoscopic repair of the anterior skull base -is there a learning curve? Br J Neurosurg 32(4):407–411CrossRef

24.

Nyaga VN, Arbyn M, Aerts M (2014) Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Heal 72(1):1–10CrossRef

25.

Oakley GM, Orlandi RR, Woodworth BA, Batra PS, Alt JA (2016) Management of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Int Forum Allergy Rhinol 6(1):17–24CrossRef

26.

Oostra A, van Furth W, Georgalas C (2012) Extended endoscopic endonasal skull base surgery: from the sella to the anterior and posterior cranial fossa. ANZ J Surg 82(3):122–130CrossRef

27.

Ottenhausen M, Rumalla K, Alalade AF et al (2018) Decision-making algorithm for minimally invasive approaches to anterior skull base meningiomas. Neurosurg Focus 44(4):1–8CrossRef

28.

Prevedello DM, Doglietto F, Jane JA, Jagannathan J, Han J, Laws ER (2007) History of endoscopic skull base surgery: Its evolution and current reality. J Neurosurg 107(1):206–213CrossRef

29.

Ransom ER, Palmer JN, Kennedy DW, Chiu AG (2011) Assessing risk/benefit of lumbar drain use for endoscopic skull-base surgery. Int Forum Allergy Rhinol 1(3):173–177CrossRef

30.

Rivera-Serrano CM, Snyderman CH, Gardner P, Prevedello D, Wheless S, Kassam AB, Carrau RL, Germanwala A, Zanation A (2011) Nasoseptal “rescue” flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 121(5):990–993CrossRef

31.

Solares CA, Ong YK, Snyderman CH (2010) Transnasal endoscopic skull base surgery: what are the limits? Curr Opin Otolaryngol Head Neck Surg 18(1):1–7CrossRef

32.

VanGompel JJ, Frank G, Pasquini E, Zoli M, Hoover J, Lanzino G (2011) Expanded endonasal endoscopic resection of anterior fossa meningiomas: report of 13 cases and meta-analysis of the literature. Neurosurg Focus 30(5):1–6CrossRef

33.

Younus I, Gerges MM, Uribe-Cardenas R, Morgenstern PF, Eljalby M, Tabaee A, Greenfield JP, Kacker A, Anand VK, Schwartz TH (2020) How long is the tail end of the learning curve? Results from 1000 consecutive endoscopic endonasal skull base cases following the initial 200 cases. J Neurosurg:1–11. https://doi.org/10.3171/2019.12.JNS192600

34.

Zwagerman NT, Wang EW, Shin SS, Chang Y, Fernandez-miranda JC, Snyderman CH, Gardner PA (2019) Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial. J Neurosurg 131(October):1172–1178CrossRef

Title: Trends in cerebrospinal fluid leak rates following the extended endoscopic endonasal approach for anterior skull base meningioma: a meta-analysis over the last 20 years
Authors: Amir H. Zamanipoor Najafabadi
Danyal Z. Khan
Ivo S Muskens
Marike L. D. Broekman
Neil L. Dorward
Wouter R. van Furth
Hani J. Marcus
Publication date: 01-03-2021
Publisher: Springer Vienna
Keywords: Meningioma
Meningioma
Published in: Acta Neurochirurgica / Issue 3/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04641-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Trends in cerebrospinal fluid leak rates following the extended endoscopic endonasal approach for anterior skull base meningioma: a meta-analysis over the last 20 years

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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