OBJECTIVES/HYPOTHESIS: Systematically review the outcomes of endoscopic endonasal techniques to reconstruct large skull base defects (ESBR). Such surgical innovation is likely to be reported in case series, retrospective cohorts, or case-control studies rather than higher level evidence. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Embase (1980-December 7, 2010) and MEDLINE (1950-November 14, 2010) were searched using a search strategy designed to include any publication on endoscopic endonasal reconstruction of the skull base. A title search selected those articles relevant to the clinical or basic science of an endoscopic approach. A subsequent abstract search selected articles of any defect other than simple cerebrospinal fluid (CSF) fistula, sella only, meningoceles, or simple case reports. The articles selected were subject to full-text review to extract data on perioperative outcomes for ESBR. Surgical technique was used for subgroup analysis. RESULTS: There were 4,770 articles selected initially, and full-text analysis produced 38 studies with extractable data regarding ESBR. Of these articles, 12 described a vascularized reconstruction, 17 described free graft, and nine were mixed reconstructions. Three had mixed data in clearly defined patient groups that could be used for meta-analysis. The overall CSF leak rate was 11.5% (70/609). This was represented as a 15.6% leak rate (51/326) for free grafts and a 6.7% leak rate (19/283) for the vascularized reconstructions (χ(2) = 11.88, P = .001). CONCLUSIONS: Current evidence suggests that ESBR with vascularized tissue is associated with a lower rate of CSF leaks compared to free tissue graft and is similar to reported closure rates in open surgical repair.
OBJECTIVES/HYPOTHESIS: Systematically review the outcomes of endoscopic endonasal techniques to reconstruct large skull base defects (ESBR). Such surgical innovation is likely to be reported in case series, retrospective cohorts, or case-control studies rather than higher level evidence. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Embase (1980-December 7, 2010) and MEDLINE (1950-November 14, 2010) were searched using a search strategy designed to include any publication on endoscopic endonasal reconstruction of the skull base. A title search selected those articles relevant to the clinical or basic science of an endoscopic approach. A subsequent abstract search selected articles of any defect other than simple cerebrospinal fluid (CSF) fistula, sella only, meningoceles, or simple case reports. The articles selected were subject to full-text review to extract data on perioperative outcomes for ESBR. Surgical technique was used for subgroup analysis. RESULTS: There were 4,770 articles selected initially, and full-text analysis produced 38 studies with extractable data regarding ESBR. Of these articles, 12 described a vascularized reconstruction, 17 described free graft, and nine were mixed reconstructions. Three had mixed data in clearly defined patient groups that could be used for meta-analysis. The overall CSF leak rate was 11.5% (70/609). This was represented as a 15.6% leak rate (51/326) for free grafts and a 6.7% leak rate (19/283) for the vascularized reconstructions (χ(2) = 11.88, P = .001). CONCLUSIONS: Current evidence suggests that ESBR with vascularized tissue is associated with a lower rate of CSF leaks compared to free tissue graft and is similar to reported closure rates in open surgical repair.
Authors: Liuba Soldatova; Raewyn G Campbell; Ahmad H Elkhatib; Thomas W Schmidt; Nelson R Pinto; Jaime M Pinto; Daniel M Prevedello; Leo F Ditzel Filho; Bradley A Otto; Ricardo L Carrau Journal: J Neurol Surg B Skull Base Date: 2016-06-28
Authors: Leon T Lai; Michael K Morgan; Kornkiat Snidvongs; David C W Chin; Ray Sacks; Richard J Harvey Journal: J Neurol Surg B Skull Base Date: 2013-06-20