Giuseppe E Umana1, Resi Pucci2, Paolo Palmisciano3, Andrea Cassoni2, Luca Ricciardi4, Santino O Tomasi5, Lidia Strigari6, Gianluca Scalia7, Valentino Valentini2. 1. Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy. Electronic address: umana.nch@gmail.com. 2. Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy. 3. Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy. 4. Division of Neurosurgery, Department of NESMOS, Sapienza University of Rome, Rome, Italy. 5. Department of Neurological Surgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria. 6. Department of Medical Physics, IRCCS University Hospital of Bologna, Bologna, Italy. 7. Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy.
Abstract
BACKGROUND: Anterior skull base (ASB) fractures are reported in 4% of head injuries and represent 21% of all skull fractures. Cerebrospinal fluid (CSF) leaks may follow, severely exacerbating outcomes. We systematically reviewed the literature to analyze and compare the roles of endoscopic surgery, open surgery, and combined approaches in the management of CSF leak repair after posttraumatic ASB fractures. METHODS: PubMed, Web of Science, and Scopus databases were searched in accordance with the PRISMA guidelines. Studies reporting clinical data of patients with CSF leaks after ASB fracture were reviewed, focusing on management strategies and posttreatment outcomes. RESULTS: We included 29 articles comprising 888 patients. The average age at diagnosis was 34 years (range, 18-91 years), with a male predominance (54%) and a male/female ratio of 2.9:1 (647:241). Clinical data were available for 888 patients with CSF leaks after ASB fracture, reporting a median follow-up time of 33.5 months (standard deviation, ±29; range, 0.5-330.0 months). Open surgical repair was the most common approach (67.9%), followed by endoscopic surgical repair (32.1%). The endoscopy cohort showed lower rates of complications (0.7% vs. 11.1%) and fistula recurrence (2.8% vs. 5.3%) compared with open surgery. CONCLUSIONS: ASB fractures are frequently treated as late surgery, 24 hours from injury or later, especially for endoscopic surgery. Overall, the endoscopic approach is preferred, mostly because of its safety and effectiveness, offering lower failure rates than does open surgery.
BACKGROUND: Anterior skull base (ASB) fractures are reported in 4% of head injuries and represent 21% of all skull fractures. Cerebrospinal fluid (CSF) leaks may follow, severely exacerbating outcomes. We systematically reviewed the literature to analyze and compare the roles of endoscopic surgery, open surgery, and combined approaches in the management of CSF leak repair after posttraumatic ASB fractures. METHODS: PubMed, Web of Science, and Scopus databases were searched in accordance with the PRISMA guidelines. Studies reporting clinical data of patients with CSF leaks after ASB fracture were reviewed, focusing on management strategies and posttreatment outcomes. RESULTS: We included 29 articles comprising 888 patients. The average age at diagnosis was 34 years (range, 18-91 years), with a male predominance (54%) and a male/female ratio of 2.9:1 (647:241). Clinical data were available for 888 patients with CSF leaks after ASB fracture, reporting a median follow-up time of 33.5 months (standard deviation, ±29; range, 0.5-330.0 months). Open surgical repair was the most common approach (67.9%), followed by endoscopic surgical repair (32.1%). The endoscopy cohort showed lower rates of complications (0.7% vs. 11.1%) and fistula recurrence (2.8% vs. 5.3%) compared with open surgery. CONCLUSIONS: ASB fractures are frequently treated as late surgery, 24 hours from injury or later, especially for endoscopic surgery. Overall, the endoscopic approach is preferred, mostly because of its safety and effectiveness, offering lower failure rates than does open surgery.
Authors: Paolo Palmisciano; Ali S Haider; Mohammadmahdi Sabahi; Chibueze D Nwagwu; Othman Bin Alamer; Gianluca Scalia; Giuseppe E Umana; Aaron A Cohen-Gadol; Tarek Y El Ahmadieh; Kenny Yu; Omar N Pathmanaban Journal: Cancers (Basel) Date: 2021-11-26 Impact factor: 6.639