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


Authors: Komotar, R. J.; Starke, R. M.; Raper, D. M. S.; Anand, V. K.; Schwartz, T. H.
Article Title: Endoscopic endonasal versus open repair of anterior skull base CSF leak, meningocele, and encephalocele: A systematic review of outcomes
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. © 2013 Georg Thieme Verlag KG Stuttgart, New York.
Keywords: review; surgical approach; postoperative complication; systematic review; endoscopic surgery; surgical infection; recurrent disease; sepsis; surgical mortality; intermethod comparison; medline; skull base; liquorrhea; meningitis; endoscopic; csf leak; encephalocele; meningocele; open transcranial approach
Journal Title: Journal of Neurological Surgery. Part A: Central European Neurosurgery
Volume: 74
Issue: 4
ISSN: 2193-6315
Publisher: Thieme Publishing  
Date Published: 2013-07-01
Start Page: 239
End Page: 250
Language: English
DOI: 10.1055/s-0032-1325636
PROVIDER: scopus
PUBMED: 23027433
DOI/URL:
Notes: --- - "Export Date: 1 August 2013" - "Source: Scopus"
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  1. Ricardo Jorge Komotar
    13 Komotar