Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery

Karnezis, Tom T.; Baker, Andrew B.; Soler, Zachary M.; Wise, Sarah K.; Rereddy, Shruthi K.; Patel, Zara M.; Oyesiku, Nelson M.; DelGaudio, John M.; Hadjipanayis, Constantinos; Woodworth, Bradford A.; Riley, Kristen; Lee, John; Cusimano, Michael D.; Govindaraj, Satish; Psaltis, Alkis J.; Wormald, Peter John; Santoreneos, Steve; Sindwani, Raj; Trosman, Samuel J.; Stokken, Janalee K.; Woodard, Troy D.; Recinos, Pablo F.; Vandergrift, William A.; Schlosser, Rodney J.

doi:10.1002/alr.21783

Cited by 82 publications

(157 citation statements)

References 20 publications

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“…In addition, they looked at BMI independently, and demonstrated the incidence of CSF leak to be significantly higher in overweight and obese patients compared to those with normal BMI (18.8% vs 11.6%, p = 0.04) . Karnezis et al . retrospectively evaluated over 1000 patients with sellar lesions (craniopharyngioma and pituitary adenomas) from 7 different institutions and demonstrated a significantly higher postoperative CSF leak in patients with high BMI.…”

Section: Complicationsmentioning

confidence: 87%

“…Two case series also compared outcomes of vascularized vs free‐graft repair of skull‐base defects. In a multi‐institutional case series, Karnezis et al . demonstrated a significantly lower rate of postoperative CSF leaks among patients undergoing vascular flap repairs (7.5%, 16/212) compared to patients repaired with free grafts (14.5%, 20/138).…”

Section: Reconstructionmentioning

confidence: 99%

“…Numerous paradigms have been proposed for determining the need for vascularized reconstruction of skull‐base defects. The following clinical considerations are among the most common criteria for determining the indications for vascular flap reconstruction: severity of intraoperative CSF leak, site of defect, size of defect, and mechanism of defect …”

Section: Reconstructionmentioning

confidence: 99%

“…reviewed 55 pediatric skull‐base patients and showed CSF leak rates were higher in ages 5 to 10 years and 16+ years, but their study is limited by small sample sizes at each quartile. However, Karnezis et al . and Boling et al .…”

Section: Complicationsmentioning

confidence: 99%

“…assessed prior irradiation in their review of 121 patients with NSF reconstruction at multiple subsites and showed no difference of CSF leak rates in the 31% of patients who had received RT ( p = 0.72). Conversely, Karnezis et al . retrospectively studied endoscopic pituitary patients from 7 institutions (n = 1161) and demonstrated a 28% postoperative leak rate in patients with prior irradiation (albeit only 14 patients) compared to 5.6% of patients without prior irradiation ( p = 0.007).…”

Section: Complicationsmentioning

confidence: 99%

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

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157

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Complicationsmentioning

confidence: 87%

Section: Reconstructionmentioning

confidence: 99%

Section: Reconstructionmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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