Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery

Total intravenous versus inhalational anesthesia in endoscopic sinus surgery: A meta‐analysis

“…Across our included studies, there was no statistical difference between the TIVA and IA cohorts with respect to LM score, which is encouraging for low selection bias risk based on this parameter. In addition, aspects such as BMI and ASA grade proportions of the included cohorts were also comparable, which is important to note because both have also been implicated to correlate with ESS complications.…”

Continuous lumbar drainage and the postoperative complication rate of open anterior skull base surgery

“…With changing trends toward endoscopic approaches for skull base surgery, the elective use of LD in such operations has been widely investigated . Recently, a prospective study found that elective LD placement is related to lower rate of postoperative CSF leaks in endoscopic skull base operations, whereas a meta‐analysis found no difference in the postoperative CSF leak rates or successful repair rates for endoscopic CSF leak repair with elective LD placement …”

“…The insertion of a LD itself bears risks of its own, including mechanical failure of the device, alterations in drainage rate, surgical site or CNS infection, headaches, nausea, intracranial vessel damage, and devastating tension pneumoencephalus . Only a few studies explored potential methods (such as airway diversion, LD placement) to prevent tension pneumoencephalus and other CNS complications after skull base operations …”

“…6 With changing trends toward endoscopic approaches for skull base surgery, the elective use of LD in such operations has been widely investigated. 14,[16][17][18][19] Recently, a prospective study found that elective LD placement is related to lower rate of postoperative CSF leaks in endoscopic skull base operations, 20 whereas a meta-analysis found no difference in the postoperative CSF leak rates or successful repair rates for endoscopic CSF leak repair with elective LD placement. 21 Our current investigation revealed that patients who underwent elective perioperative LD insertion had a higher rate of malignancy as well as a higher rate of dural and intracranial extension of their lesions, and that they were treated more often with adjuvant therapy and had a longer postoperative hospitalization period.…”

“Inverted Gull Wing” Dural Closure and Middle Fossa Floor Reconstruction After Transzygomatic Infratemporal Fossa Approach

“…Many risk factors have been associated with postoperative CSF leak after cranial surgery, including age, increased body mass index, diabetes, complex surgical resections, particularly those that combine microscopic transcranial with endoscopic nasal sinus approaches. [1][2][3][4] The use of steroid therapy, chemotherapy, and radiotherapy can further complicate wound healing and, in turn, the repercussions of CSF leak. 5 Infratemporal fossa approaches for tumors that require removal of the middle fossa floor can provide additional challenges with gravity-dependent CSF drainage into the dead space of the tumor resection cavity.…”