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J Neurol Surg B Skull Base
DOI: 10.1055/s-0044-1785486
Original Article

Systematic Review: Success Rate of Endoscopic Endonasal versus Combined Endonasal and Transorbital Neuroendoscopic Approach for Nontraumatic Cerebrospinal Fluid Leak Repairs in the Lateral Recess of Sphenoid Sinus

Umnia Nasir Ahmed 
1   University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom
,
Mohammed Saqlain Siddiqui 
1   University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom
,
Haissan Iftikhar 
2   Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
,
Karan Jolly 
2   Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
,
Hannah Nieto 
2   Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
3   Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
,
Jameel Muzaffar 
2   Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
4   Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Abstract

Background Cerebrospinal fluid (CSF) leaks from the lateral recess of the sphenoid sinus (LRS) occur due to a skull base defect and are important to treat due to the associated morbidity, e.g., life-threatening meningitis. Nontraumatic CSF leaks have a predilection toward obesity which is a rising phenomenon. LRS is notoriously difficult to access because of its lateral location and its associated neurovascular complications. An alternative surgical corridor has been explored which is the transorbital neuroendoscopic (TONES) approach.

Objective To compare the success rate of the endoscopic endonasal with the TONES approaches.

Rationale This is the first systematic review on the endoscopic endonasal and combined transorbital approaches to treat CSF leaks from the LRS.

Method A PRISMA-concordant systematic review. PubMed, MEDLINE, EMBASE, Web of Science, and SCOPUS were searched. The studies underwent abstract and full-text screening by two reviewers. The data collected included patient demographic, surgical approach, reconstruction method, layers and materials, follow-up period, ROBINS-I bias, complications, and success rate.

Results In total, 26 of 4,385 studies were included for further synthesis. Of these studies, a total of 336 patients were identified from a cohort of 910 patients. The endoscopic endonasal approach showed a repair success rate of 95.24% and the combined TONES and endonasal approach showed a success rate of 100%.

Conclusion Both the endoscopic endonasal and transorbital approach provide a good success rate. However, due to the small TONES sample, large, randomized control trials are needed.

Keywords

lateral recess of the sphenoid sinus - cerebrospinal fluid leak - skull base - spontaneous - transpterygoid - TONES


Publication History

Received: 02 December 2023

Accepted: 27 February 2024

Article published online:
08 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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