학술논문
CSF rhinorrhoea after endonasal intervention to the skull base (CRANIAL): A multicentre prospective observational study
Document Type
article
Author
CRANIAL Consortium; Danyal Z Khan; Hani J Marcus; Soham Bandyopadhyay; Benjamin E Schroeder; Vikesh Patel; Alice O’Donnell; Neurology and Neurosurgery Interest Group; British Neurosurgical Trainee Research Collaborative; Anastasios Giamouriadis; Pragnesh Bhatt; Bhaskar Ram; Adithya Varma; Philip Weir; Brendan Hanna; Theodore C Hirst; Patrick McAleavey; Alessandro Paluzzi; Georgios Tsermoulas; Shahzada Ahmed; Wai Cheong Soon; Yasir Arafat Chowdhury; Suhaib Abualsaud; Shumail Mahmood; Paresh Naik; Zohra Haiderkhan; Rafid Al-Mahfoudh; Andrea Perera; Mircea Rus; Adam Williams; Charles Hand; Kumar Abhinav; Cristina Cernei; Aiman Dilnawaz; Richard Mannion; Thomas Santarius; James Tysome; Rishi Sharma; Angelos G Kolias; Neil Donnelly; Ashwin Venkatesh; Caroline Hayhurst; Amr Mohamed; Benjamin Stew; Joseph Merola; Setthasorn Zhi Yang Ooi; Mahmoud Kamel; Mohammad Habibullah Khan; Sahibzada Abrar; Christopher Mckeon; Daniel McSweeney; Mohsen Javadpour; Peter Lacy; Daniel Murray; Elena Roman; Kismet Hossain-Ibrahim; Peter Ross; David Bennett; Nathan McSorley; Adam Hounat; Patrick Statham; Mark Hughes; Alhafidz Hamdan; Caroline Scott; Jigi Moudgil-Joshi; Anuj Bahl; Anna Bjornson; Daniel Gatt; Nick Phillips; Neeraj Kalra; Melissa Bautista; Seerat Shirazi; Catherine E Gilkes; Christopher P Millward; Ahmad MS Ali; Dimitris Paraskevopoulos; Jarnail Bal; Samir Matloob; Rhannon Lobo; Nigel Mendoza; Ramesh Nair; Arthur Dalton; Adarsh Nadig; Lucas Hernandez; Nick Thomas; Eleni Maratos; Jonathan Shapey; Sinan Al-Barazi; Asfand Baig Mirza; Mohamed Okasha; Prabhjot Singh Malhotra; Razna Ahmed; Neil L Dorward; Joan Grieve; Parag Sayal; David Choi; Ivan Cabrilo; Hugo Layard Horsfall; Jonathan Pollock; Alireza Shoakazemi; Oscar Maccormac; Guru N K Amirthalingam; Andrew Martin; Simon Stapleton; Florence Hogg; Daniel Richardson; Kanna Gnanalingham; Omar Pathmanaban; Daniel M Fountain; Raj Bhalla; Cathal J Hannan; Annabel Chadwick; Alistair Jenkins; Claire Nicholson; Syed Shumon; Mohamed Youssef; Callum Allison; Graham Dow; Iain Robertson; Laurence Johann Glancz; Murugan Sitaraman; Ashwin Kumaria; Ananyo Bagchi; Simon Cudlip; Jane Halliday; Rory J Piper; Alexandros Boukas; Meriem Amarouche; Damjan Veljanoski; Samiul Muquit; Ellie Edlmann; Haritha Maripi; Yi Wang; Mehnaz Hossain; Andrew Alalade; Syed Maroof; Pradnya Patkar; Saurabh Sinha; Showkat Mirza; Duncan Henderson; Mohammad Saud Khan; Nijaguna Mathad; Jonathan Hempenstall; Difei Wang, Department of Neurosurgery; Pavan Marwaha; Simon Shaw; Georgios Solomou; Alina Shrestha; Andrew Fraser; Theodore Hirst; Yasir Chowdhury; Sobiya Bilal; Jack Wildman; Priya Babu; Cian Carey; Renitha Reddi Bathuni; Joseph Nathaniel Brennan; Howra Ktayen; Sandhya T Trichinopoly; Danyal Khan; Seun Sobawale; Amir Suliman; Rory Piper; Will Owen; Afaq Sartaj; Edward Goacher; Euan Strachan; Giorgios Solomou
Source
Frontiers in Oncology, Vol 12 (2023)
Subject
Language
English
ISSN
2234-943X
Abstract
ObjectiveDespite progress in endonasal skull-base neurosurgery, cerebrospinal fluid (CSF) rhinorrhoea remains common and significant. The CRANIAL study sought to determine 1) the scope of skull-base repair methods used, and 2) corresponding rates of postoperative CSF rhinorrhoea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull-base tumors.MethodsA prospective observational cohort study of 30 centres performing endonasal skull-base neurosurgery in the UK and Ireland (representing 91% of adult units). Patients were identified for 6 months and followed up for 6 months. Data collection and analysis was guided by our published protocol and pilot studies. Descriptive statistics, univariate and multivariable logistic regression models were used for analysis.ResultsA total of 866 patients were included - 726 TSA (84%) and 140 EEA (16%). There was significant heterogeneity in repair protocols across centres. In TSA cases, nasal packing (519/726, 72%), tissue glues (474/726, 65%) and hemostatic agents (439/726, 61%) were the most common skull base repair techniques. Comparatively, pedicled flaps (90/140, 64%), CSF diversion (38/140, 27%), buttresses (17/140, 12%) and gasket sealing (11/140, 9%) were more commonly used in EEA cases. CSF rhinorrhoea (biochemically confirmed or requiring re-operation) occurred in 3.9% of TSA (28/726) and 7.1% of EEA (10/140) cases. A significant number of patients with CSF rhinorrhoea (15/38, 39%) occurred when no intraoperative CSF leak was reported. On multivariate analysis, there may be marginal benefits with using tissue glues in TSA (OR: 0.2, CI: 0.1-0.7, p