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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Komotar
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Daniel M S
authors.initials: DM
authors.lastname: Raper
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D004677:Encephalocele / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008588:Meningocele / Q000601:surgery*; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D012008:Recurrence; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult