title: Endoscopic Endonasal Anterior Skull Base Surgery: A Systematic Review of Complications During the Past 65 Years.
abstract: BACKGROUND
  Endoscopic skull base surgery is becoming more popular as an approach to the anterior skull base for tumors and cerebrospinal fluid (CSF) fistulae. It offers the advantages of better cosmesis and improved quality of life after surgery. We reviewed the complication rates reported in the literature.
  
  
  METHODS
  A literature search was performed in the electronic database Ovid MEDLINE (1950 to August 25, 2015) with the search item "([Anterior] AND Skull base surgery) AND endoscopic."
  
  
  RESULTS
  We identified 82 relevant studies that included 7460 cases. An average overall complication rate of 17.1% (range 0%-68.0%) and a mortality rate of 0.4% (0%-10.0%) were demonstrated in a total of 82 studies that included 7460 cases. The average CSF leak rate for all studies was 8.9% (0%-40.0%) with meningiomas and clival lesions having the greatest CSF leak rates. The most frequent benign pathology encountered was pituitary adenomas (n = 3720, 49.8% of all cases) and the most frequent malignant tumor was esthesioneuroblastoma (n = 120, 1.6% of all cases). Studies that included only CSF fistula repairs had a lower average total complication rate (12.9%) but a greater rate of meningitis compared with studies that reported mixed pathology (2.4% vs. 1.3%). A trend towards a lower total complication rate with increasing study size was observed.
  
  
  CONCLUSIONS
  The endoscopic approach is an increasingly accepted technique for anterior skull base tumor surgery and is associated with acceptable complication rates. Increasing experience with this technique can decrease rates of complications.
authors.affiliation: Victor Horsley Department of Neurosurgery National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom. Electronic address: anoukmt@yahoo.com.
authors.forename: Anouk
authors.initials: A
authors.lastname: Borg
authors.affiliation: Victor Horsley Department of Neurosurgery National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Kirkman
authors.affiliation: Victor Horsley Department of Neurosurgery National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Choi
mesh_terms: D000236:Adenoma / Q000601:surgery; D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology*; D018304:Esthesioneuroblastoma, Olfactory / Q000601:surgery; D005402:Fistula / Q000601:surgery*; D006801:Humans; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D008581:Meningitis / Q000453:epidemiology; D009026:Mortality; D009296:Nasal Cavity; D057605:Natural Orifice Endoscopic Surgery; D044583:Neuroendoscopy / Q000379:methods*; D009666:Nose; D009669:Nose Neoplasms / Q000601:surgery; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D019291:Skull Base / Q000601:surgery; D019292:Skull Base Neoplasms / Q000601:surgery*
keywords: Complications; Endonasal; Endoscopic; Skull base