Journal of Neurological Surgery Part B: Skull Base最新文献

{"title":"Rates of Hereditary Paraganglioma Syndromes and Secretory Head and Neck Paragangliomas: A Single-Institution Experience.","authors":"Rance J T Fujiwara, Hitomi Sakano, Daniel E Killeen, J Walter Kutz, Brandon Isaacson","doi":"10.1055/a-2607-5611","DOIUrl":"10.1055/a-2607-5611","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to characterize the rate of secretory tumors and the rate and types of genetic variations identified in patients diagnosed with head and neck (HN) paragangliomas.</p><p><strong>Study design: </strong>A retrospective case review.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Participants: </strong>About 74 patients with HN paragangliomas treated with gamma knife radiosurgery.</p><p><strong>Main outcome measures: </strong>Genetics testing via the Ambry Genetics Hereditary Paraganglioma and Pheochromocytoma Panel, and 24-hour urine metanephrine and catecholamine levels, were obtained. Pathogenic and likely pathogenic variations were tabulated. Levels of 24-hour urinary epinenephrine, norepinephrine, metanephrine, normetanephrine, and dopamine were recorded and correlated with rates of genetic variations.</p><p><strong>Results: </strong>Of 74 patients, 46 (62.2%) and 38 (51.4%) underwent laboratory and genetics testing, respectively; 29 (39.2%) completed both. Nine (19.6%) had abnormally elevated 24-hour urine metanephrine/catecholamine, of whom eight (88.9%) had elevated normetanephrine levels. Pathogenic/likely pathogenic variations were found in 15/38 (39.5%) patients. Among those with both genetics and laboratory testing, 4/12 (33.3%) with a pathogenic variation had evidence of secretory tumors, compared with 1/17 (5.9%) of those without a variation. Conversely, 80% (4/5) of patients with abnormally elevated metanephrine or catecholamine studies had a pathogenic genetic variation, compared with 33.3% (8/24) with normal laboratory results.</p><p><strong>Conclusion: </strong>This is a single-institution cohort with HN paragangliomas who underwent genetic testing and urine catecholamine and metanephrine studies. We demonstrate that a large fraction of patients presenting with HN paragangliomas have pathogenic genetic variations and secreting tumors. Genetic testing and counseling, and laboratory studies, should thus be performed in patients diagnosed with HN paragangliomas.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"287-292"},"PeriodicalIF":0.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skull Base Reconstruction Following Endoscopic Pituitary Surgery: A Global Survey.","authors":"Fabio P Gazmenga, Daniel M Prevedello, Ricardo L Carrau, Marcelo H Sampaio, Mateus Dal Fabbro","doi":"10.1055/a-2607-1028","DOIUrl":"10.1055/a-2607-1028","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to better learn how pituitary surgery centers around the world perform the reconstruction step of endoscopic endonasal transsphenoidal pituitary surgery and to understand the rationale behind their strategies.</p><p><strong>Design: </strong>Survey.</p><p><strong>Setting and participants: </strong>Representatives of 311 centers across 54 countries were invited.</p><p><strong>Main outcome measures: </strong>Online 15-question questionnaire.</p><p><strong>Results: </strong>Representatives of 121 centers from 36 countries responded to the survey. We recorded a preference for multilayer reconstruction in all scenarios presented. In cases of intraoperative cerebrospinal fluid (CSF) leak and extended approaches, respondents reported greater use of autologous materials, such as fat grafts, fascia lata, and pedicled flaps. Although there was no statistical significance for most of the scenarios analyzed, we observed a greater tendency to use pedicled flaps in centers with ENT specialists on the team and a lower likelihood of using them in centers with a higher surgical volume. For cases where no CSF leak is expected preoperatively, the overall preference was for the use of rescue flaps (56.10%), especially in centers in which an ENT surgeon was present (69.77%). Once a nasoseptal flap has been created, the preference is for the nasal septum to heal by secondary intention (52.23%).</p><p><strong>Conclusion: </strong>This survey provides additional evidence of the wide variability in practice and strategies among specialized pituitary/skull base surgery centers worldwide. Trends toward multilayer reconstruction, use of the nasoseptal flaps, and autologous grafts were observed. The presence of an otolaryngologist on the team influences the reconstruction strategy adopted at the institution.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"299-307"},"PeriodicalIF":0.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Objective and Subjective Olfactory Dysfunction in SARS-CoV-2-Positive Patients Undergoing Skull Base Surgery.","authors":"Bastien A Valencia-Sanchez, Prishae Wilson, Natasha N Najmi, Alaa Alhalabi, Kaisorn Chaichana, Angela M Donaldson","doi":"10.1055/a-2599-4262","DOIUrl":"10.1055/a-2599-4262","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the association between objective and subjective olfactory assessments in patients with recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection undergoing endoscopic endonasal skull base surgery (EESBS).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic medical center.</p><p><strong>Participants: </strong>Adult patients with and without recent SARS-CoV-2 infection who underwent EESBS for sellar and parasellar lesion resection between 2020 and 2024 at the Mayo Clinic in Florida, Jacksonville, FL.</p><p><strong>Main outcome measures: </strong>Pre- and postoperative self-reported olfactory dysfunction and University of Pennsylvania Smell Identification Test (UPSIT) scores were collected.</p><p><strong>Results: </strong>Patients with recent SARS-CoV-2 infection had a similar rate of discrepant preoperative objective olfactory assessments (38.2%, 26/68) compared with SARS-CoV-2-negative patients (39.9%, 127/318). SARS-CoV-2-positive patients were twice as likely to report postoperative subjective olfactory dysfunction (46.2%, 12/26) compared with SARS-CoV-2-negative patients (18.1%, 23/127, <i>p</i>  = 0.002). There was no statistically significant difference in the mean preoperative ( <i>p</i>  = 0.162) or postoperative ( <i>p</i>  = 0.724) UPSIT scores between both groups.</p><p><strong>Conclusion: </strong>Patients with recent SARS-CoV-2 infection and discrepant preoperative objective olfactory assessments were twice as likely to self-report olfactory dysfunction following EESBS compared with SARS-CoV-2-negative controls. This increase in self-reported olfactory dysfunction was not accompanied by changes in objective psychophysical testing. These findings suggest that SARS-CoV-2 infection may impact subjective olfactory recovery following EESBS.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"345-351"},"PeriodicalIF":0.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Expensive is ENT Surgeons' Involvement in Retrosigmoid Craniotomies? A Time-Driven Activity-Based Cost Analysis.","authors":"Danyal A Quraishi, D Mitchell Self, Steven Glener, Advith Sarikonda, Neerav Kumar, Emily L Isch, Matthews Lan, Arbaz Momin, Ashmal Sami Kabani, James J Evans, Kevin D Judy, Nicholas Clark, Christopher J Farrell, Ahilan Sivaganesan","doi":"10.1055/a-2607-0611","DOIUrl":"10.1055/a-2607-0611","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to examine the impact of ear, nose, and throat (ENT) surgeons' involvement on intraoperative costs and operating room (OR) times for retrosigmoid craniotomies using time-driven activity-based costing (TDABC).</p><p><strong>Design: </strong>A retrospective, single-center analysis was conducted. TDABC methodology was utilized to calculate total intraoperative costs. Multiple linear regression analysis was performed to assess the independent effect of ENT surgeons' involvement on surgical costs and OR time.</p><p><strong>Setting: </strong>All procedures were performed at the Thomas Jefferson University Hospital and affiliated sites between 2017 and 2022.</p><p><strong>Participants: </strong>About 255 patients underwent retrosigmoid craniotomy (166 neurosurgery only, 89 with ENT surgeons' involvement).</p><p><strong>Main outcome measures: </strong>Main outcome measures include total intraoperative costs calculated using TDABC methodology, OR time, supply costs, and personnel costs.</p><p><strong>Results: </strong>Inclusion of ENT surgeons was significantly associated with increased total costs (B = $4,082 ± $1,015, <i>p</i>  < 0.001) and OR time (B = 135 ± 38 minutes, <i>p</i>  < 0.001). The mean total cost of neurosurgery-only cases was $7,538 ± $3,977, compared with $14,217 ± $3,485 for multidisciplinary cases. Personnel costs were the primary driver of this increase, with no significant difference in supply costs between groups.</p><p><strong>Conclusion: </strong>While ENT collaboration can enhance outcomes in select cases, such as those involving vestibular schwannomas, its routine inclusion may not be cost-effective. Our study demonstrates the marginal cost of ENT collaboration for retrosigmoid craniotomies. Future studies may build on our costing framework by integrating outcomes with costs to determine the true cost-effectiveness of cross-specialty collaboration.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 3","pages":"e65-e74"},"PeriodicalIF":0.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum: Presentation Abstracts of the North American Skull Base Society.","authors":"","doi":"10.1055/s-0045-1809309","DOIUrl":"10.1055/s-0045-1809309","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1055/s-015-61030.][This corrects the article DOI: 10.1055/s-0045-1803753.][This corrects the article DOI: 10.1055/s-0045-1803827.].</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"86 Suppl 1","pages":"e1"},"PeriodicalIF":0.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Strategies for Expanding the Endoscopic Caudal Access to the Craniovertebral Junction: A Cadaveric Comparative Analysis of Nasofrontal Trephination and Posterior Palatectomy.","authors":"Moataz D Abouammo, Maithrea S Narayanan, Mohammad Bilal Alsavaf, Mohammed Alwabili, Simona Serioli, Guilherme Mansur, Jimmy Qiu, Chandrima Biswas, Noha E Shalaby, Serena Capelli, Jaskaran S Gosal, Mohamed Ammo, Mona A H Shehata, Kyle K VanKoevering, Kyle C Wu, Francesco Doglietto, Daniel M Prevedello, Ricardo L Carrau","doi":"10.1055/a-2565-9342","DOIUrl":"10.1055/a-2565-9342","url":null,"abstract":"<p><strong>Objectives: </strong>Although the endoscopic endonasal approach (EEA) has emerged as a preferred alternative to traditional transoral access for craniovertebral junction (CVJ) surgery, its limited inferior reach beyond the C1 level remains a significant challenge. This study investigates the effectiveness of using a contralateral nasofrontal trephination (CNT) or a posterior palatectomy (PP) to enhance the caudal reach to the CVJ region.</p><p><strong>Design: </strong>A quantitative cadaveric study.</p><p><strong>Setting: </strong>Cadaver dissection laboratory.</p><p><strong>Participants: </strong>A total of 15 adult human cadaveric heads.</p><p><strong>Methods: </strong>EEA, EEA + PP, and EEA + CNT approaches to the CVJ were performed. Neuronavigation was used for objective measurements quantifying the volume of surgical freedom, surface area of deep exposure, entry point sagittal angle, and inferior reach below the odontoid process.</p><p><strong>Main outcome measures and results: </strong>EEA + CNT demonstrated superior surgical metrics across all parameters. Surface exposure was significantly greater with EEA + CNT (107.04 cm ² ) versus EEA + PP (86.26 cm ² ) and standard EEA (69.78 cm ² ; <i>p</i>  < 0.001). The volume of surgical freedom showed similar superiority with EEA + CNT (60.21 cm ³ ), followed by EEA + PP (34.14 cm ³ ) and EEA (26.13 cm ³ ; <i>p</i>  < 0.001). Inferior reach below the odontoid (CNT: 6.35 cm; PP: 2.17 cm; EEA: 0.9 cm; <i>p</i>  < 0.0001) and surgical trajectory angle (CNT: 50.1 degrees; PP: 21.4 degrees; EEA: 16.6 degrees; <i>p</i>  < 0.0001) demonstrated significant stepwise improvements with each adjunct technique.</p><p><strong>Conclusion: </strong>Both CNT and PP techniques significantly enhance the surgical corridor of traditional EEA for CVJ access. A CNT afforded superior surgical exposure while maintaining minimal invasiveness. PP offers a viable alternative when external incisions are undesired and lesions are confined within the C2-C3 level.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 2","pages":"190-199"},"PeriodicalIF":0.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual and Community-Level Social Determinant Associations with Skull Base Chordoma and Chondrosarcoma Disparities in the United States.","authors":"David J Fei-Zhang, Rishabh Sethia, Atharva Desai, Anthony M Sheyn, Jill N D'Souza, Daniel C Chelius, Jeffrey C Rastatter","doi":"10.1055/a-2596-3916","DOIUrl":"10.1055/a-2596-3916","url":null,"abstract":"<p><strong>Objective: </strong>Using multivariate models of social determinants of health (SDoH) featuring census-level Yost Index-socioeconomic status (SES) measures, to determine whether community-level SDoH factors quantifiably influence skull base chordoma-chondrosarcoma disparities more than individual-level SDoH factors on care-prognostic differences nationally.</p><p><strong>Design setting participants: </strong>Retrospective cohort, skull base chordomas/chondrosarcoma patients diagnosed between 2010 and 2018 from SEER (Surveillance, Epidemiology, and End Results) were analyzed by multivariate, age-adjusted regressions and Cox proportional hazards models; covariates of sex, race-ethnicity, census-level rurality-urbanicity, census-level Yost-Index score (aggregating 7 SES-measures of education, income, housing).</p><p><strong>Main outcome measures: </strong>Mortality, late-staging, first-line/nonfirst-line treatment, delay-in-treatment.</p><p><strong>Results: </strong>Across 1,530 skull base chordomas and chondrosarcomas, delay-of-treatment featured a markedly positive independent predictor of minority race/ethnicity (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.27-1.34; <i>p</i>  < 0.001). Five-year all-cause mortality showed markedly positive predictors of male-sex (1.82; 1.30-2.56; <i>p</i>  < 0.001), minority race/ethnicity (OR, 1.94; 95% CI, 1.32-2.87; <i>p</i>  = 0.001), and decreasing Yost-SES (OR, 1.61; 95% CI, 1.14-2.26; <i>p</i>  = 0.006). Three-year all-cause mortality featured markedly positive predictors of male-sex (OR, 1.82; 95% CI, 1.30-2.56; <i>p</i>  < 0.001) and minority race/ethnicity (OR, 1.75; 95% CI, 1.18-2.58; <i>p</i>  = 0.005). Receipt of nonfirst-line radiation therapy showed a markedly positive independent predictor of minority race/ethnicity (OR, 1.34; 95% CI, 1.06-1.71; <i>p</i>  = 0.016). Receipt of first-line primary surgery showed a markedly negative independent predictor of decreasing Yost-SES (OR, 0.71; 95% CI, 0.53-0.96; <i>p</i>  = 0.024). Advanced-staging showed a markedly positive independent predictor of decreasing Yost-SES (OR, 1.85; 95% CI, 1.19-2.89; <i>p</i>  = 0.006).</p><p><strong>Conclusion: </strong>Through interactional models of individual- and community-level social determinant factors, this study observed detrimental, interrelated SDoH associations with poorer care and prognosis of chordoma and chondrosarcoma patients while quantifiably delineating the strength of factor association with observed disparities.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 2","pages":"182-189"},"PeriodicalIF":0.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Prognosis of Delayed Facial Nerve Palsy After Vestibular Schwannoma Resection: Systematic Review and Meta-analysis.","authors":"Ashton Huppert Steed, Katherine Riordan, Melissa Papuc, Alma Jukic, Kory A Johnson, Annie Pico, Mazen Zaher, Pedro Aguilar-Salinas, Peter Nakaji","doi":"10.1055/a-2587-6401","DOIUrl":"10.1055/a-2587-6401","url":null,"abstract":"<p><strong>Objective: </strong>Delayed facial nerve palsy (DFNP) is a complication of microsurgical resection of vestibular schwannoma (VS). This study aims to clarify the definition and incidence of DFNP, as well as evaluate long-term CNVII prognosis in affected patients.</p><p><strong>Databases reviewed: </strong>PubMed, Embase, and Scopus databases.</p><p><strong>Methods: </strong>A systematic literature search was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Full-text publications were included if they reported DFNP incidence, CNVII prognosis, demographic data, and how they defined DFNP.</p><p><strong>Results: </strong>Ten studies with 2,122 patients who underwent surgical resection for VS were included. Meta-analysis demonstrated a mean incidence of DFNP of 13%, with a mean recovery to House-Brackmann (HB) I/II of 85%. Definitions of DFNP varied widely. Four studies utilized a broad definition of DFNP, without requiring any specific level of change in HB grade in the postoperative period. Two studies defined DFNP as deterioration of CNVII function by at least one HB grade, and an additional four studies defined DFNP as deterioration of CNVII function by at least two HB grades.</p><p><strong>Conclusion: </strong>The prognosis of CNVII function after DFNP was favorable with 85% of patients regaining function to HB grade I/II within 12 months. Given the heterogeneity in definitions of DFNP, it remains challenging to determine the true incidence of DFNP after VS resection. Grading DFNP by degree of severity would improve studies of this entity. We propose utilizing a novel DFNP Severity Scale to more accurately track prognosis in patients with DFNP based on pre- and postoperative HB scores.</p><p><strong>Level of evidence: </strong>Level III-systematic review of nonrandomized cohort studies and retrospective reviews.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 2","pages":"123-130"},"PeriodicalIF":0.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Posterior Fossa Morphometric Analyses with Cerebrospinal Fluid Flow Parameters in Patients with Chiari Malformation Type 1.","authors":"Samet Dinc, Aynur Turan, Rafet Ozay, Sahin Hanalioglu","doi":"10.1055/a-2590-6293","DOIUrl":"10.1055/a-2590-6293","url":null,"abstract":"<p><strong>Objectives: </strong>Chiari malformation (CM) is a congenital condition characterized by herniating cerebellar tonsils (HCTs) into the spinal canal. Although mostly managed through posterior decompression surgery, there is a lack of consensus about the need for surgery in asymptomatic patients or those with mild clinical findings. This study aimed to evaluate cerebrospinal fluid (CSF) flow parameters in patients with CM type 1 (CM-1) and compare them with posterior cranial fossa (PCF) morphometric measurements to use these measurements for predicting disease progression.</p><p><strong>Design: </strong>Retrospective analysis.</p><p><strong>Setting: </strong>Department of Neurosurgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Health Sciences University Participants: Adult patients ( <i>n</i>  = 95; mean age = 40.8 ± 13.8 years; 76 females) diagnosed with CM-1 between January 2017 and October 2018.</p><p><strong>Main outcome measures: </strong>Symptoms at presentation, CSF flow score, PCF morphometric measurements-measured using brain and spinal cord magnetic resonance imaging and computed tomography.</p><p><strong>Results: </strong>Coughing headache, presence of additional pathology (syringomyelia), PCF volume and height, Boogard's angle, foramen magnum surface area, HCT length, and HCT surface area (HCTSA) were significant factors affecting CSF flow. Further, multivariate regression analysis revealed that the HCT length and HCTSA, the presence of additional pathology, and Boogard's angle were independent predictors of CSF flow scores.</p><p><strong>Conclusion: </strong>The morphometric measures, HCT length, HCTSA, and Boogard's angle, and the presence of additional pathology are important predictive factors for reduced CSF flow at the craniovertebral junction in patients with CM-1. These factors can help clinicians predict the disease's clinical progression and plan surgical treatment.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 2","pages":"225-233"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Routine Lumbar Drains Necessary for Endoscopic Reconstruction after Resection of Anterior and Central Skull Base Tumors?","authors":"Jacob C Harris, David K Lerner, Iulia Tapescu, Alan D Workman, Jennifer E Douglas, Michael A Kohanski, Christina Jackson, John Y K Lee, Philip B Storm, James N Palmer, Nithin D Adappa","doi":"10.1055/a-2575-4718","DOIUrl":"10.1055/a-2575-4718","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The expanded endonasal approach (EEA) is historically associated with high rates of postoperative cerebrospinal fluid (CSF) leak. Therefore, many surgeons advocate for routine lumbar drain (LD) placement despite mixed evidence of their efficacy. We report outcomes for anterior and central skull base reconstructions after EEA without LDs.</p><p><strong>Design setting and participants: </strong>A retrospective review was conducted evaluating consecutive patients undergoing EEAs for resection of central and anterior skull base pathology from 2015 to 2024 at two academic institutions.</p><p><strong>Main outcome measures: </strong>Incidence of postoperative CSF leak.</p><p><strong>Results: </strong>Eighty-five patients underwent a total of 89 EEAs. Patients were predominantly female (62.9%) with an average age of 45.1 years (range 11 months-84 years). Tumors included primarily craniopharyngiomas (49.4%) and meningiomas (46.1%). No LDs were placed perioperatively, and there was an 100% intraoperative high-flow CSF leak rate. Skull base reconstruction was performed using pedicled nasoseptal flaps (NSFs) in all cases, tensor fascia lata grafts in 82 cases, and fat grafts in 78 cases. The postoperative CSF leak rate was 7.9%. Suprasellar tumors were associated with lower rates of postoperative CSF leak compared with tuberculum sella and planum sphenoidale pathology ( <i>p</i>  = 0.030), whereas meningiomas trended toward higher CSF leak rates compared with craniopharyngiomas ( <i>p</i>  = 0.059).</p><p><strong>Conclusion: </strong>We report a low rate of postoperative CSF leak without LD placement after EEA. Our results suggest that successful skull base reconstructions may be performed with multilayered closures using vascularized NSFs without the need for routine CSF diversion.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 2","pages":"157-164"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}