{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T18:12:53Z","timestamp":1790273573170,"version":"4.1.0"},"reference-count":63,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T00:00:00Z","timestamp":1710201600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Despite significant advances in understanding of skull base reconstruction principles, the role of tissue sealants in modifying postoperative cerebrospinal fluid (CSF) leak outcomes remains controversial. We evaluate postoperative CSF leak incidence associated with tissue sealant use in skull base defect repair during endoscopic skull base surgery (ESBS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>Web of Science, PubMed\/MEDLINE, Scopus, and Cochrane Library.<\/jats:p><\/jats:sec><jats:sec><jats:title>Review Methods<\/jats:title><jats:p>Systematic review and meta\u2010analysis of risk differences (RD). A search strategy identified original studies reporting CSF leakage following ESBS with disaggregation by tissue sealant use and\/or type.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>27 non\u2010randomized studies (<jats:italic>n<\/jats:italic>\u2009=\u20092,403) were included for qualitative and meta\u2010analysis. Reconstruction with a tissue sealant did not significantly reduce postoperative CSF leak risk compared with reconstruction without sealant (RD[95% CI]\u2009=\u20090.02[\u22120.01, 0.05]). Sub\u2010analyses of dural sealant (\u22120.02[\u22120.11, 0.07]) and fibrin glue (0.00[\u22120.07, 0.07]) compared with no sealant were similarly unremarkable. Postoperative CSF leakage was not significantly modulated in further sub\u2010analyses of DuraSeal (0.02[\u22120.02, 0.05]), Adherus (\u22120.03[\u22120.08, 0.03]), or Bioglue (\u22120.06[\u22120.23, 0.12]) versus no dural sealant use, or Tisseel\/Tissucol versus fibrin glue nonuse (0.00[\u22120.05, 0.05]). No significant association was seen comparing dural sealant use versus fibrin glue use on pairwise (0.01[\u22120.03, 0.05]) or network meta\u2010analysis (\u22120.01[\u22120.05, 0.04]). Limitations in source literature prevented sub\u2010analyses stratified by leak characteristics, defect size and location, and accompanying reconstruction materials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Tissue sealant use did not appear to impact postoperative CSF leak incidence when compared with nonuse. Higher quality studies are warranted to thoroughly elucidate the clinical value of adjunct sealant use in endoscopic skull base reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>N\/A <jats:italic>Laryngoscope<\/jats:italic>, 134:3425\u20133436, 2024<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.31390","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T09:58:40Z","timestamp":1710237520000},"page":"3425-3436","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Tissue Sealant Impact on Skull Base Reconstruction Outcomes: A Systematic Review and <scp>Meta\u2010Analysis<\/scp>"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2300-3904","authenticated-orcid":false,"given":"Jonathan C.","family":"Pang","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California, Irvine  Orange California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin F.","family":"Bitner","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California, Irvine  Orange California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline M.","family":"Nottoli","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California, Irvine  Orange California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2656-1060","authenticated-orcid":false,"given":"Arash","family":"Abiri","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California, Irvine  Orange California 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