{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T13:00:06Z","timestamp":1779886806767,"version":"3.53.1"},"reference-count":6,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Intraoperative cerebrospinal fluid (CSF) leaks are associated with increased risk of postoperative CSF leaks despite multilayered reconstruction with vascularized tissue. A recent randomized controlled trial (RCT) examining the use of perioperative lumbar drains (LD) in high-risk skull base defects identified a significant reduction in postoperative CSF leak incidence (21.2 vs. 8.2%; p\u2009=\u20090.017). This study was conducted to assess the efficacy of the selective use of CSF diversion, for patients with intraoperative CSF leaks involving endoscopic endonasal approaches (EEA) to the skull base.<\/jats:p><jats:p>\n          Method\u2003Consecutive endoscopic endonasal surgeries of the skull base from a pre-RCT cohort and post-RCT cohort were compared. The following case characteristics between the two cohorts were examined: patient age, body mass index (BMI), rate of revision surgery, tumor histology, use of CSF diversion, and vascularized reconstruction. The primary measured outcome was postoperative CSF leak.<\/jats:p><jats:p>\n          Results\u2003The pre-RCT cohort included 76 patients and the post-RCT cohort included 77 patients, with dural defects in either the anterior or posterior cranial fossa (pituitary and parasellar\/suprasellar surgeries excluded). There was a significant reduction in the incidence of postoperative CSF leak in the post-RCT cohort (27.6 vs. 12.9%; p\u2009=\u20090.04). On subgroup analysis, there was a trend toward improvement in CSF leak rate of the anterior cranial fossa (19.2 vs. 10.5%; p\u2009=\u20090.27), whereas CSF leak rates of the posterior cranial fossa were significantly reduced compared with the pre-RCT cohort (41.4 vs. 12.8%; p\u2009=\u20090.02).<\/jats:p><jats:p>\n          Conclusion\u2003This study demonstrates that the integration of selective CSF diversion into the reconstructive algorithm improved postoperative CSF leak rates.<\/jats:p>","DOI":"10.1055\/a-1680-1870","type":"journal-article","created":{"date-parts":[[2021,10,27]],"date-time":"2021-10-27T22:38:38Z","timestamp":1635374318000},"page":"339-342","source":"Crossref","is-referenced-by-count":5,"title":["From Research to Clinical Practice: Long-Term Impact of Randomized Clinical Trial Examining the Effect of Lumbar Drains on Cerebrospinal Fluid Leak Rates Following Endonasal Skull Base Surgery"],"prefix":"10.1055","volume":"83","author":[{"given":"Philippe","family":"Lavigne","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Centre Hospitalier Universitaire de l'Universite de Montreal, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric W.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Gardner","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl H.","family":"Snyderman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,12,14]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1002\/lary.22475","article-title":"Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence","volume":"122","author":"R J Harvey","year":"2012","journal-title":"Laryngoscope"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2014.7.FOCUS14350","article-title":"Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak","volume":"37","author":"B D Thorp","year":"2014","journal-title":"Neurosurg Focus"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1177\/0194599816670370","article-title":"Efficacy of perioperative lumbar drainage following endonasal endoscopic cerebrospinal fluid leak repair","volume":"156","author":"O H Ahmed","year":"2017","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.3171\/2018.4.JNS172447","article-title":"Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial","volume":"131","author":"N T Zwagerman","year":"2018","journal-title":"J Neurosurg"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"61","DOI":"10.4103\/picr.PICR_36_18","article-title":"Real world evidence (RWE): are we (RWE) ready?","volume":"9","author":"V R Suvarna","year":"2018","journal-title":"Perspect Clin Res"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.clinthera.2018.12.013","article-title":"The case for real-world evidence in the future of clinical research on chronic myeloid leukemia","volume":"41","author":"J Webster","year":"2019","journal-title":"Clin Ther"}],"container-title":["Journal of Neurological Surgery Part B: Skull Base"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1680-1870.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T10:45:49Z","timestamp":1660128349000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1680-1870"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,27]]},"references-count":6,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2022,7,26]]},"published-print":{"date-parts":[[2022,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1680-1870","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6331","2193-634X"],"issn-type":[{"value":"2193-6331","type":"print"},{"value":"2193-634X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,10,27]]},"published":{"date-parts":[[2021,10,27]]}}}