{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T15:59:10Z","timestamp":1773158350615,"version":"3.50.1"},"reference-count":43,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>Incidence of postoperative CSF leak.<\/jats:p>\n                  <jats:p>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\u201384 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 (p\u2009=\u20090.030), whereas meningiomas trended toward higher CSF leak rates compared with craniopharyngiomas (p\u2009=\u20090.059).<\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1055\/a-2575-4718","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T18:57:55Z","timestamp":1744052275000},"page":"157-164","source":"Crossref","is-referenced-by-count":0,"title":["Are Routine Lumbar Drains Necessary for Endoscopic Reconstruction after Resection of Anterior and Central Skull Base Tumors?"],"prefix":"10.1055","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6811-626X","authenticated-orcid":false,"given":"Jacob C.","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David K.","family":"Lerner","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iulia","family":"Tapescu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan D.","family":"Workman","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3634-2067","authenticated-orcid":false,"given":"Jennifer E.","family":"Douglas","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Kohanski","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Y.K.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip B.","family":"Storm","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James N.","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nithin D.","family":"Adappa","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1227\/01.NEU.0000339121.20101.85","article-title":"Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations","volume":"64","author":"A R Dehdashti","year":"2009","journal-title":"Neurosurgery"},{"issue":"12","key":"ref2","doi-asserted-by":"crossref","first-page":"2878","DOI":"10.3390\/cancers14122878","article-title":"Midline skull base meningiomas: transcranial and endonasal perspectives","volume":"14","author":"C Mastantuoni","year":"2022","journal-title":"Cancers (Basel)"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1002\/ohn.537","article-title":"Impact of frailty on postoperative outcomes in extended endonasal skull base surgery for suprasellar 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Kuan","year":"2018","journal-title":"J Neurol Surg B Skull Base"},{"issue":"03","key":"ref39","first-page":"330","article-title":"Clinical and technical factors in endoscopic skull base surgery associated with reconstructive success","volume":"62","author":"A Abiri","year":"2024","journal-title":"Rhinology"},{"issue":"03","key":"ref40","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1002\/alr.22910","article-title":"Comparison of high-flow CSF leak closure with nasoseptal flap following endoscopic endonasal approach in adult and pediatric populations","volume":"12","author":"P Papagiannopoulos","year":"2022","journal-title":"Int Forum Allergy Rhinol"},{"issue":"06","key":"ref41","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1055\/s-0038-1645854","article-title":"Pediatric endoscopic endonasal approaches for skull base lesions in the very young: is it safe and effective?","volume":"79","author":"J Nation","year":"2018","journal-title":"J Neurol Surg B Skull 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