{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T23:20:04Z","timestamp":1783120804300,"version":"3.54.6"},"reference-count":35,"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":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Endoscopic endonasal surgery for skull base tumors has advanced significantly, but postoperative cerebrospinal fluid (CSF) leak remains a significant concern. Introducing the vascularized pedicled nasoseptal flap (PNSF) has markedly reduced CSF leak rates, though outcomes remain variable across different studies. This systematic review and meta-analysis aimed to compare the efficacy of vascularized versus nonvascularized reconstruction techniques in these procedures.<\/jats:p>\n                  <jats:p>Three databases (PubMed, Cochrane, and Embase) were systematically searched to identify studies comparing CSF leak rates between PNSF and nonvascularized techniques for reconstruction after endoscopic endonasal skull base surgeries. It was designed according to the preferred reporting items for systematic reviews and meta-analyses reporting guidelines. Statistical analysis was performed using Review Manager, with heterogeneity evaluated via the I\n                  2 statistic.<\/jats:p>\n                  <jats:p>After thorough selection, twenty articles were selected, and a total of 4,088 patients were included, of whom 1,851 were assigned to the nasoseptal flap group, and 2,237 were assigned to the no-flap group. The postoperative CSF leak ratio was significantly lower in the group that underwent reconstruction with PNSF compared with all the other grouped methods, respectively, 3.4 and 5.6% (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.34\u20130.66; p\u2009&lt;\u20090.00001; I\n                  2\u2009=\u200954%).<\/jats:p>\n                  <jats:p>Our results suggest that using the PNSF is associated with a lower incidence of postoperative CSF leak than other reconstruction techniques in endoscopic skull base surgeries and may be used for patients at risk of this complication.<\/jats:p>","DOI":"10.1055\/a-2642-1155","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T11:00:22Z","timestamp":1752231622000},"page":"469-476","source":"Crossref","is-referenced-by-count":0,"title":["Pedicled Nasoseptal Flap After Endoscopic Endonasal Resection of Skull Base Tumors: A Comparative Meta-Analysis with Other Modalities of Reconstruction"],"prefix":"10.1055","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8952-9662","authenticated-orcid":false,"given":"Adriano M.","family":"Lino-Filho","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goi\u00e1s, Clinics Hospital, Goi\u00e2nia, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateus N. F.","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goi\u00e1s, Clinics Hospital, Goi\u00e2nia, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ot\u00e1vio A. De P. M.","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goi\u00e1s, Clinics Hospital, Goi\u00e2nia, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00falia B.","family":"Gomes","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, General Hospital of Goi\u00e2nia, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weder S.","family":"Borges-Junior","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goi\u00e1s, Clinics Hospital, Goi\u00e2nia, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leandro A.","family":"de Camargo","sequence":"additional","affiliation":[{"name":"Division of Otorhinolaryngology, Department of Surgery, Medical School, Clinics Hospital, Federal University of Goi\u00e1s, Goi\u00e2nia, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7458-258X","authenticated-orcid":false,"given":"Rodrigo","family":"Cavalcante","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goi\u00e1s, Clinics Hospital, Goi\u00e2nia, Goi\u00e1s, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1007\/s40136-020-00283-w","article-title":"Open and endoscopic skull base approaches","volume":"8","author":"K Tadokoro","year":"2020","journal-title":"Curr Otorhinolaryngol Rep"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1007\/s00701-020-04334-5","article-title":"Predicting post-operative cerebrospinal fluid (CSF) leak following endoscopic transnasal pituitary and anterior skull base surgery: a multivariate analysis","volume":"162","author":"C J Hannan","year":"2020","journal-title":"Acta Neurochir (Wien)"},{"issue":"10","key":"ref3","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1097\/01.mlg.0000234933.37779.e4","article-title":"A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap","volume":"116","author":"G Hadad","year":"2006","journal-title":"Laryngoscope"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"e0245119","DOI":"10.1371\/journal.pone.0245119","article-title":"Skull base reconstruction: a question of flow? A critical analysis of 521 endoscopic endonasal surgeries","volume":"16","author":"G Di Perna","year":"2021","journal-title":"PLoS One"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1227\/01.NEU.0000255354.64077.66","article-title":"Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery","volume":"60","author":"F Esposito","year":"2007","journal-title":"Oper Neurosurg (Hagerstown)"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1002\/lary.20861","article-title":"Endoscopic repair of high-flow cranial base defects using a bilayer button","volume":"120","author":"A J Luginbuhl","year":"2010","journal-title":"Laryngoscope"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.wneu.2011.08.034","article-title":"Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series","volume":"80","author":"V Garcia-Navarro","year":"2013","journal-title":"World Neurosurg"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1016\/j.wneu.2015.08.025","article-title":"Cranial base repair using suturing technique combined with a mucosal flap for cerebrospinal fluid leakage during endoscopic endonasal surgery","volume":"84","author":"T Hara","year":"2015","journal-title":"World Neurosurg"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.3171\/2018.4.JNS18366","article-title":"Three types of dural suturing for closure of CSF leak after endoscopic transsphenoidal surgery","volume":"131","author":"T Ishikawa","year":"2018","journal-title":"J Neurosurg"},{"issue":"S 01","key":"ref10","first-page":"ONS44","article-title":"Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap","volume":"63","author":"A B Kassam","year":"2008","journal-title":"Neurosurgery"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"518","DOI":"10.2500\/ajra.2009.23.3378","article-title":"Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery","volume":"23","author":"A M Zanation","year":"2009","journal-title":"Am J Rhinol Allergy"},{"key":"ref12","first-page":"372","article-title":"statement: an updated guideline for reporting systematic reviews","volume":"2021","author":"M J Page","year":"2020","journal-title":"BMJ"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"J AC Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"J A Sterne","year":"2016","journal-title":"BMJ"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1002\/alr.21069","article-title":"Olfactory outcomes following endoscopic pituitary surgery with or without septal flap reconstruction: a randomized controlled trial","volume":"3","author":"S Tam","year":"2013","journal-title":"Int Forum Allergy Rhinol"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"e513","DOI":"10.1016\/j.wneu.2013.06.005","article-title":"Incidence and significance of intraoperative cerebrospinal fluid leak in endoscopic pituitary surgery using intrathecal fluorescein","volume":"82","author":"D Jakimovski","year":"2014","journal-title":"World Neurosurg"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"e271","DOI":"10.1016\/j.wneu.2021.08.051","article-title":"Single-layer fascia patchwork closure for the extended endoscopic transsphenoidal transtuberculum transplanum approach: deep suturing technique and preliminary results","volume":"155","author":"M Tosaka","year":"2021","journal-title":"World Neurosurg"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"750","DOI":"10.3171\/2019.12.JNS192600","article-title":"How long is the tail end of the learning curve? 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Zhang","year":"2023","journal-title":"Front Surg"},{"issue":"02","key":"ref34","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s10143-018-1034-1","article-title":"Olfactory function in patients after transsphenoidal surgery for pituitary adenomas-a short review","volume":"42","author":"M Majovsky","year":"2019","journal-title":"Neurosurg Rev"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.jocn.2020.01.072","article-title":"Patient wellbeing and quality of life after nasoseptal flap closure for endoscopic skull base reconstruction","volume":"74","author":"M Castle-Kirszbaum","year":"2020","journal-title":"J Clin Neurosci"}],"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-2642-1155.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T22:35:04Z","timestamp":1783118104000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2642-1155"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,10]]},"references-count":35,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2026,7,3]]},"published-print":{"date-parts":[[2026,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2642-1155","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6331","2193-634X"],"issn-type":[{"value":"2193-6331","type":"print"},{"value":"2193-634X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,10]]}}}