{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:19:14Z","timestamp":1791346754853,"version":"4.3.1"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The purpose of this study was to evaluate the outcome of a modified graded reconstruction technique based on the size of intraoperative CSF leaks in patients undergoing endoscopic endonasal surgery performed by a single surgeon in the early years of his practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The database of patients who underwent endoscopic endonasal approaches (EEAs) between September 2020 and August 2024 was included. Surgical complexity was categorized into levels II, III, and IV. Intraoperative CSF leak was categorized into 4 grades (0\u20133). Patients were divided into 2 timeline groups (those undergoing an EEA between 2020 and 2022 [group A] and between 2023 and 2024 [group B]) to assess the trends in surgical complexity and repair outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 69 patients with a mean age of 56 \u00b1 16.9 years (range 12\u201383 years) were identified; 34 (49.3%) were female. The median body mass index was 31 (&gt; 25 in 82.6%). The most common pathology was nonsecretory macroadenoma (57.9%). The EEA at complexity levels II, III, and IV was performed in 36.2%, 46.4%, and 17.4% of the patients, respectively. Intraoperative CSF leaks grades 1, 2, and 3 were encountered in 39.1%, 7.2%, and 17.4% of the patients, whereas 36.2% did not develop leaks (grade 0). Fat grafts and collagen matrix were used for all patients with grades 1\u20133. Patients with complexity level II only developed grade 1 and 2 leaks, and none of level III developed grade 3. A nasoseptal flap was used in 4 patients (5.8%), with all having level IV surgery and grade 3 intraoperative leak. Only 1 patient (1.4%) developed a postoperative CSF leak, and a lumbar drain was only used for this patient (1.4%) at the revision surgery. The rate of grades 2 and 3 leaks in group B was significantly lower than in group A (8.3% vs 33.3%, p = 0.022). Temporary nasal packing usage was also significantly lower in group B (8.3%) than in group A (28.9%) (p = 0.049), whereas high-complexity EEA rates and pedicled flap usage were not correlated with the year of surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>A graded endoscopic endonasal repair protocol, combined with the judicious use of lumbar drains and nasoseptal flaps rather than a reflexive approach, helps in minimizing postoperative CSF leak rates. Cross-training of neurosurgery graduates focusing on skull base practice is highly recommended for maximizing good outcomes in their early years of practice. With growing experience, intraoperative leak rates tend to decrease, and the reconstruction relies on a tailored multilayer strategy rather than bulky synthetic materials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.11.focus24733","type":"journal-article","created":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T06:52:07Z","timestamp":1738392727000},"page":"E6","source":"Crossref","is-referenced-by-count":4,"title":["Modified graded skull base reconstruction for intraoperative CSF leak repair in endoscopic endonasal surgeries: a single-surgeon experience in initial years of practice and nuances in the early learning curve"],"prefix":"10.3171","volume":"58","author":[{"given":"Mehdi","family":"Khaleghi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of South Alabama, Mobile, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan Hussain","family":"Shahid","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Alabama, Mobile, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudhir","family":"Suggala","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Alabama, Mobile, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett","family":"Dyess","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Alabama, Mobile, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula Noelle","family":"Hummel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Alabama, Mobile, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle N.","family":"Chason","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Alabama, Mobile, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danner","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Alabama, Mobile, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jai Deep","family":"Thakur","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Alabama, Mobile, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Evolution of reconstructive techniques following endoscopic expanded endonasal approaches","volume":"19","author":"Kassam A","year":"2005","unstructured":"Kassam A, Carrau RL, Snyderman CH, Gardner P, Mintz A. Evolution of reconstructive techniques following endoscopic expanded endonasal approaches. Neurosurg Focus. 2005;19(1):E8."},{"issue":"1","key":"b2","series-title":"Skull Base","first-page":"73","article-title":"Endoscopic reconstruction of cranial base defects following endonasal skull base surgery","volume":"17","author":"Snyderman CH","year":"2007","unstructured":"Snyderman CH, Kassam AB, Carrau R, Mintz A. Endoscopic reconstruction of cranial base defects following endonasal skull base surgery. Skull Base. 2007;17(1):73\u201378."},{"issue":"2","key":"b3","series-title":"Laryngoscope","first-page":"205","article-title":"The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus","volume":"115","author":"Carrau RL","year":"2005","unstructured":"Carrau RL, Snyderman CH, Kassam AB. The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus. 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Neurosurg Focus. 2014;37(4):E4."},{"issue":"5","key":"b17","series-title":"Am J Rhinol Allergy","first-page":"518","article-title":"Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery","volume":"23","author":"Zanation AM","year":"2009","unstructured":"Zanation AM, Carrau RL, Snyderman CH,  Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy. 2009;23(5):518\u2013521."},{"issue":"13","key":"b18","series-title":"Patient series. J Neurosurg Case Lessons","first-page":"CASE23744","article-title":"Supraorbital keyhole approaches in the first 3 years of practice: outcomes and lessons learned","volume":"7","author":"Shahid AH","year":"2024","unstructured":"Shahid AH, Butler D, Dyess G, Bassett M, Harris L, Hummel U,  Supraorbital keyhole approaches in the first 3 years of practice: outcomes and lessons learned. Patient series. 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Neurosurgery. 2008;62(5 Suppl 2):ONSE342\u2013ONSE343."},{"issue":"1","key":"b24","series-title":"Int Forum Allergy Rhinol","first-page":"101","article-title":"Multi-institutional study of risk factors for perioperative morbidity following transnasal endoscopic pituitary adenoma surgery","volume":"6","author":"Boling CC","year":"2016","unstructured":"Boling CC, Karnezis TT, Baker AB,  Multi-institutional study of risk factors for perioperative morbidity following transnasal endoscopic pituitary adenoma surgery. Int Forum Allergy Rhinol. 2016;6(1):101\u2013107."},{"issue":"2","key":"b25","series-title":"Pituitary","first-page":"174","article-title":"Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients","volume":"14","author":"Gondim JA","year":"2011","unstructured":"Gondim JA, Almeida JP, Albuquerque LA,  Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients. Pituitary. 2011;14(2):174\u2013183."},{"issue":"5","key":"b26","series-title":"J Neurosurg","first-page":"762","article-title":"Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: a 10-year experience with 376 patients","volume":"93","author":"Seiler RW","year":"2000","unstructured":"Seiler RW, Mariani L. Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: a 10-year experience with 376 patients. J Neurosurg. 2000;93(5):762\u2013765."},{"issue":"8","key":"b27","series-title":"Laryngoscope","first-page":"1283","article-title":"Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery","volume":"113","author":"Shiley SG","year":"2003","unstructured":"Shiley SG, Limonadi F, Delashaw JB,  Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery. 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Auris Nasus Larynx. 2013;40(4):373\u2013378."},{"issue":"1","key":"b32","series-title":"Acta Neurochir (Wien)","first-page":"146","article-title":"Customized ventral bony and dural opening in the transplanum\/transtuberculum and transclival variants of extended endoscopic endonasal approach to suprasellar craniopharyngiomas: an approach-based stepwise cadaveric dissection and clinical applicability","volume":"166","author":"Khaleghi M","year":"2024","unstructured":"Khaleghi M, Otto B, Carrau R, Abouammo MD, Prevedello DM. Customized ventral bony and dural opening in the transplanum\/transtuberculum and transclival variants of extended endoscopic endonasal approach to suprasellar craniopharyngiomas: an approach-based stepwise cadaveric dissection and clinical applicability. 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