{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:13:38Z","timestamp":1784304818751,"version":"3.55.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T00:00:00Z","timestamp":1717545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Post-operative CSF leak is the major source of morbidity following transsphenoidal approaches (TSA) and expanded endonasal approaches (EEA) to lesions of the sella turcica and the ventral skull base. There are conflicting reports in the literature as to whether obesity (BMI \u226530) is a risk factor for this complication. We aimed to evaluate data collected as part of prospective multi-centre cohort study to address this question.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) study database was reviewed and patients were divided into obese and non-obese cohorts. Data on patient demographics, underlying pathology, intra-operative findings and skull base repair techniques were analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>TSA were performed on 726 patients, of whom 210 were obese and 516 were non-obese. The rate of post-operative CSF leak in the obese cohort was 11\/210 (5%), compared to 17\/516 (3%) in the non-obese cohort, which was not statistically significant (\u03c7<jats:sup>2 =<\/jats:sup> 1.520, p=0.217). EEA were performed on 140 patients, of whom 28 were obese and 112 were non-obese. The rate of post-operative CSF leak in the obese cohort was 2\/28 (7%), which was identical to the rate observed in the non-obese cohort 8\/112 (7%) Fisher\u2019s Exact Test, p=1.000). These results persisted following adjustment for inter-institutional variation and baseline risk of post-operative CSF leak.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>CSF leak rates following TSA and EEA, in association with modern skull base repair techniques, were found to be low in both obese and non-obese patients. However, due to the low rate of post-operative CSF leak, we were unable to fully exclude a small contributory effect of obesity to the risk of this complication.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2024.1353494","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T19:32:20Z","timestamp":1718134340000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["The impact of obesity on rates of post-operative CSF leak following endoscopic skull base surgery: results from a prospective international multi-centre cohort study"],"prefix":"10.3389","volume":"15","author":[{"name":"CRANIAL Consortium","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,6,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"7206713","DOI":"10.1155\/2022\/7206713","article-title":"Pituitary adenoma surgery survey: neurosurgical centers and pituitary adenomas","volume":"2022","author":"Netuka","year":"2022","journal-title":"Int J Endocrinol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3171\/2010.10.JNS09406","article-title":"Endoscopic endonasal skull base surgery: analysis of complications in the authors\u2019 initial 800 patients","volume":"114","author":"Kassam","year":"2011","journal-title":"J Neurosurg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"5104","DOI":"10.3390\/cancers14205104","article-title":"Mayo clinic clival chordoma case series: impact of endoscopic training on clinical care","volume":"14","author":"Hong","year":"2022","journal-title":"Cancers"},{"key":"B4","doi-asserted-by":"publisher","first-page":"93","DOI":"10.3171\/2020.5.JNS20925","article-title":"The management of clival chordomas: an Italian multicentric study","volume":"135","author":"Cavallo","year":"2020","journal-title":"J Neurosurg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"E7","DOI":"10.3171\/2016.9.FOCUS16299","article-title":"Endoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis","volume":"41","author":"Moussazadeh","year":"2016","journal-title":"Neurosurg Focus"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20186","article-title":"Comparison of transnasal endoscopic and open craniofacial resection for Malignant tumors of the anterior skull base","volume":"119","author":"Eloy","year":"2009","journal-title":"Laryngoscope"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","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":"Zwagerman","year":"2018","journal-title":"J Neurosurg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000002581","article-title":"International tuberculum sellae meningioma study: preoperative grading scale to predict outcomes and propensity-matched outcomes by endonasal versus transcranial approach","volume":"93","author":"Magill","year":"2023","journal-title":"Neurosurgery"},{"key":"B9","doi-asserted-by":"publisher","first-page":"696","DOI":"10.3171\/2023.7.JNS23437","article-title":"Analysis of visual impairment score in a series of 48 tuberculum sellae meningiomas operated on via the endoscopic endonasal approach","volume":"140","author":"Bove","year":"2024","journal-title":"J Neurosurg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-020-04641-x","article-title":"Trends in cerebrospinal fluid leak rates following the extended endoscopic endonasal approach for anterior skull base meningioma: a meta-analysis over the last 20 years","volume":"163","author":"Zamanipoor Najafabadi","year":"2021","journal-title":"Acta Neurochir (Wien)"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.surneu.2005.03.041","article-title":"Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma cases","volume":"64","author":"Grotenhuis","year":"2005","journal-title":"Surg Neurol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22241","article-title":"Nationwide analysis of unplanned 30-day readmissions after transsphenoidal pituitary surgery","volume":"9","author":"Rizvi","year":"2019","journal-title":"Int Forum Allergy Rhinol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3171\/2012.2.JNS111837","article-title":"Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery","volume":"116","author":"Dlouhy","year":"2012","journal-title":"J Neurosurg"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3171\/2016.12.JNS1694","article-title":"Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery","volume":"128","author":"Fraser","year":"2018","journal-title":"J Neurosurg JNS"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3171\/2017.11.JNS172141","article-title":"Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients","volume":"130","author":"Conger","year":"2018","journal-title":"J Neurosurg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.jocn.2014.08.009","article-title":"Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery","volume":"22","author":"Ivan","year":"2015","journal-title":"J Clin Neurosci"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-984125","article-title":"Endoscopic reconstruction of cranial base defects following endonasal skull base surgery","volume":"17","author":"Snyderman","year":"2007","journal-title":"Skull Base"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1729904","article-title":"Risk factors and reconstruction techniques for persistent cerebrospinal fluid leak in patients undergoing endoscopic endonasal approach to the posterior fossa","volume":"83","author":"Torres-Bayona","year":"2022","journal-title":"J Neurol Surg B Skull Base"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-0729","article-title":"Cerebrospinal fluid corticosteroid levels and cortisol metabolism in patients with idiopathic intracranial hypertension: a link between 11beta-HSD1 and intracranial pressure regulation","volume":"95","author":"Sinclair","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"B20","doi-asserted-by":"publisher","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":"Hannan","year":"2020","journal-title":"Acta Neurochir (Wien)"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1055\/a-1757-3069","article-title":"Fat in the fossa and the sphenoid sinus: a simple and effective solution to CSF leaks in transsphenoidal surgery. Cohort study and systematic review","volume":"84","author":"Baig Mirza","year":"2023","journal-title":"J Neurol Surg B Skull Base"},{"key":"B22","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1055\/s-0039-1679896","article-title":"Predictive factors, 30-day clinical outcomes, and costs associated with cerebrospinal fluid leak in pituitary adenoma resection","volume":"81","author":"Parikh","year":"2020","journal-title":"J Neurol Surg B Skull Base"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31817e2c43","article-title":"Minimally invasive pituitary surgery","volume":"118","author":"Senior","year":"2008","journal-title":"Laryngoscope"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1177\/0194599815617130","article-title":"Causes for 30-day readmission following transsphenoidal surgery","volume":"154","author":"Hendricks","year":"2016","journal-title":"Otolaryngology\u2013Head Neck Surg"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2020.12.171","article-title":"CSF rhinorrhoea after endonasal intervention to the skull base (CRANIAL) - part 1: multicenter pilot study","volume":"149","year":"2021","journal-title":"World Neurosurg"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.1049627","article-title":"CSF rhinorrhoea after endonasal intervention to the skull base (CRANIAL): A multicentre prospective observational study","volume":"12","year":"2022","journal-title":"Front Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2020.12.169","article-title":"CSF rhinorrhea after endonasal intervention to the skull base (CRANIAL) - part 2: impact of COVID-19","volume":"149","year":"2021","journal-title":"World Neurosurg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-008-0087-5","article-title":"Endoscopic pituitary surgery","volume":"11","author":"Cappabianca","year":"2008","journal-title":"Pituitary"},{"key":"B29","doi-asserted-by":"publisher","first-page":"E3","DOI":"10.3171\/foc.2005.19.1.4","article-title":"Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica","volume":"19","author":"Kassam","year":"2005","journal-title":"Neurosurg Focus"},{"key":"B30","doi-asserted-by":"publisher","first-page":"E4","DOI":"10.3171\/foc.2005.19.1.5","article-title":"Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum","volume":"19","author":"Kassam","year":"2005","journal-title":"Neurosurg Focus"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1080\/02688697.2020.1795622","article-title":"CSF rhinorrhoea after endonasal intervention to the anterior skull base (CRANIAL): proposal for a prospective multicentre observational cohort study","volume":"35","author":"Khan","year":"2021","journal-title":"Br J Neurosurg"},{"key":"B32","doi-asserted-by":"publisher","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":"Esposito","year":"2007","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"B33","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1471-2288-11-21","article-title":"Comparing methods to estimate treatment effects on a continuous outcome in multicentre randomized controlled trials: a simulation study","volume":"11","author":"Chu","year":"2011","journal-title":"BMC Med Res Methodol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.1954","article-title":"Marginal effects-quantifying the effect of changes in risk factors in logistic regression models","volume":"321","author":"Norton","year":"2019","journal-title":"Jama"},{"key":"B35","doi-asserted-by":"publisher","first-page":"R127","DOI":"10.1186\/cc10240","article-title":"The added value of ordinal analysis in clinical trials: an example in traumatic brain injury","volume":"15","author":"Roozenbeek","year":"2011","journal-title":"Crit Care"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21622","article-title":"Multi-institutional study of risk factors for perioperative morbidity following transnasal endoscopic pituitary adenoma surgery","volume":"6","author":"Boling","year":"2016","journal-title":"Int Forum Allergy Rhinol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21783","article-title":"Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery","volume":"6","author":"Karnezis","year":"2016","journal-title":"Int Forum Allergy Rhinol"},{"key":"B39","doi-asserted-by":"publisher","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":"Zanation","year":"2009","journal-title":"Am J Rhinology Allergy"},{"key":"B40","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1227\/01.NEU.0000316414.20247.32","article-title":"Expanded endoscopic endonasal approach for treatment of clival chordomas: early results in 12 patients","volume":"63","author":"Dehdashti","year":"2008","journal-title":"Neurosurgery"},{"key":"B41","doi-asserted-by":"publisher","first-page":"107276","DOI":"10.1016\/j.clineuro.2022.107276","article-title":"Clinical risk factors associated with cerebrospinal fluid leak in facial trauma: a retrospective analysis","volume":"217","author":"Eisinger","year":"2022","journal-title":"Clin Neurol Neurosurg"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2005.102.5.0825","article-title":"Extended transsphenoidal approach","volume":"102","author":"Laws","year":"2005","journal-title":"J Neurosurg"},{"key":"B43","doi-asserted-by":"publisher","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":"Hadad","year":"2006","journal-title":"Laryngoscope"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-023-05581-y","article-title":"Multi-layered repair of high-flow CSF fistulae following endoscopic skull base surgery without nasal packing or lumbar drains: technical refinements to optimise outcome","volume":"165","author":"Hannan","year":"2023","journal-title":"Acta Neurochir (Wien)"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-021-01723-x","article-title":"Sinonasal outcomes associated with the use of BioGlue\u00ae in endoscopic transsphenoidal pituitary surgery","volume":"45","author":"Hannan","year":"2022","journal-title":"Neurosurg Rev"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20861","article-title":"Endoscopic repair of high-flow cranial base defects using a bilayer button","volume":"120","author":"Luginbuhl","year":"2010","journal-title":"Laryngoscope"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-986427","article-title":"Who is the skull base surgeon of the future","volume":"17","author":"Snyderman","year":"2007","journal-title":"Skull Base"},{"key":"B48","doi-asserted-by":"publisher","first-page":"Doc01","DOI":"10.3205\/cto000116","article-title":"Comprehensive review on rhino-neurosurgery","volume":"14","author":"Hosemann","year":"2015","journal-title":"GMS Curr Top Otorhinolaryngol Head Neck Surg"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1046519","article-title":"Machine learning driven prediction of cerebrospinal fluid rhinorrhoea following endonasal skull base surgery: a multicentre prospective observational study","volume":"13","author":"Das","year":"2023","journal-title":"Front Oncol"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2024.1353494\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T19:32:23Z","timestamp":1718134343000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2024.1353494\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,5]]},"references-count":49,"alternative-id":["10.3389\/fendo.2024.1353494"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2024.1353494","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,5]]},"article-number":"1353494"}}