{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:56:15Z","timestamp":1787241375206,"version":"build-2736575974"},"reference-count":67,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sci.","Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: Expanded endoscopic endonasal approaches (EEAs) provide direct ventral access to adult intradural skull base tumors; however, postoperative complications are variably defined and reported in the literature. This review aimed to synthesize the overall spectrum of adult intradural EEA complications and distinguish pathology-specific evidence from large mixed EEA complication cohorts. Methods: A PRISMA 2020 systematic review and meta-analysis searched PubMed\/MEDLINE, Embase, and Web of Science from database inception through July 2026. Eligible studies included adults or adult-separable subgroups undergoing expanded EEAs for intradural skull base tumors. The primary outcomes were CSF leak, meningitis or intracranial infection, new neurological deficit or vascular injury\/stroke, hydrocephalus, mortality, and postoperative seizures. Pathology-specific adult intradural series with exact counts were quantitatively synthesized when appropriate, and large mixed EEA cohorts were summarized separately when the eligible subgroup was not separable. Results: After full-text eligibility assessment, 48 reports were retained in the extraction-status set. Three strictly adult-only exact-count reports contributed to the primary CSF leak meta-analysis, yielding a random-effects incidence of 23.0% (95% CI, 10.5\u201343.1%; I2 = 78.7%). A sensitivity analysis adding one mixed-age cohort yielded 23.8% (95% CI, 14.5\u201336.6%; I2 = 68.9%), while a broader sensitivity analysis including both mixed-age reports yielded 21.1% (95% CI, 12.2\u201333.8%; I2 = 69.4%). Meningitis was reported in 6\/166 patients across four studies (3.6%; 95% exact CI, 1.3\u20137.7%), and new neurological deficit\/vascular injury\/stroke was reported in 4\/166 patients across four studies (2.4%; 95% exact CI, 0.7\u20136.1%). Postoperative seizures were reported in 4\/652 patients across two studies (0.6%; 95% exact CI, 0.2\u20131.6%). Large mixed EEA cohorts were summarized separately because adult intradural tumor subsets could not be separated. Conclusions: CSF leak was the most consistently reported complication after expanded EEAs for adult intradural skull base tumors. The strict adult-only random-effects estimate was 23.0%, but it was based on only three studies and showed substantial heterogeneity, limiting its generalizability. Meningitis, neurological\/vascular events, and seizures were uncommon in the extractable data and were summarized descriptively rather than being meta-analyzed. Large mixed EEA cohorts provide important safety context but cannot substitute for standardized adult intradural, pathology-specific reporting.<\/jats:p>","DOI":"10.3390\/brainsci16080887","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T09:48:31Z","timestamp":1787219311000},"page":"887","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Complication Spectrum Following Expanded Endoscopic Endonasal Surgery for Intradural Skull Base Tumors: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3311-8091","authenticated-orcid":false,"given":"Badr","family":"Hafiz","sequence":"first","affiliation":[{"name":"Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Prince Saud Al-Faisal Road, P.O. Box 40047, Jeddah 21499, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9849-4006","authenticated-orcid":false,"given":"Thamer","family":"Alsharif","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, King Abdulaziz Specialist Hospital, Taif 26521, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1380-631X","authenticated-orcid":false,"given":"Faisal","family":"Sukkar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. Sulaiman Al Habib Medical Group Holding Company, Jeddah 23618, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0664-5750","authenticated-orcid":false,"given":"Fahad","family":"Okal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah 22384, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Enani","sequence":"additional","affiliation":[{"name":"Neurosurgery Section, Department of Surgery, King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moaath","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, King Abdulaziz Specialist Hospital, Taif 26521, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrazag","family":"Ajlan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. Sulaiman Al Habib Medical Group Holding Company, Jeddah 23618, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Aref","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Prince Saud Al-Faisal Road, P.O. Box 40047, Jeddah 21499, Saudi Arabia"},{"name":"Faculty of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Binmahfoodh","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Prince Saud Al-Faisal Road, P.O. Box 40047, Jeddah 21499, Saudi Arabia"},{"name":"Faculty of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3053-7912","authenticated-orcid":false,"given":"Saleh","family":"Baeesa","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Prince Saud Al-Faisal Road, P.O. Box 40047, Jeddah 21499, Saudi Arabia"},{"name":"Department of Neurosurgery, Dr. Sulaiman Al Habib Medical Group Holding Company, Jeddah 23618, Saudi Arabia"},{"name":"Faculty of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"v1","DOI":"10.1093\/neuonc\/noac202","article-title":"CBTRUS statistical report: Primary brain and other central nervous system tumors diagnosed in United States in 2015\u20132019","volume":"24","author":"Ostrom","year":"2022","journal-title":"Neuro Oncol."},{"key":"ref_2","first-page":"E3","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. 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