• Danyal Z Khan, Soham Bandyopadhyay, Vikesh Patel, Benjamin E Schroeder, Ivan Cabrilo, David Choi, Simon A Cudlip, Neil Donnelly, Neil L Dorward, Daniel M Fountain, Joan Grieve, Jane Halliday, Angelos G Kolias, Richard J Mannion, Alice O'Donnell, Nick Phillips, Rory J Piper, Bhavna Ramachandran, Thomas Santarius, Parag Sayal, Rishi Sharma, Georgios Solomou, James R Tysome, Hani J Marcus, Neurology and Neurosurgery Interest Group (NANSIG), British Neurosurgical Trainee Research Collaborative (BNTRC), and CRANIAL Steering Committee, Andrew F Alalade, Shahzada Ahmed, Sinan Al-Barazi, Rafid Al-Mahfoudh, Anuj Bahl, David Bennett, Raj Bhalla, Pragnesh Bhatt, Graham Dow, Anastasios Giamouriadis, Catherine Gilkes, Kanna Gnanalingham, Brendan Hanna, Caroline Hayhurst, Jonathan Hempenstall, Kismet Hossain-Ibrahim, Mark Hughes, Mohsen Javadpour, Alistair Jenkins, Mahmoud Kamel, Mohammad Habibullah Khan, Peter Lacy, Eleni Maratos, Andrew Martin, Nijaguna Mathad, Nigel Mendoza, Showkat Mirza, Sam Muquit, Ramesh Nair, Claire Nicholson, Alex Paluzzi, Dimitris Paraskevopoulos, Omar Pathmanaban, Jonathan Pollock, Bhaskar Ram, Iain Robertson, Peter Ross, Simon Shaw, Alireza Shoakazemi, Saurabh Sinha, Simon Stapleton, Patrick Statham, Benjamin Stew, Nick Thomas, Georgios Tsermoulas, Philip Weir, and Adam Williams.
• Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals Trust, Cambridge, UK.
• Br J Neurosurg. 2020 Sep 10: 1-10.

BackgroundThe endonasal transsphenoidal approach (TSA) has emerged as the preferred approach in order to treat pituitary adenoma and related sellar pathologies. The recently adopted expanded endonasal approach (EEA) has improved access to the ventral skull base whilst retaining the principles of minimally invasive surgery. Despite the advantages these approaches offer, cerebrospinal fluid (CSF) rhinorrhoea remains a common complication. There is currently a lack of comparative evidence to guide the best choice of skull base reconstruction, resulting in considerable heterogeneity of current practice. This study aims to determine: (1) the scope of the methods of skull base repair; and (2) the corresponding rates of postoperative CSF rhinorrhoea in contemporary neurosurgical practice in the UK and Ireland.MethodsWe will adopt a multicentre, prospective, observational cohort design. All neurosurgical units in the UK and Ireland performing the relevant surgeries (TSA and EEA) will be eligible to participate. Eligible cases will be prospectively recruited over 6 months with 6 months of postoperative follow-up. Data points collected will include: demographics, tumour characteristics, operative data), and postoperative outcomes. Primary outcomes include skull base repair technique and CSF rhinorrhoea (biochemically confirmed and/or requiring intervention) rates. Pooled data will be analysed using descriptive statistics. All skull base repair methods used and CSF leak rates for TSA and EEA will be compared against rates listed in the literature.Ethics And DisseminationFormal institutional ethical board review was not required owing to the nature of the study - this was confirmed with the Health Research Authority, UK.ConclusionsThe need for this multicentre, prospective, observational study is highlighted by the relative paucity of literature and the resultant lack of consensus on the topic. It is hoped that the results will give insight into contemporary practice in the UK and Ireland and will inform future studies.

5 keywords...

hide…