World Neurosurg. 2021 May;149:e1077-e1089. doi: 10.1016/j.wneu.2020.12.171. Epub 2021 Jan 11.
CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective multicenter observational study seeking to determine 1) the scope of skull base repair methods used and 2) corresponding rates of postoperative cerebrospinal fluid (CSF) rhinorrhea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull base tumors. We sought to pilot the project, assessing the feasibility and acceptability by gathering preliminary data.
A prospective observational cohort study was piloted at 12 tertiary neurosurgical units in the United Kingdom. Feedback regarding project positives and challenges were qualitatively analyzed.
A total of 187 cases were included: 159 TSA (85%) and 28 EEA (15%). The most common diseases included pituitary adenomas (n = 142/187), craniopharyngiomas (n = 13/187). and skull base meningiomas (n = 4/187). The most common skull base repair techniques used were tissue glues (n = 132/187, most commonly Tisseel), grafts (n = 94/187, most commonly fat autograft or Spongostan) and vascularized flaps (n = 51/187, most commonly nasoseptal). These repairs were most frequently supported by nasal packs (n = 125/187) and lumbar drains (n = 20/187). Biochemically confirmed CSF rhinorrhea occurred in 6/159 patients undergoing TSA (3.8%) and 2/28 patients undergoing EEA (7.1%). Four patients undergoing TSA (2.5%) and 2 patients undergoing EEA (7.1%) required operative management for CSF rhinorrhea (CSF diversion or direct repair). Qualitative feedback was largely positive (themes included user-friendly and efficient data collection and strong support from senior team members), demonstrating acceptability.
Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is a precedent for multicenter dissemination of this project, to establish a benchmark of contemporary practice in skull base neurosurgery, particularly with respect to patients undergoing EEA.
颅底（CSF Rhinorrhoea After Endonasal Intervention to the Skull Base）是一项前瞻性多中心观察性研究，旨在确定 1）用于颅底修复的方法范围，以及 2）经鼻蝶入路（TSA）和扩展经鼻入路（EEA）治疗颅底肿瘤术后脑脊液（CSF）鼻漏的相应发生率。我们旨在对该项目进行试点，通过收集初步数据来评估其可行性和可接受性。
该前瞻性观察性队列研究在英国的 12 个三级神经外科单位进行了试点。定性分析了对项目优缺点的反馈。
共纳入 187 例患者：159 例 TSA（85%）和 28 例 EEA（15%）。最常见的疾病包括垂体腺瘤（n=142/187）、颅咽管瘤（n=13/187）和颅底脑膜瘤（n=4/187）。最常用的颅底修复技术包括组织胶（n=132/187，最常用 Tisseel）、移植物（n=94/187，最常用脂肪自体移植物或 Spongostan）和血管化皮瓣（n=51/187，最常用鼻中隔）。这些修复方法最常通过鼻内填塞（n=125/187）和腰椎引流（n=20/187）来支持。经生化证实的 CSF 鼻漏发生在 159 例 TSA 手术患者中 6 例（3.8%）和 28 例 EEA 手术患者中 2 例（7.1%）。4 例 TSA 手术患者（2.5%）和 2 例 EEA 手术患者（7.1%）因 CSF 鼻漏需要手术治疗（CSF 分流或直接修复）。定性反馈基本为正面（主题包括用户友好且高效的数据收集和来自高级团队成员的大力支持），表明该项目具有可接受性。
我们的试点经验突出了 CRANIAL 的可接受性和可行性。该项目有在多中心推广的先例，可为颅底神经外科建立当代实践的基准，特别是在接受 EEA 治疗的患者方面。
