Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 8;86(2):138-159.
doi: 10.1055/s-0044-1785486. eCollection 2025 Apr.

Systematic Review: Success Rate of Endoscopic Endonasal versus Combined Endonasal and Transorbital Neuroendoscopic Approach for Nontraumatic Cerebrospinal Fluid Leak Repairs in the Lateral Recess of Sphenoid Sinus

Umnia Nasir Ahmed  1 , Mohammed Saqlain Siddiqui  1 , Haissan Iftikhar  2 , Karan Jolly  2 , Hannah Nieto  2   3 , Jameel Muzaffar  2   4
Affiliations

Systematic Review: Success Rate of Endoscopic Endonasal versus Combined Endonasal and Transorbital Neuroendoscopic Approach for Nontraumatic Cerebrospinal Fluid Leak Repairs in the Lateral Recess of Sphenoid Sinus

Umnia Nasir Ahmed et al. J Neurol Surg B Skull Base. .

Abstract

Background Cerebrospinal fluid (CSF) leaks from the lateral recess of the sphenoid sinus (LRS) occur due to a skull base defect and are important to treat due to the associated morbidity, e.g., life-threatening meningitis. Nontraumatic CSF leaks have a predilection toward obesity which is a rising phenomenon. LRS is notoriously difficult to access because of its lateral location and its associated neurovascular complications. An alternative surgical corridor has been explored which is the transorbital neuroendoscopic (TONES) approach. Objective To compare the success rate of the endoscopic endonasal with the TONES approaches. Rationale This is the first systematic review on the endoscopic endonasal and combined transorbital approaches to treat CSF leaks from the LRS. Method A PRISMA-concordant systematic review. PubMed, MEDLINE, EMBASE, Web of Science, and SCOPUS were searched. The studies underwent abstract and full-text screening by two reviewers. The data collected included patient demographic, surgical approach, reconstruction method, layers and materials, follow-up period, ROBINS-I bias, complications, and success rate. Results In total, 26 of 4,385 studies were included for further synthesis. Of these studies, a total of 336 patients were identified from a cohort of 910 patients. The endoscopic endonasal approach showed a repair success rate of 95.24% and the combined TONES and endonasal approach showed a success rate of 100%. Conclusion Both the endoscopic endonasal and transorbital approach provide a good success rate. However, due to the small TONES sample, large, randomized control trials are needed.

Keywords: TONES; cerebrospinal fluid leak; lateral recess of the sphenoid sinus; skull base; spontaneous; transpterygoid.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Flow diagram of search results and included studies following title and abstract screen and full-text screen. *No data on success rate of patients in the study with a lateral sphenoid recess leak. **Reason for exclusion was not labelled during screening.
Fig. 2
Fig. 2
ROBINS-I scores.
Fig. 3
Fig. 3
Baseline characteristics of repair success risk ratio of leaks in the lateral recess of sphenoid sinus versus other leak types.
Fig. 4
Fig. 4
Baseline characteristics of combined transorbital and endonasal repair success risk ratio of leaks in the lateral recess of sphenoid sinus versus other leak types.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Wang J, Bidari S, Inoue K, Yang H, Rhoton A., Jr Extensions of the sphenoid sinus: a new classification. Neurosurgery. 2010;66(04):797–816. - PubMed
    1. Francies O, Makalanda L, Paraskevopolous D, Adams A. Imaging review of the anterior skull base. Acta Radiol Open. 2018;7(05):2.058460118776487E15. - PMC - PubMed
    1. Alonso R C, de la Peña M J, Caicoya A G, Rodriguez M R, Moreno E A, de Vega Fernandez V M. Spontaneous skull base meningoencephaloceles and cerebrospinal fluid fistulas. Radiographics. 2013;33(02):553–570. - PubMed
    1. Al-Sebeih K, Karagiozov K, Elbeltagi A, Al-Qattan F. Non-traumatic cerebrospinal fluid rhinorrhea: diagnosis and management. Ann Saudi Med. 2004;24(06):453–458. - PMC - PubMed
    1. Le C, Strong E B, Luu Q. Management of anterior skull base cerebrospinal fluid leaks. J Neurol Surg B Skull Base. 2016;77(05):404–411. - PMC - PubMed