Table 3.

The rates and methods of confirmation and management of intraoperative CSF leak and postoperative CSF rhinorrhoea

Measure	Transsphenoidal approach	Expanded endonasal approach	Both approaches
Intraoperative CSF leak
No. of studies reporting	87/95 (92%)	53/55 (97%)	32/43 (82%)
Methods of confirmation (number of studies)	Valsalva (n = 32) IT fluorescein (n = 6) Observation alone (n = 2) IT saline (n = 1) Not specified (n = 54)	Valsalva (n = 3) IT fluorescein (n = 5) Observation alone (n = 2) Not specified (n = 45)	Valsalva (n = 12) IT fluorescein (n = 4) Observation alone (n = 2) Not specified (n = 25)
Grading methods (number of studies)	Esposito-Kelly (n = 15) High/low flow (n = 13) Modified Esposito-Kelly (n = 1) Anatomical grading (n = 2) Not specified (n = 64)	Esposito-Kelly (n = 4) High/low flow (n = 12) Not specified (n = 43)	Esposito-Kelly (n = 13) High/low flow (n = 12) Modified Esposito-Kelly (n = 2) Not specified (n = 16)
Postoperative CSF rhinorrhea
No. of studies reporting	94/95 (99%)	55/55 (100%)	41/43 (95%)
Adjuncts for confirmation (number of studies)	β2 transferrin (n = 10) tes-tape (n = 1) Not specified (n = 84)	Pneumocephalus on CT (n = 2) β2 transferrin (n = 3) Not specified (n = 50)	β2 transferrin (n = 4) Pneumocephalus on CT (n = 5) MRI (n = 3) Leaning forward (n = 4) Tch99 cisternography (n = 1) IT fluorescein (n = 1) Endoscopic exploration (n = 2) Not specified (n = 23
CSFR management methods (number of studies)	Lumbar drain (n = 28) Reoperation (n = 46) VPS (n = 2) Combined lumbar drain and reoperation (n = 17) Serial lumbar punctures (n = 1) Not specified (n = 1)	Lumbar drain (n = 18) Reoperation (n = 30) VPS (n = 3) EVD (n = 1) Not specified (n = 3)	Lumbar drain (n = 15) Reoperation (n = 24) Combined lumbar drain and reoperation (n = 4) Not specified (n = 8)

IT intrathecal, Tch technetium, CSF cerebrospinal fluid, MRI magnetic resonance imaging, CT computed topography, VPS ventriculo-peritoneal shunt, EVD external ventricualr drain