Doucette, Madison M.

Abstract Objective To evaluate whether postoperative intracranial pressure–lowering interventions reduce recurrence of lateral skull base spontaneous cerebrospinal fluid leaks after surgical repair. Data Sources Ovid MEDLINE, Embase, Cochrane CENTRAL, Web of Science Core Collection, and Scopus were searched from inception through April 7, 2025. Review Methods The review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and included studies of adults with lateral skull base spontaneous cerebrospinal fluid leaks undergoing primary repair where postoperative intracranial pressure–lowering interventions were specified. Pooled recurrence rates were calculated by intervention type and compared with cohorts that did not receive intracranial pressure–lowering therapy. Results Thirty‐six studies including 687 patients (737 cases) met inclusion criteria. Six comparative cohorts (34 treated, 155 untreated) showed no significant difference in recurrence (risk ratio 1.16, 95% confidence interval [CI]: 0.14–9.76; I 2 = 0%). Across 82 intervention‐only cases, recurrence occurred in three (pooled proportion 0.10, 95% CI: 0.04–0.26; I 2 = 0%). Among 650 control‐only cases, 45 recurred (pooled proportion 0.09, 95% CI: 0.07–0.12; I 2 = 0%). No heterogeneity was observed across pooled analyses. Conclusion Available evidence does not support universal postoperative intracranial pressure–lowering therapy after lateral skull base spontaneous cerebrospinal fluid leak repair. Limited observational data suggest acetazolamide may be associated with lower recurrence, whereas lumbar drainage has not demonstrated sustained benefit. Given the heterogeneity in patient selection and intervention practices, postoperative management should be individualized. Future prospective studies are needed to better define the role of targeted therapy in high‐risk patients.

Objective: To compare the prevalence and patterns of transverse sinus stenosis (TSS) in patients with lateral skull base spontaneous cerebrospinal fluid (sCSF) leaks and idiopathic intracranial hypertension (IIH), to clarify its role in leak pathogenesis and implications for venous-directed therapies. Study design: Retrospective case-control study. Setting: Single tertiary care institution. Patients: Adults with lateral skull base sCSF leaks confirmed by clinical, laboratory, or surgical findings, and adults with IIH without cranial CSF leaks meeting Modified Dandy criteria. Intervention: Independent magnetic resonance venography evaluation by 2 fellowship-trained neuroradiologists. Main outcome measures: Presence, laterality, and severity of TSS. Results: Eighteen patients with sCSF leaks and 78 patients with IIH were included. The rate of individual TSS, including both unilateral and bilateral cases, was higher in the IIH cohort than in the sCSF leak cohort (bilateral TSS: n=66, 84.6% vs. n=6, 33.3%; P <0.001). Severe bilateral TSS was observed more in the IIH cohort (n=40, 51.3%) compared with the sCSF leak cohort (n=1, 5.6%; P <0.001). Conclusions: Though patients with lateral skull base sCSF leaks have TSS, the significantly lower rate compared with patients with IIH suggests that TSS may play a lesser role in the pathogenesis of lateral skull base defects. These findings indicate that the role of transverse sinus stenting in lateral skull base sCSF leaks remains uncertain and highlight the need to further investigate local remodeling processes when considering the role of venous sinus stenting in this population.

Abstract Objective Microscopic surgery assessment tools vary in objectivity and requirements for determining surgical proficiency. Artificial intelligence methods for objective microsurgical analysis have become more common, but their applications to mastoidectomy have not been reconciled with earlier efforts. This scoping review aimed to (1) compile and compare objective features and assessment targets of microscopic surgery analysis tools and (2) inform the development of a standardized annotation framework for mastoidectomy. Data Sources Ovid MEDLINE®, Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL, Ovid), Cochrane Database of Systematic Reviews (Ovid), and Scopus. Review Methods A scoping review of English‐language, full‐text articles describing any objective analysis tool for microscopic surgery performed by participants of any level. Extracted data included procedure type, evaluation modality, and classification into five domains: checklist/rating‐based, instrument motion analysis, error identification, workflow modeling, and artificial intelligence‐assisted feedback. Results Of 2203 screened studies, 52 met the inclusion criteria across otolaryngology, ophthalmology, and neurological surgery. Manual assessments (n = 42, 80.8%) primarily used checklists, rating scales, or end‐product evaluations. Automated assessments (n = 10, 19.2%) incorporated motion tracking and artificial intelligence‐assisted feedback. Otolaryngology contributed 28 tools, 22 of which evaluated mastoidectomy, cochlear implantation, or temporal bone dissection. Virtual reality was the most commonly reported training platform (n = 13). Conclusion Although instrument tracking and artificial intelligence‐assisted feedback have been explored, evaluation of microscopic surgery remains largely manual and subjective, with limited adoption of automated assessment tools. The lack of a standardized framework for automated mastoidectomy assessment represents a potential area for future development.