Response by the Authors of Original Article
Bibliographic record
Abstract
Letter to: Hemi-transseptal versus Combined Transseptal/Transnasal Approach to the Sellar Region: Differences in Incidence of Postoperative CSF Leak Rate J Neurol Surg B Skull Base eFirst DOI: 10.1055/s-0037-1620247 Hemi-transseptal versus Combined Transseptal/Transnasal Approach to the Sellar Region: Differences in Incidence of Postoperative CSF Leak Rate We thank the authors for their interest in our study and for their comments about the similarities and differences with the combined transseptal/transnasal approach, described by their own group. We acknowledge the similarities in the two techniques and we believe the main advantages are consistent between the two; we believe this general approach will gain more popularity over time. Regarding the subject of postoperative cerebrospinal fluid (CSF) leak, inadequate flap length may theoretically be a contributing factor in certain instances; however, we believe other patient risk factors were likely more contributory in our population. Such risk factors include, among others, diabetes mellitus, obesity, degree of extension of approach, redo cases, prior radiation, choice of sealant available, and raised intracranial pressure. In our experience, a full-size nasoseptal flap is still not required in the overwhelming majority of routine pituitary surgeries. The posterior half of the septal mucosa up to the level of the osteocartilaginous junction, as described in our papers,[ 1 ] [ 2 ] will usually provide adequate bony coverage up to the level of the planum sphenoidale and will avoid the problems of excessive flap bulk and donor site morbidity. The hemitransseptal approach was initially devised and adopted due to its polyvalence in allowing a greater number of reconstructive options at the end of the case, when it becomes evident the that initial flap is inadequate. There is no significant disadvantage to harvesting a full-size flap at any time with our approach. Our concern harvesting a full-size flap in all cases is the risk of inducing cartilage devitalization and necrosis, particularly if some parts of the septal cartilage are separated from their feeding perichondria bilaterally at the same time, even if only temporarily. In our practice, a decision to harvest a full-size nasoseptal flap is made at the beginning of surgery when this is anticipated to be necessary and the contralateral posterior septal mucosa is fashioned into an anteriorly-based flap which is flipped anteriorly over the cartilage donor site.[ 3 ] This results in a posterior septectomy which very rarely causes any symptoms and significantly speeds up the healing process postoperatively. Whatever the philosophy of the operating team, the most important factor is the experience and comfort of that team in adequately treating the primary pathology and minimizing morbidity postoperatively. The hemitransseptal approach has served us well over the past 6 years, with swift and excellent surgical access, as well as rapid healing. Improvement in our preoperative patient selection for full-size nasoseptal flap harvest has further decreased our postoperative CSF leak rate to 3.2% over the last 18 months. Future studies should further elucidate the criteria to aid in this decision making.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".