The aim in this paper was to determine risk factors for the development of a postoperative CSF leak after an endoscopic endonasal approach (EEA) for resection of skull base tumors.
A retrospective review of patients who underwent EEA for the resection of intradural pathology between January 1997 and June 2012 was performed. Basic demographic data were collected, along with patient body mass index (BMI), tumor pathology, reconstruction technique, lumbar drainage, and outcomes.
Of the 615 patients studied, 103 developed a postoperative CSF leak (16.7%). Sex and perioperative lumbar drainage did not affect CSF leakage rates. Posterior fossa tumors had the highest rate of CSF leakage (32.6%), followed by anterior skull base lesions (21.0%) and sellar/suprasellar lesions (9.9%) (p < 0.0001). There was a higher leakage rate for overweight and obese patients (BMI > 25 kg/m2) than for those with a healthy-weight BMI (18.7% vs 11.5%; p = 0.04). Patients in whom a pedicled vascularized flap was used for reconstruction had a lower leakage rate than those in whom a free graft was used (13.5% vs 27.8%; p = 0.0015). In patients with a BMI > 25 kg/m2, the use of a pedicled flap reduced the rate of CSF leakage from 29.5% to 15.0% (p = 0.001); in patients of normal weight, this reduction did not reach statistical significance (21.9% [pedicled flap] vs 9.2% [free graft]; p = 0.09).
Preoperative BMI > 25 kg/m2 and tumor location in the posterior fossa were associated with higher rates of postoperative CSF leak. Use of a pedicled vascularized flap may be associated with reduced risk of a CSF leak, particularly in overweight patients.
DlouhyBJ, MadhavanK, ClingerJD, ReddyA, DawsonJD, O’BrienEK, : Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery. 116:1311–1317, 20122244350210.3171/2012.2.JNS111837)| false
EloyJAKuperanABChoudhryOJHarirchianSLiuJK: Efficacy of the pedicled nasoseptal flap without cerebrospinal fluid (CSF) diversion for repair of skull base defects: incidence of postoperative CSF leaks. Int Forum Allergy Rhinol2:397–4012012
EloyJA, KuperanAB, ChoudhryOJ, HarirchianS, LiuJK: Efficacy of the pedicled nasoseptal flap without cerebrospinal fluid (CSF) diversion for repair of skull base defects: incidence of postoperative CSF leaks. 2:397–401, 20122252868610.1002/alr.21040)| false
EloyJAShuklaPAChoudhryOJSinghRLiuJK: Assessment of frontal lobe sagging after endoscopic endonasal transcribriform resection of anterior skull base tumors: is rigid structural reconstruction of the cranial base defect necessary?Laryngoscope122:2652–26572012
EloyJA, ShuklaPA, ChoudhryOJ, SinghR, LiuJK: Assessment of frontal lobe sagging after endoscopic endonasal transcribriform resection of anterior skull base tumors: is rigid structural reconstruction of the cranial base defect necessary?122:2652–2657, 20122307080210.1002/lary.23539)| false
GrussCL, Al KomserM, AghiMK, PletcherSD, GoldbergAN, McDermottM, : Risk factors for cerebrospinal leak after endoscopic skull base reconstruction with nasoseptal flap. 151:516–521, 20142489807510.1177/0194599814536688)| false
HoriguchiKMuraiHHasegawaYHanazawaTYamakamiISaekiN: Endoscopic endonasal skull base reconstruction using a nasal septal flap: surgical results and comparison with previous reconstructions. Neurosurg Rev33:235–2412010
IllingESchlosserRJPalmerJNCuréJFoxNWoodworthBA: Spontaneous sphenoid lateral recess cerebrospinal fluid leaks arise from intracranial hypertension, not Sternberg’s canal. Int Forum Allergy Rhinol4:246–2502014
KoutourousiouMFilhoFVCostacouTFernandez-MirandaJCWangEWSnydermanCH: Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery. J Neurosurg121:359–3662014
MehtaGU, OldfieldEH: Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas. 116:1299–1303, 20122248279310.3171/2012.3.JNS112160)| false
PepperJPLinEMSullivanSEMarentetteLJ: Perioperative lumbar drain placement: an independent predictor of tension pneumocephalus and intracranial complications following anterior skull base surgery. Laryngoscope121:468–4732011
PepperJP, LinEM, SullivanSE, MarentetteLJ: Perioperative lumbar drain placement: an independent predictor of tension pneumocephalus and intracranial complications following anterior skull base surgery. 121:468–473, 20112129864210.1002/lary.21409)| false