Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery

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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.

ABBREVIATIONS BMI = body mass index; EEA = endoscopic endonasal approach; ENB = esthesioneuroblastoma; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension.

Article Information

Correspondence Eric W. Wang, Department of Otolaryngology, Center for Cranial Base Surgery, 200 Lothrop St., EEI 521, Pittsburgh, PA 15213. email: wangew@upmc.edu.

INCLUDE WHEN CITING Published online June 9, 2017; DOI: 10.3171/2016.12.JNS1694.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



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    Effect of vascularized flap on rate of postoperative CSF leak. Figure is available in color online only.

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    CSF leakage rate versus tumor pathology. PA = pituitary adenoma. Figure is available in color online only.

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    CSF leakage rate versus tumor location. Figure is available in color online only.



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