J Neurol Surg B Skull Base 2024; 85(01): 009-014
DOI: 10.1055/a-1970-7970
Original Article

Predictors and Complications of Cerebrospinal Fluid Leak after Endoscopic Endonasal Surgery: A Single Institution Retrospective Review

Brandon Laing
1   Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
,
Benjamin Best
1   Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
,
Daniel Aaronson
1   Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
,
Gillian Harrison
1   Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
,
Nathan Zwagerman
1   Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
› Author Affiliations

Abstract

Background The endoscopic endonasal approach (EEA) is a commonly used technique for resection of sellar, suprasellar, and anterior fossa masses. One of the most troublesome complications of this technique is cerebrospinal fluid (CSF) leak. In this study, we evaluate the risk factors and consequences of CSF leak on surgical outcomes.

Methods The current study is a retrospective single-institution cohort study evaluating patients who underwent EEA for sellar and/or suprasellar masses from July 2017 to March of 2020. Risk factors for intraoperative and postoperative CSF leak were evaluated, including sellar defect size, tumor volume and pathology, age, body mass index, prior endoscopic endonasal surgery, lumbar drain placement, nasoseptal and mucosal graft use, year of surgery, and cavernous sinus invasion. Postoperative infection, perioperative antibiotic use, and length of stay were also evaluated.

Results Our study included 175 patients. Sellar defect size (p = 0.015) and intraoperative CSF leak (p < 0.001) were significantly associated with an increased risk of postoperative CSF leak. Patients with nasoseptal flaps were more likely to have a postoperative CSF leak than those with free mucosal grafts (p = 0.025). Intraoperative CSF leak, Cushing's disease, and lumbar drain placement were associated with an increased length of stay.

Conclusion Sellar defect size, intraoperative CSF leak, and nasoseptal flap use were associated with an increased risk of postoperative CSF leak. Intraoperative CSF leak, Cushing's disease, and lumbar drain placement are all associated with an increased length of stay.



Publication History

Received: 19 August 2022

Accepted: 25 October 2022

Accepted Manuscript online:
02 November 2022

Article published online:
06 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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