J Neurol Surg B Skull Base 2014; 75 - A132
DOI: 10.1055/s-0034-1370538

Predictors of Cerebrospinal Fluid Leak after Vestibular Schwannoma Surgery

William R. Copeland 1, Grant W. Mallory 1, Brian A. Neff 1, Colin L. Driscoll 1, Michael J. Link 1
  • 1Rochester, USA

Introduction: Cerebrospinal fluid (CSF) leak following vestibular schwannoma (VS) resection can result in increased morbidity and healthcare costs to the patient. We sought to identify predictors of CSF leak in patients following surgery for VS.

Methods: We reviewed a prospectively maintained database of all patients having undergone resection of VS at our institution from September 1999 to May 2013. Data collected included patient age, gender, body mass index (BMI), tumor size, history of prior tumor treatment (surgery or radiation), surgical approach, and operative times. Both univariate and multivariate regression analyses were performed to test all preoperative variables as predictors of a postoperative CSF leak. Operative times were compared in a matched cohort as data for the entire series is not yet available.

Results: 462 patients underwent surgery during the study period. A total of 50 patients experienced a CSF leak for a leak rate of 10.8%. Five patients with a delayed leak (>30 days postoperatively) were excluded from analysis. Patient age, gender, and tumor size had no association with CSF leak. There was a trend for patients with a history of prior tumor treatment to experience CSF leak, though this did not reach statistical significance (14.0% vs 6.5%; p = 0.08). Among patients in the matched cohort that experienced a CSF leak, a trend for longer operative times was found (436 vs 412 minute; p = 0.13). A significant association did exist between increasing BMI and the development of a CSF leak, with patients classified as obese (BMI >30 kg/m2) having an increased likelihood (HR 1.8; p = 0.05). Similarly, a translabyrinthine approach conferred a higher risk (HR 2.1; p = 0.01). Both increasing BMI and a translabyrinthine approach remained statistically significant predictors on multivariate analysis.

Conclusion: Among patients having VS surgery, those with increased BMI and/or undergoing a translabyrinthine approach are at higher risk of developing a postoperative CSF leak.