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Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery
Author(s) -
Karnezis Tom T.,
Baker Andrew B.,
Soler Zachary M.,
Wise Sarah K.,
Rereddy Shruthi K.,
Patel Zara M.,
Oyesiku Nelson M.,
DelGaudio John M.,
Hadjipanayis Constantinos G.,
Woodworth Bradford A.,
Riley Kristen O.,
Lee John,
Cusimano Michael D.,
Govindaraj Satish,
Psaltis Alkis,
Wormald Peter John,
Santoreneos Steve,
Sindwani Raj,
Trosman Samuel,
Stokken Janalee K.,
Woodard Troy D.,
Recinos Pablo F.,
Vandergrift W. Alexander,
Schlosser Rodney J.
Publication year - 2016
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21783
Subject(s) - medicine , craniopharyngioma , leak , cerebrospinal fluid leak , surgery , pituitary neoplasm , odds ratio , cerebrospinal fluid , transsphenoidal surgery , pituitary adenoma , adenoma , pituitary gland , hormone , environmental engineering , engineering
Background In patients undergoing transnasal endoscopic sellar surgery, an analysis of risk factors and predictors of intraoperative and postoperative cerebrospinal fluid leak (CSF) would provide important prognostic information. Methods A retrospective review of patients undergoing endoscopic sellar surgery for pituitary adenomas or craniopharyngiomas between 2002 and 2014 at 7 international centers was performed. Demographic, comorbidity, and tumor characteristics were evaluated to determine the associations between intraoperative and postoperative CSF leaks. Correlations between reconstructive and CSF diversion techniques were associated with postoperative CSF leak rates. Odds ratios (OR) were identified using a multivariate logistic regression model. Results Data were collected on 1108 pituitary adenomas and 53 craniopharyngiomas. Overall, 30.1% of patients had an intraoperative leak and 5.9% had a postoperative leak. Preoperative factors associated with increased intraoperative leaks were mild liver disease, craniopharyngioma, and extension into the anterior cranial fossa. In patients with intraoperative CSF leaks, postoperative leaks occurred in 10.3%, with a higher postoperative leak rate in craniopharyngiomas (20.8% vs 5.1% in pituitary adenomas). Once an intraoperative leak occurred, craniopharyngioma (OR = 4.255, p = 0.010) and higher body mass index (BMI) predicted postoperative leak (OR = 1.055, p = 0.010). In patients with an intraoperative leak, the use of septal flaps reduced the occurrence of postoperative leak (OR = 0.431, p = 0.027). Rigid reconstruction and CSF diversion techniques did not impact postoperative leak rates. Conclusion Intraoperative CSF leaks can occur during endoscopic sellar surgery, especially in larger tumors or craniopharyngiomas. Once an intraoperative leak occurs, risk factors for postoperative leaks include craniopharyngiomas and higher BMI. Use of septal flaps decreases this risk.