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Successful repair of intraoperative cerebrospinal fluid leaks improves outcomes in endoscopic skull base surgery
Author(s) -
Shahangian Arash,
Soler Zachary M.,
Baker Andrew,
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,
Khan Mohemmed N.,
Psaltis Alkis,
Wormald Peter J.,
Santoreneos Stephen,
Sindwani Raj,
Trosman Samuel,
Stokken Janalee K.,
Woodard Troy D.,
Recinos Pablo F.,
Vandergrift W. Alexander,
Boling Caitlin,
Schlosser Rodney J.
Publication year - 2017
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.21845
Subject(s) - medicine , leak , surgery , cerebrospinal fluid leak , cerebrospinal fluid , odds ratio , confidence interval , skull , pneumocephalus , anesthesia , complication , environmental engineering , engineering
Background The impact of failed cerebrospinal fluid leak (CSF) leak repair in endoscopic skull base surgery has not been adequately studied. Methods In this investigation we reviewed patients who had undergone endoscopic skull base surgery between 2002 and 2014 at 7 international centers. Demographic variables, comorbidities, tumor characteristics, and repair techniques were evaluated to determine association with successful repair of CSF leak. Postoperative complications and length of stay were compared among groups. Results Data were collected on 2097 patients who were divided into 3 groups: (1) those with no intraoperative leak (n = 1533); (2) those with successful repair of their intraoperative leak (n = 452); and (3) those with failed repair (n = 112). Compared with successful repair, failed repair was associated with an increased risk of intracranial infection (odds ratio [OR], 5.6; 95% confidence interval [CI], 5.3‐13.15), pneumocephalus (OR, 16; 95% CI, 5.8‐44.4), 30‐day readmission (OR, 8.4; 95% CI, 5.3‐13.5), reoperation (OR, 115.4; 95% CI, 56.3‐236.8), and prolonged hospital stay (14.9 vs 7.0 days, p < 0.01). Outcomes in patients who had successful repairs of intraoperative leaks were similar to those who never had leakage. Intraoperative use of pedicled nasoseptal flaps was associated with successful repair (OR, 0.60; 95% CI, 0.34‐0.92). Conclusion Intraoperative CSF leaks are a frequent and expected occurrence during endoscopic skull base surgery. Failed CSF leak repair has a significant impact on patient outcomes, with increased rates of postoperative pneumocephalus, intracranial infections, reoperation, deep vein thrombosis, readmission, and prolonged hospital stay. Recognition and repair of intraoperative CSF leaks reduces postoperative complications. Use of pedicled nasoseptal flaps improves outcomes in reconstructing defects at higher risk for postoperative leak.