Risk factor for cerebrospinal fluid leak after endoscopic endonasal skull base surgery: a single-center experience

Abstract

Background

One of the major complications in endoscopic endonasal skull base surgery (EESBS) is postoperative cerebrospinal fluid (CSF) leaks. Recently, EESBS has been applied to various skull base diseases as well as more complicated cases influenced by previous treatment with or without various comorbidities.

Aims/objectives

This study aimed to assess the factors that influence the results of postoperative CSF leak after EESBS with mixed patient backgrounds.

Materials and methods

We conducted a retrospective analysis of the clinical records of patients undergoing EESBS in our institution from 2012 to 2017.

Results

Out of a total of 230 cases of EESBS, 11 (4.8%) suffered from postoperative CSF leakage. The rate of CSF leakage for pituitary adenoma, Rathke’s cleft cyst, chordoma, and meningioma was 3.5%, 0%, 3.6% and 8.0%, respectively. Multiple variate analysis revealed that repeated surgery (p = .008) and intraoperative CSF leak (p = .044) were significant risk factors for postoperative CSF leakage.

Conclusions and significance

The rate of postoperative CSF leakage in this study was comparable to previous reports, and repeated surgery may increase postoperative CSF leakage. The surgical strategy for tumor removal as well as skull base reconstruction should be given careful consideration according to tumor pathology and the patient’s condition.

Chinese abstract

背景：内窥镜鼻腔颅底手术（EESBS）的主要并发症之一是术后脑脊液（CSF）泄漏。近来, EESBS已被应用于各种颅底疾病, 以及受先前治疗影响的有或没有各种合并症的更复杂的病例。

目的：本研究旨在评估影响不同背景的患者在EESBS术后脑脊液泄漏的结果的因素。

材料和方法：我们对2012年至2017年在本院接受EESBS手术的患者的临床记录进行了回顾性分析。

结果：在230例EESBS中, 有11例（4.8％）患有术后CSF泄漏。垂体腺瘤、Rathke裂囊肿、脊索瘤和脑膜瘤的CSF漏出率分别为3.5％、0％、3.6％和8.0％。多因素分析表明, 重复手术（p¼.008）和术中CSF漏（p¼.004）是术后CSF泄漏的重要危险因素。

结论和意义：本研究的术后脑脊液泄漏率与以前的报道相当, 重复手术可能会增加术后脑脊液漏出率。应根据肿瘤病理和患者病情, 仔细考虑肿瘤切除和颅底重建的手术方案。

Keywords:

• Endoscopic endonasal skull base surgery
• postoperative cerebrospinal fluid leak
• multiple surgeries

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

The study complied with the standards of the Declaration of Helsinki and the current ethical guidelines and was approved by the Institutional Review Board and Research Ethics Committee of Keio University School of Medicine (Approval No. 20150236).

This manuscript has not been published and is not under consideration for publication elsewhere. All the authors have read the manuscript and have approved this submission.