Successful repair of intraoperative cerebrospinal fluid leaks improves outcomes in endoscopic skull base surgery.

Autor: Shahangian A; Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC., Soler ZM; Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC., Baker A; Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC., Wise SK; Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA., Rereddy SK; Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.; Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA., Patel ZM; Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA., Oyesiku NM; Department of Neurosurgery, Emory University, Atlanta, GA., DelGaudio JM; Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA., Hadjipanayis CG; Department of Neurosurgery, Emory University, Atlanta, GA.; Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York City, NY., Woodworth BA; Division of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL., Riley KO; Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL., Lee J; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada., Cusimano MD; Department of Neurosurgery University of Toronto, St. Michael's Hospital, Toronto, ON, Canada., Govindaraj S; Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, New York City, NY., Khan MN; Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, New York City, NY., Psaltis A; Department of Otolaryngology-Head & Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia., Wormald PJ; Department of Otolaryngology-Head & Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia., Santoreneos S; Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, SA, Australia., Sindwani R; Section of Rhinology, Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH., Trosman S; Section of Rhinology, Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH., Stokken JK; Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, MN., Woodard TD; Section of Rhinology, Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH., Recinos PF; Section of Rhinology, Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH., Vandergrift WA 3rd; Department of Neurosurgery, Medical University of South Carolina, Charleston, SC., Boling C; Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC., Schlosser RJ; Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.
Jazyk: angličtina
Zdroj: International forum of allergy & rhinology [Int Forum Allergy Rhinol] 2017 Jan; Vol. 7 (1), pp. 80-86. Date of Electronic Publication: 2016 Aug 31.
DOI: 10.1002/alr.21845
Abstrakt: 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.
(© 2016 ARS-AAOA, LLC.)
Databáze: MEDLINE
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