Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery
| Autor: | Eric W. Wang, Mark Kubik, Paul A. Gardner, Juan C. Fernandez-Miranda, M. Koutourousiou, Shannon Fraser, Carl H. Snyderman |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Leak Adolescent Skull Base Neoplasms Neurosurgical Procedures Surgical Flaps Body Mass Index Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Lumbar Risk Factors Humans Medicine Pituitary Neoplasms Obesity Child 030223 otorhinolaryngology Aged Retrospective Studies Aged 80 and over Skull Base Cerebrospinal Fluid Leak Cerebrospinal fluid leak business.industry Infant Endoscopy General Medicine Perioperative Middle Aged medicine.disease Surgery Skull medicine.anatomical_structure Postoperative cerebrospinal fluid leak Child Preschool Skull base surgery Female Nasal Cavity business Body mass index 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neurosurgery. 128:1066-1071 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/2016.12.jns1694 |
| Popis: | OBJECTIVEThe aim in this paper was to determine risk factors for the development of a postoperative CSF leak after an endoscopic endonasal approach (EEA) for resection of skull base tumors.METHODSA retrospective review of patients who underwent EEA for the resection of intradural pathology between January 1997 and June 2012 was performed. Basic demographic data were collected, along with patient body mass index (BMI), tumor pathology, reconstruction technique, lumbar drainage, and outcomes.RESULTSOf the 615 patients studied, 103 developed a postoperative CSF leak (16.7%). Sex and perioperative lumbar drainage did not affect CSF leakage rates. Posterior fossa tumors had the highest rate of CSF leakage (32.6%), followed by anterior skull base lesions (21.0%) and sellar/suprasellar lesions (9.9%) (p < 0.0001). There was a higher leakage rate for overweight and obese patients (BMI > 25 kg/m2) than for those with a healthy-weight BMI (18.7% vs 11.5%; p = 0.04). Patients in whom a pedicled vascularized flap was used for reconstruction had a lower leakage rate than those in whom a free graft was used (13.5% vs 27.8%; p = 0.0015). In patients with a BMI > 25 kg/m2, the use of a pedicled flap reduced the rate of CSF leakage from 29.5% to 15.0% (p = 0.001); in patients of normal weight, this reduction did not reach statistical significance (21.9% [pedicled flap] vs 9.2% [free graft]; p = 0.09).CONCLUSIONSPreoperative BMI > 25 kg/m2 and tumor location in the posterior fossa were associated with higher rates of postoperative CSF leak. Use of a pedicled vascularized flap may be associated with reduced risk of a CSF leak, particularly in overweight patients. |
| Databáze: | OpenAIRE |
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