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Successful repair of intraoperative cerebrospinal fluid leaks improves outcomes in endoscopic skull base surgery
- Source :
- International Forum of Allergy & Rhinology. 7:80-86
- Publication Year :
- 2016
- Publisher :
- Wiley, 2016.
-
Abstract
- 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.
- Subjects :
- medicine.medical_specialty
Leak
Cerebrospinal fluid leak
business.industry
Deep vein
Odds ratio
medicine.disease
Thrombosis
Surgery
03 medical and health sciences
0302 clinical medicine
medicine.anatomical_structure
Pneumocephalus
Cerebrospinal fluid
Otorhinolaryngology
Anesthesia
Immunology and Allergy
Medicine
030223 otorhinolaryngology
Complication
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 20426976
- Volume :
- 7
- Database :
- OpenAIRE
- Journal :
- International Forum of Allergy & Rhinology
- Accession number :
- edsair.doi...........01e10e3e935dd4d214049dc0a212170a