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Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery
- Source :
- International Forum of Allergy & Rhinology. 6:1117-1125
- Publication Year :
- 2016
- Publisher :
- Wiley, 2016.
-
Abstract
- Background In patients undergoing transnasal endoscopic sellar surgery, an analysis of risk factors and predictors of intraoperative and postoperative cerebrospinal fluid leak (CSF) would provide important prognostic information. Methods A retrospective review of patients undergoing endoscopic sellar surgery for pituitary adenomas or craniopharyngiomas between 2002 and 2014 at 7 international centers was performed. Demographic, comorbidity, and tumor characteristics were evaluated to determine the associations between intraoperative and postoperative CSF leaks. Correlations between reconstructive and CSF diversion techniques were associated with postoperative CSF leak rates. Odds ratios (OR) were identified using a multivariate logistic regression model. Results Data were collected on 1108 pituitary adenomas and 53 craniopharyngiomas. Overall, 30.1% of patients had an intraoperative leak and 5.9% had a postoperative leak. Preoperative factors associated with increased intraoperative leaks were mild liver disease, craniopharyngioma, and extension into the anterior cranial fossa. In patients with intraoperative CSF leaks, postoperative leaks occurred in 10.3%, with a higher postoperative leak rate in craniopharyngiomas (20.8% vs 5.1% in pituitary adenomas). Once an intraoperative leak occurred, craniopharyngioma (OR = 4.255, p = 0.010) and higher body mass index (BMI) predicted postoperative leak (OR = 1.055, p = 0.010). In patients with an intraoperative leak, the use of septal flaps reduced the occurrence of postoperative leak (OR = 0.431, p = 0.027). Rigid reconstruction and CSF diversion techniques did not impact postoperative leak rates. Conclusion Intraoperative CSF leaks can occur during endoscopic sellar surgery, especially in larger tumors or craniopharyngiomas. Once an intraoperative leak occurs, risk factors for postoperative leaks include craniopharyngiomas and higher BMI. Use of septal flaps decreases this risk.
- Subjects :
- medicine.medical_specialty
Leak
Cerebrospinal fluid leak
business.industry
Pituitary tumors
Odds ratio
medicine.disease
Comorbidity
Craniopharyngioma
Surgery
03 medical and health sciences
Liver disease
0302 clinical medicine
medicine.anatomical_structure
Otorhinolaryngology
Anterior cranial fossa
medicine
Immunology and Allergy
030223 otorhinolaryngology
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 20426976
- Volume :
- 6
- Database :
- OpenAIRE
- Journal :
- International Forum of Allergy & Rhinology
- Accession number :
- edsair.doi...........c0b8ce5c1350c6f53af67b0bea497987