Journal article
Risk Factors for Intraoperative and Postoperative Cerebrospinal Fluid Leaks in Endoscopic Transsphenoidal Sellar Surgery
Otolaryngology-head and neck surgery, Vol.158(5), pp.952-960
05/01/2018
DOI: 10.1177/0194599818756272
PMID: 29405885
Abstract
Objective. To determine the factors associated with intra-and postoperative cerebrospinal fluid (CSF) leaks in setting of endoscopic transsphenoidal sellar surgery.
Study Design. Retrospective cohort.
Setting. Tertiary referral center.
Subjects and Methods. This study included 806 patients who underwent endoscopic transsphenoidal sellar surgery between 2004 and 2016. The associations between CSF leaks (intraand postoperative) and patient demographics, medical history, tumor characteristics, and intraoperative repair techniques were analyzed.
Results. In sum, 205 (25.4%) patients had a CSF leak: 188 (23.3%) intraoperative leaks and 38 (4.7%) postoperative leaks. Twenty-one (2.6%) patients had postoperative leaks after having repair of an intraoperative leak; 55% of patients with a postoperative leak had an intraoperative leak repaired. On multivariate analysis, body mass index (BMI), hydrocephalus, suprasellar extension, and craniopharyngioma significantly predicted intraoperative CSF leaks, while only BMI and hydrocephalus predicted postoperative CSF leaks. Patients having septal flap repairs of CSF leaks had a higher postoperative leak rate relative to other repair techniques (odds ratio, 6.37; P =.013). Rigid reconstruction did not correlate with leaks.
Conclusion. For this large cohort of patients undergoing endoscopic transsphenoidal sellar surgery, BMI and hydrocephalus were identified as predictors of postoperative CSF leaks, including those occurring after repair of intraoperative leak. These variables may put stress on the surgical repair of sellar defects, and consideration of these risk factors may help counsel patients and guide perioperative decision making in regard to repair strategies and CSF diversion techniques.
Details
- Title: Subtitle
- Risk Factors for Intraoperative and Postoperative Cerebrospinal Fluid Leaks in Endoscopic Transsphenoidal Sellar Surgery
- Creators
- Priyesh N. Patel - Vanderbilt University Medical CenterAlicia M. Stafford - Vanderbilt UniversityJames R. Patrinely - Vanderbilt UniversityDerek K. Smith - Vanderbilt UniversityJustin H. Turner - Vanderbilt University Medical CenterPaul T. Russell - Vanderbilt University Medical CenterKyle D. Weaver - Vanderbilt University Medical CenterLola B. Chambless - Vanderbilt University Medical CenterRakesh K. Chandra - Vanderbilt University Medical Center
- Resource Type
- Journal article
- Publication Details
- Otolaryngology-head and neck surgery, Vol.158(5), pp.952-960
- DOI
- 10.1177/0194599818756272
- PMID
- 29405885
- NLM abbreviation
- Otolaryngol Head Neck Surg
- ISSN
- 0194-5998
- eISSN
- 1097-6817
- Publisher
- Sage
- Number of pages
- 9
- Language
- English
- Date published
- 05/01/2018
- Academic Unit
- Preventive and Community Dentistry; Dental Research
- Record Identifier
- 9984966853802771
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