Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery

Tom T Karnezis; Andrew B Baker; Zachary M Soler; Sarah K Wise; Shruthi K Rereddy; Zara M Patel; Nelson M Oyesiku; John M DelGaudio; Constantinos G Hadjipanayis; Bradford A Woodworth; Kristen O Riley; John Lee; Michael D Cusimano; Satish Govindaraj; Alkis Psaltis; Peter John Wormald; Steve Santoreneos; Raj Sindwani; Samuel Trosman; Janalee K Stokken; Troy D Woodard; Pablo F Recinos; W Alexander Vandergrift 3rd; Rodney J Schlosser

doi:10.1002/alr.21783

Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery

Int Forum Allergy Rhinol. 2016 Nov;6(11):1117-1125. doi: 10.1002/alr.21783. Epub 2016 Aug 23.

Authors

Tom T Karnezis¹, Andrew B Baker², Zachary M Soler², Sarah K Wise³, Shruthi K Rereddy³, Zara M Patel³, Nelson M Oyesiku⁴, John M DelGaudio³, Constantinos G Hadjipanayis³, Bradford A Woodworth⁵, Kristen O Riley⁶, John Lee⁷, Michael D Cusimano⁸, Satish Govindaraj⁹, Alkis Psaltis¹⁰, Peter John Wormald¹⁰, Steve Santoreneos¹¹, Raj Sindwani¹², Samuel Trosman¹², Janalee K Stokken¹³, Troy D Woodard¹², Pablo F Recinos¹², W Alexander Vandergrift 3rd¹⁴, Rodney J Schlosser²

Affiliations

¹ Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC. karnezis@gmail.com.
² Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.
³ Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.
⁴ Department of Neurosurgery, Emory University, Atlanta, GA.
⁵ Division of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL.
⁶ Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL.
⁷ Department of Otolaryngology-Head & Neck Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.
⁸ Department of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
⁹ Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, New York, NY.
¹⁰ Department of Otolaryngology-Head & Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia.
¹¹ Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia.
¹² Section of Rhinology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH.
¹³ Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, MN.
¹⁴ Department of Neurosurgery, Medical University of South Carolina, Charleston, SC.

PMID: 27552303
DOI: 10.1002/alr.21783

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.

Keywords: craniopharyngioma; intraoperative leak; pituitary tumor; postoperative leak; skull base reconstruction.

MeSH terms

Adult
Aged
Cerebrospinal Fluid Leak
Craniopharyngioma / epidemiology
Craniopharyngioma / surgery*
Endoscopy / adverse effects*
Female
Humans
Intraoperative Complications*
Male
Middle Aged
Odds Ratio
Pituitary Neoplasms / epidemiology
Pituitary Neoplasms / surgery*
Postoperative Complications*
Retrospective Studies