Author(s): Almhanedi H.; Looby S.; Javadpour M.; Al-Mahfoudh R.; Bhojak M.
Source: British Journal of Neurosurgery; 2018; vol. 32 (no. 1); p. 79
Publication Date: 2018
Publication Type(s): Conference Abstract
Abstract:Objectives: Assessment of risk factors for postoperative CSF leak following endoscopic transnasal pituitary and anterior skull base surgery. Design: Prospective Cohort. Subjects: Database of 270 transnasal pituitary and anterior skull base procedures performed by a single surgeon between June 2006 and June 2015. Methods: Factors assessed included patient’s age, sex, pathology of tumour, previous surgery or radiotherapy, extent of tumour resection, degree of intraoperative CSF leak, CSF leak repair method and experience of surgeon. Results: Postoperative CSF leak occurred in 8.5% procedures. The rate of postoperative CSF leak was 7.2% for pituitary adenomas, 12.7% for non-pituitary lesions, 8% for first time surgery, 10% for those with previous surgery, and 22% for those with previous radiotherapy. Higher postoperative CSF leak occurred in those with high flow intraoperative CSF fistula 17.3% compared to those with minor or moderate intraoperative leak. It occurred in 3.4% of cases where a nasoseptal flap was used. Extent of resection did not appear to influence the CSF leak rate. In this series, CSF leak occurred in 19% of the first 90 cases, 7% of the second 90 cases, and 0% of the last 90 cases. Conclusions: Non-adenomatous tumour pathology, previous radiotherapy and high flow intraoperative CSF leak significantly increase the risk of postoperative CSF leak, whereas the use of multi-layered closure, nasoseptal flap and surgeon experience reduce this risk. Adoption of a multi-layered closure technique can bring this risk close to zero.