Risk Factors Associated with Postoperative CSF Leak in Extrasellar Tumors

Huan Zhang; Sophie Peeters; Gennadiy Vengorivich; Layal Antoury; Ki Wan Park; Christine Wells; Jeffrey D. Suh; Jivianne T. Lee; Anthony Heaney; Marvin Bergsneider; Won Kim; Marilene B. Wang

doi:10.1055/s-0042-1760355

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2024; 85(01): 015-020
DOI: 10.1055/s-0042-1760355

Original Article

Risk Factors Associated with Postoperative CSF Leak in Extrasellar Tumors

Huan Zhang

¹Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States

,

Sophie Peeters

²Department of Neurosurgery, Los Angeles, California, United States

,

Gennadiy Vengorivich

¹Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States

,

Layal Antoury

¹Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States

,

Ki Wan Park

¹Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States

,

Christine Wells

³Statistical Consulting Group, Los Angeles, California, United States

,

Jeffrey D. Suh

¹Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States

,

Jivianne T. Lee

¹Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States

,

Anthony Heaney

⁴Division of Endocrinology, Diabetes, and Metabolism, Los Angeles, California, United States

,

Marvin Bergsneider

²Department of Neurosurgery, Los Angeles, California, United States

,

Won Kim

²Department of Neurosurgery, Los Angeles, California, United States

,

Marilene B. Wang

¹Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, United States

› Author Affiliations

Abstract

Objective While postoperative cerebrospinal fluid (CSF) leak rates of pituitary tumors have been frequently studied, there are fewer studies examining postoperative CSF leak rates for extrasellar tumors. The purpose of this study was to identify risk factors for the development of postoperative CSF leak in patients undergoing endoscopic surgery for extrasellar tumors.

Methods A retrospective chart review was done for patients who underwent endoscopic resection for extrasellar tumors between 2008 and 2020. Age, gender, tumor type, tumor location, tumor size, reconstruction technique, medical comorbidities, and other potential risk factors were identified. Data was analyzed to identify significant risk factors for development of postoperative CSF leak.

Results There were 100 patients with extrasellar tumors who developed intraoperative CSF leaks. Seventeen patients (17%) developed postoperative CSF leaks. Leaks occurred at a median of 2 days following surgery (range 0–34 days). Clival tumors had a significantly higher incidence of postoperative leak than those in other sites (p < 0.05). There were no significant differences in other locations, body mass index, tumor size, reconstruction technique, medical comorbidities, or other factors. There were nearly twice as many intraoperative grade III leaks in those who developed postoperative CSF leak, but this was not statistically significant (p = 0.12).

Conclusion Extrasellar tumors, particularly clival tumors, have a higher rate of postoperative CSF leak than pituitary tumors. Prophylactic lumbar drains can be considered for patients at high risk for developing postoperative CSF leak.

Keywords

skull base - extrasellar - cerebrospinal fluid leak - repair

Full Text

References

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