Background: The endoscopic Endonasal Approach(EEA) is a commonly used technique for resection of sellar,suprasellar and anterior fossa masses. One of the troublesome complications of this technique is cerebrospinal fluid leak. In this study we evaluate the risk factors and consequences of cerebrospinal fluid leak on surgical outcomes. Methods: The current study is a retrospective single-institution cohort study evaluating patients who underwent EEA for sellar and/or suprasellar masses from July 2017 to March of 2020. Risk factors for intraoperative and postoperative CSF leak were evaluated including, sellar defect size, tumor volume and pathology, age,BMI,prior endoscopic endonasal surgery, lumbar drain placement, nasoseptal and mucosal graft use, year of surgery, and cavernous sinus invasion. Postoperative infection, perioperative antibiotic use and length of stay were also evaluated. Results: Our study included 175 patients. Sellar defect size(p=.015) ,intraoperative CSF leak(p<.001), were significantly associated with increased risk of postoperative CSF leak. Patients with nasoseptal flaps were more likely to have a postoperative CSF leak than those with free mucosal grafts(p=.025).Intraoperative CSF leak, Cushing’s Disease and Lumbar Drain placement were associated with an increased length of stay. Conclusion: Sellar defect size, intraoperative CSF leak and nasoseptal flap were associated with an increased risk of postoperative CSF leak. Intraoperative CSF Leak, Cushing’s Disease and Lumbar drain placement are all associated with an increased length of stay.
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