Risk factor for cerebrospinal fluid leak after endoscopic endonasal skull base surgery: a single-center experience

Ozawa, Hiroyuki; Sekimizu, Mariko; Saito, Shin; Nakamura, Shintaro; Mikoshiba, Takuya; Watanabe, Yoshihiro; Ikari, Yuichi; Toda, Masahiro; Ogawa, Kaoru

doi:10.1080/00016489.2021.1900600

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…Postoperative CSF leak was related to over €14000 additional costs per case and occurred in 9,6% and 7,5% in the total cohort or in patients with pituitary adenoma, respectively. Compared to previous studies reporting a prevalence between 0,9 and 5,2% ( 14 , 15 , 48 , 78 , 79 ) after transsphenoidal pituitary surgery, the prevalence of postoperative CSF leak in the present study was high. However, this needs to be placed in perspective with the complexity of our case-mix in a tertiary referral centre and potential selection bias (i.e., more severe cases undergo surgical intervention rather than ELD placement).…”

Section: Discussioncontrasting

confidence: 96%

“…However, this needs to be placed in perspective with the complexity of our case-mix in a tertiary referral centre and potential selection bias (i.e., more severe cases undergo surgical intervention rather than ELD placement). Known risk groups for postoperative CSF leak are patients with higher BMI, third ventricle invasion, craniopharyngioma, previous skull base irradiation, prior surgery and intra-operative CSF leak (74,78,(80)(81)(82). For these patients particularly, tailored skull base reconstruction methods are critical to prevent and/or manage CSF leak optimally (83).…”

Section: Postoperative Csf Leakmentioning

confidence: 99%

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Costs and Its Determinants in Pituitary Tumour Surgery

Dekkers

Vries²,

Najafabadi³

et al. 2022

Front. Endocrinol.

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PurposeValue-based healthcare (VBHC) provides a framework to improve care by improving patient outcomes and reducing healthcare costs. To support value-based decision making in clinical practice we evaluated healthcare costs and cost drivers in perioperative care for pituitary tumour patients.MethodsWe retrospectively assessed financial and clinical data for surgical treatment up to the first year after surgery of pituitary tumour patients treated between 2015 and 2018 in a Dutch tertiary referral centre. Multivariable regression analyses were performed to identify determinants of higher costs.Results271 patients who underwent surgery were included. Mean total costs (SD) were €16339 (13573) per patient, with the following cost determinants: surgery time (€62 per minute; 95% CI: 50, 74), length of stay (€1331 per day; 95% CI 1139, 1523), admission to higher care unit (€12154 in total; 95% CI 6413, 17895), emergency surgery (€10363 higher than elective surgery; 95% CI: 1422, 19305) and postoperative cerebrospinal fluid leak (€14232; 95% CI 9667, 18797). Intradural (€7128; 95% CI 10421, 23836) and combined transsphenoidal/transcranial surgery (B: 38494; 95% CI 29191, 47797) were associated with higher costs than standard. Further, higher costs were found in these baseline conditions: Rathke’s cleft cyst (€9201 higher than non-functioning adenoma; 95% CI 1173, 17230), giant adenoma (€19106 higher than microadenoma; 95% CI 12336, 25877), third ventricle invasion (€14613; 95% CI 7613, 21613) and dependent functional status (€12231; 95% CI 3985, 20477). In patients with uncomplicated course, costs were €8879 (3210) and with complications €17551 (14250).ConclusionsLength of hospital stay, and complications are the main drivers of costs in perioperative pituitary tumour healthcare as were some baseline features, e.g. larger tumors, cysts and dependent functional status. Costs analysis may correspond with healthcare resource utilization and guide further individualized care path development and capacity planning.

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Section: Discussioncontrasting

confidence: 96%

Section: Postoperative Csf Leakmentioning

confidence: 99%

Costs and Its Determinants in Pituitary Tumour Surgery

Dekkers

Vries²,

Najafabadi³

et al. 2022

Front. Endocrinol.

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“…1,11 Another study analyzed the percentage of leak in all skull base tumors and noted chordomas to have postoperative CSF leak rates of approximately 3.6%, while the rate for meningiomas was 8.0%. 12 Factors associated with an increased risk included tumor pathologies such as craniopharyngiomas, presence of Cushing's disease, and intraoperative CSF leaks. 11 Tumor location played a role as well, with posterior fossa tumors having the highest rate of CSF leak at 32.6%.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Postoperative CSF Leak in Extrasellar Tumors

Zhang

Peeters

Vengorivich

et al. 2023

J Neurol Surg B Skull Base

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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.

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“…Several studies reported that intraoperative CSF leakage was an independent factor of postoperative CSF leakage ( 11 , 22 ). However, a few literature studies analyzed the postoperative CSF leakage by classifying intraoperative CSF leakage flow.…”

Section: Discussionmentioning

confidence: 99%

“…Noteworthy, as one of the most common complications in EES ( 2 – 4 ), CSF leakage after operation not only increases the duration of hospital stay ( 5 ) and readmission rates but also increases the risk of postoperative intracranial infection and seriously affects the prognosis ( 6 ). It has been reported that postoperative CSF leakage ranges from 7.2% to 25.4% ( 7 – 11 ), making EES questionable.…”

Section: Introductionmentioning

confidence: 99%

Exploration of the causes of cerebrospinal fluid leakage after endoscopic endonasal surgery for sellar and suprasellar lesions and analysis of risk factors

et al. 2022

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ObjectivePostoperative cerebrospinal fluid (CSF) leakage following endoscopic endonasal surgery (EES) is a frequent complication. This study aims to identify potential risk factors of postoperative CSF leakage.MethodsA retrospective review of 360 patients who underwent EES was included. The associations between postoperative CSF leakage and patient demographics, medical history, tumor characteristics, and intraoperative repair techniques were analyzed; the diagnosis and repair of postoperative CSF leakage were also introduced.ResultsPostoperative CSF leakage occurred in 14 patients (3.9%), 2 of them cured by lumbar cistern drainage, 12 underwent endoscopic repair. Among these 12 cases, 3 were repaired twice, and the rest were cured the first time. During the repair surgery, insufficient embedded fat was detected in one case detected, seven with breached inner artificial dura, three had vascularized pedicle nasoseptal flap (VP-NSF) displacement, two with VP-NSF perforation, two with VP-NSF inactivation, and one with imperfect adherence to VP-NSF to the skull base. Eight cases had intracranial infections. Excluding one case who died of severe intracranial infection, the rest were cured and discharged without obvious sequelae. Multivariate analysis revealed that the suprasellar lesion, subarachnoid invasion, and intraoperative grade 3 flow CSF leakage were the risk factors of CSF leakage after operation, while the bone flap was a protective factor.ConclusionBone flap combined with VP-NSF and iodoform gauze for skull base reconstruction is recommended in high-risk patients, while postoperative lumbar cistern drain remains dispensable.

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Risk factor for cerebrospinal fluid leak after endoscopic endonasal skull base surgery: a single-center experience

Cited by 8 publications

References 17 publications

Costs and Its Determinants in Pituitary Tumour Surgery

Costs and Its Determinants in Pituitary Tumour Surgery

Risk Factors Associated with Postoperative CSF Leak in Extrasellar Tumors

Exploration of the causes of cerebrospinal fluid leakage after endoscopic endonasal surgery for sellar and suprasellar lesions and analysis of risk factors

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