Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

Dlouhy, Brian J.; Madhavan, Karthik; Clinger, John D.; Reddy, Ambur; Dawson, Jeffrey D.; O’Brien, Erin; Chang, Eugene H.; Graham, Scott M.; Greenlee, Jeremy D.W.

doi:10.3171/2012.2.jns111837

Cited by 115 publications

(148 citation statements)

References 44 publications

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“…7 Dlouhy and colleagues 7 performed a retrospective review of 121 patients who underwent TSS, noting that the average BMI of patients with CSF rhinorrhea was greater than those with no postoperative leak. In our analysis, we noted a significantly greater proportion of obesity, as defined by BMI, among Cushing's disease patients than in the non-Cushing's disease cohort.…”

Section: Discussionmentioning

confidence: 99%

“…5 Despite a superior safety profile and decreased morbidity relative to transcranial approaches, TSS harbors risks, including a potential for hypopituitarism as well as cerebrospinal fluid (CSF) leak. [6][7][8][9][10][11] Some have suggested the latter risk is especially pronounced in Cushing's disease, characterized by poor wound healing due to a high cortisol environment. 12,13 Nonetheless, population-based studies definitively illustrating an increased CSF leak rate in Cushing's disease patients are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Inpatient Complications After Transsphenoidal Surgery in Cushing’s Versus Non-Cushing’s Disease Patients

Svider

Raikundalia

Pines

et al. 2015

Ann Otol Rhinol Laryngol

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Objective: Transsphenoidal surgery (TSS) harbors a potential for hypopituitarism, cerebrospinal fluid (CSF) leaks, and other complications. We utilized the Nationwide Inpatient Sample Database (NIS) to compare inpatient complication rates between Cushing's disease (CD) and non-Cushing's disease (NCD) patients undergoing TSS. Methods: Inpatient hospitalization data for 960 CD and 12 110 NCD patients who underwent TSS between 2002 and 2010 were accessed. Demographic information, outcomes, and complication rates were evaluated. Results: Patients with CD had a female predilection (81.7%) and were younger (40.5 ± 14.4 years) than NCD patients (47.8% female; 52.1 ± 16.3 years) (P < .001). Length of stay and total charges did not differ between groups. Patients with CD had significantly greater postoperative diabetes insipidus rates (14.0% vs 9.6%, P < .001) and urinary/renal complications (1.7% vs 0.9%, P = .027). After adjusting for possible confounders, the relationship between urinary/renal complications and CD status strengthened. There was no difference in rates of CSF leak and iatrogenic pituitary disorders overall. Conclusion: No differences were noted in the rate of early CSF leaks between postoperative TSS CD and NCD patients. Postoperative diabetes insipidus did not significantly differ between groups after adjusting for confounders. Only odds of urinary/renal complications in CD patients was significant after adjustment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inpatient Complications After Transsphenoidal Surgery in Cushing’s Versus Non-Cushing’s Disease Patients

Svider

Raikundalia

Pines

et al. 2015

Ann Otol Rhinol Laryngol

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“…Likewise idiopathic intracranial hypertension associated with a high BMI and young age can also increase the risk of a leak. 4,45 In the present population, age, sex, and BMI did not significantly correlate with CSF leaks. This is not entirely surprising since cranial defects were not spontaneous but rather iatrogenic and the persistence of a leak had more to do with the size of the skull base opening and the success of the repair than the patient's body habitus.…”

Section: Risk Of Csf Leaks Associated With Esbsmentioning

confidence: 68%

Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

Banu

Szentirmai

Mascarenhas

et al. 2014

JNS

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Object Postoperative pneumocephalus is a common occurrence after endoscopic endonasal skull base surgery (ESBS). The risk of cerebrospinal fluid (CSF) leaks can be high and the presence of postoperative pneumocephalus associated with serosanguineous nasal drainage may raise suspicion for a CSF leak. The authors hypothesized that specific patterns of pneumocephalus on postoperative imaging could be predictive of CSF leaks. Identification of these patterns could guide the postoperative management of patients undergoing ESBS. Methods The authors queried a prospectively acquired database of 526 consecutive ESBS cases at a single center between December 1, 2003, and May 31, 2012, and identified 258 patients with an intraoperative CSF leak documented using intrathecal fluorescein. Postoperative CT and MRI scans obtained within 1–10 days were examined and pneumocephalus was graded based on location and amount. A discrete 0–4 scale was used to classify pneumocephalus patterns based on size and morphology. Pneumocephalus was correlated with the surgical approach, histopathological diagnosis, and presence of a postoperative CSF leak. Results The mean follow-up duration was 56.7 months. Of the 258 patients, 102 (39.5%) demonstrated pneumocephalus on postoperative imaging. The most frequent location of pneumocephalus was frontal (73 [71.5%] of 102), intraventricular (34 [33.3%]), and convexity (22 [21.6%]). Patients with craniopharyngioma (27 [87%] of 31) and meningioma (23 [68%] of 34) had the highest incidence of postoperative pneumocephalus compared with patients with pituitary adenomas (29 [20.6%] of 141) (p < 0.0001). The incidence of pneumocephalus was higher with transcribriform and transethmoidal approaches (8 of [73%] 11) than with a transsellar approach (9 of [7%] 131). There were 15 (5.8%) of 258 cases of postoperative CSF leak, of which 10 (66.7%) had pneumocephalus, compared with 92 (38%) of 243 patients without a postoperative CSF leak (OR 3.3, p = 0.027). Pneumocephalus located in the convexity, interhemispheric fissure, sellar region, parasellar region, and perimesencephalic region was significantly correlated with a postoperative CSF leak (OR 4.9, p = 0.006) and was therefore termed “suspicious” pneumocephalus. In contrast, frontal or intraventricular pneumocephalus was not correlated with postoperative CSF leak (not significant) and was defined as “benign” pneumocephalus. The amount of convexity pneumocephalus (p = 0.002), interhemispheric pneumocephalus (p = 0.005), and parasellar pneumocephalus (p = 0.007) (determined using a scale score of 0–4) was also significantly related to postoperative CSF leaks. Using a series of permutation-based multivariate analyses, the authors established that a model containing the learning curve, the transclival/transcavernous approach, and the presence of “suspicious” pneumocephalus provides the best overall prediction for postoperative CSF leaks. Conclusions Postoperative pneumocephalus is much more common following extended approaches than following transsellar surgery. Merely the presence of pneumocephalus, particularly in the frontal or intraventricular locations, is not necessarily associated with a postoperative CSF leak. A “suspicious” pattern of air, namely pneumocephalus in the convexity, interhemispheric fissure, sella, parasellar, or perimesencephalic locations, is significantly associated with a postoperative CSF leak. The presence and the score of “suspicious” pneumocephalus on postoperative imaging, in conjunction with the learning curve and the type of endoscopic approach, provide the best predictive model for postoperative CSF leaks.

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“…These factors include expanded EEAs, certain pathologic conditions (ie, craniopharyngioma), postoperative adjuvant therapies, idiopathic intracranial hypertension, and transplanum approaches with exposure of the third ventricle. 24,[27][28][29] Similarly, although the incidence of postoperative CSF leaks following resection of even large pituitary adenomas is less than 10%, EEAs for ventral skull base meningiomas are associated with a considerably higher incidence (more than 30% for olfactory groove and more than 20% for tuberculum sellae meningiomas). 30,31 CSF leaks following FESS are most commonly associated with injury to the ethmoid roof or the LLCP.…”

Section: Surgical Traumatic Cerebrospinal Fluid Leaksmentioning

confidence: 95%

Endoscopic Endonasal Repair of Spontaneous and Traumatic Cerebrospinal Fluid Rhinorrhea

Gonen

Monteiro

Klironomos

et al. 2015

Neurosurgery Clinics of North America

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Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

Cited by 115 publications

References 44 publications

Inpatient Complications After Transsphenoidal Surgery in Cushing’s Versus Non-Cushing’s Disease Patients

Inpatient Complications After Transsphenoidal Surgery in Cushing’s Versus Non-Cushing’s Disease Patients

Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

Endoscopic Endonasal Repair of Spontaneous and Traumatic Cerebrospinal Fluid Rhinorrhea

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