Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery

Abstract

Background: The retrosigmoid approach represents a crucial surgical route to address different lesions in the cerebellopontine angle but cerebrospinal fluid (CSF) leak still remains the most frequent complication after this approach. Here, we analyzed the impact of different factors in CSF leak development after a retrosigmoid approach. Identifying risk factors related to a specific approach may help the surgeon to tailor the perioperative management and to appropriately counsel patients regarding their risk profile. Methods: We retrospectively reviewed the clinical, surgical, and outcome data of 103 consecutive patients (M/F, 47/56; mean follow-up 35.6 ± 23.9 months) who underwent a retrosigmoid approach for different cerebellopontine angle pathologies and studied the impact of different factors on the occurrence of a CSF leak to univariate and multivariate analysis. Results: Seventy-nine patients (76.7%) were operated for tumors growing in the cerebellopontine angle. Twenty-four patients (23.2%) underwent microvascular decompression to treat a drug-resistant trigeminal neuralgia. Sixteen patients (15.5%) developed CSF leak in the postoperative course of which six underwent surgical revision. Performing a craniectomy as surgical procedure (P = 0.0450) and performing a reopening procedure (second surgery; P = 0.0079) were significantly associated to a higher risk of developing CSF leak. Moreover, performing a reopening procedure emerged as an independent factor for CSF developing on multivariate analysis (P = 0.0156). Conclusion: Patients submitted to craniectomy and patients who underwent a second surgery showed an higher CSF leak rate. Ongoing improvement of biomaterial technology may help neurosurgeons to prevent this potentially life-threatening complication.

Rates of cerebrospinal fluid leak and pseudomeningocele formation after posterior fossa craniotomy versus craniectomy: A systematic review and meta-analysis

“…Full-text review of the resulting 22 articles excluded another 13 studies. The remaining nine full-text retrospective studies[ 6 , 7 , 10 , 12 , 15 , 17 , 20 - 22 ] were included in the meta-analysis [ Figure 1 ]. Please refer to Supplementary Table 2 for detailed description of individual studies including study characteristics, patient demographics, operative details, postoperative outcomes, and references.…”

“…This could potentially skew the result towards favoring craniotomies given their significantly lower occurrence of pseudomeningocele formation. In addition, only two studies were included in the combined outcome but not in the CSF leak comparison;[ 17 , 21 ] one of which favored craniectomies[ 21 ] causing substantial heterogeneity (I 2 = 59%). Thus, it is difficult to attribute this difference in significance to the incorporation of articles that did not differentiate between postoperative CSF leak and pseudomeningocele, which was the rationale behind including the combined outcome.…”

“…[ 1 ] Recent studies have also shown that performing a craniotomy, where the bone flap is replaced or substituted, decreases the risk of CSF leak when compared to performing a craniectomy where the bone flap is removed without a substitute. [ 17 , 20 ] However, to the best of our knowledge, there has not been a systematic review and meta-analysis to synthesize evidence on the topic. In this article, we perform a systematic review and meta-analysis to evaluate the risk of CSF leak following posterior fossa craniotomy versus craniectomy surgeries.…”

Incidence of Postoperative CSF Leaks in Class III Obese Patients Undergoing Middle Cranial Fossa Approach for Spontaneous CSF Leak Repair

“…The use of prophylactic LDs for CSF leak repairs remains controversial. Previous reports have shown that universal LD is not necessary for sCSF-L repair with the MCF approach in obese patients (10,11). However, the postoperative CSF leak rate in class III obese patients (body mass index [BMI] > 40) undergoing sCSF-L repair and thus the need for prophylactic LD placement in this population has not been extensively studied.…”

Factors associated with cerebrospinal fluid leak after retrosigmoid approach

“…We read with great interest the article by Montano et al . [ 1 ] on the factors associated with cerebrospinal fluid (CSF) leak after a retrosigmoid approach for cerebellopontine angle surgery. The authors have rightly pointed out that performing a craniectomy and a reopening procedure as significantly associated with a higher risk of CSF leak.…”