Cerebrospinal fluid

Engineering

Leak

Neurosurgery

Surgery

Multivariate analysis

Psychiatry

Pituitary adenoma

Cerebrospinal fluid leak

Neurology

Endoscopy

Environmental engineering

Neuroradiology

Skull

Transsphenoidal surgery

Internal medicine

Univariate analysis

Endoscopic surgery

Adenoma

Medicine

Interventional radiology

Acta Neurochirurgica

Background Post-operative CSF leak is the major source of morbidity following endoscopic transsphenoidal surgery. The purpose of this study was to identify factors associated with post-operative CSF leak in patients undergoing this surgery and facilitate the prospective identification of patients at higher risk of this complication. Methods A review of a prospectively maintained database containing details of 270 endoscopic transsphenoidal operations performed by the senior author over a 9-year period was performed. Univariate analysis was performed using the Chi-squared and Fisher’s exact tests, as appropriate. A logistic regression model was constructed for multivariate analysis. Results The rate of post-operative CSF leak in this series was 9%. On univariate analysis, previous surgery, resection of craniopharyngiomas, adenomas causing Cushing’s disease and intra-operative CSF leaks were associated with an increased risk of post-operative CSF leak. The use of a vascularised nasoseptal flap and increasing surgical experience were associated with a decreased rate of CSF leak. On multivariate analysis, a resection of tumour for Cushing’s disease (OR 5.79, 95% CI 1.53–21.95, p = 0.01) and an intra-operative CSF leak (OR 4.56, 95% CI 1.56–13.32, p = 0.006) were associated with an increased risk of post-operative CSF leak. Increasing surgical experience (OR 0.14, 95% CI 0.04–0.46, p = 0.001) was strongly associated with a decreased risk of post-operative CSF leak. Conclusions Increasing surgical experience is a strong predictor of a decreased risk of developing post-operative CSF leak following endoscopic transsphenoidal surgery. Patients with Cushing’s disease and those who develop an intra-operative CSF leak should be managed with meticulous skull base repair and close observation for signs of CSF leak post-operatively.

Predicting post-operative cerebrospinal fluid (CSF) leak following endoscopic transnasal pituitary and anterior skull base surgery: a multivariate analysis