title: Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery.
abstract: OBJECTIVE
  Postoperative CSF leakage can be a serious complication after a transsphenoidal surgical approach. An elevated body mass index (BMI) is a significant risk factor for spontaneous CSF leaks. However, there is no evidence correlating BMI with postoperative CSF leak after transsphenoidal surgery. The authors hypothesized that patients with elevated BMI would have a higher incidence of CSF leakage complications following transsphenoidal surgery.
  
  
  METHODS
  The authors conducted a retrospective review of 121 patients who, between August 2005 and March 2010, underwent endoscopic endonasal transsphenoidal surgeries for resection of primarily sellar masses. Patients requiring extended transsphenoidal approaches were excluded. A multivariate statistical analysis was performed to investigate the association of BMI and other risk factors with postoperative CSF leakage.
  
  
  RESULTS
  In 92 patients, 96 endonasal endoscopic transsphenoidal surgeries were performed that met inclusion criteria. Thirteen postoperative leaks occurred and required subsequent treatment, including lumbar drainage and/or reoperation. The average BMI of patients with a postoperative CSF leak was significantly greater than that in patients with no postoperative CSF leak (39.2 vs 32.9 kg/m(2), p = 0.006). Multivariate analyses indicate that for every 5-kg/m(2) increase in BMI, patients undergoing a transsphenoidal approach for a primarily sellar mass have 1.61 times the odds (95% CI 1.10-2.29, p = 0.016, by multivariate logistic regression) of having a postoperative CSF leak.
  
  
  CONCLUSIONS
  Elevated BMI is an independent predictor of postoperative CSF leak after an endonasal endoscopic transsphenoidal approach. The authors recommend that patients with BMI greater than 30 kg/m(2) have meticulous sellar reconstruction at surgery and close monitoring postoperatively.
authors.affiliation: Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Dlouhy
authors.forename: Karthik
authors.initials: K
authors.lastname: Madhavan
authors.forename: John D
authors.initials: JD
authors.lastname: Clinger
authors.forename: Ambur
authors.initials: A
authors.lastname: Reddy
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Dawson
authors.forename: Erin K
authors.initials: EK
authors.lastname: O'Brien
authors.forename: Eugene
authors.initials: E
authors.lastname: Chang
authors.forename: Scott M
authors.initials: SM
authors.lastname: Graham
authors.forename: Jeremy D W
authors.initials: JD
authors.lastname: Greenlee
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D020863:Central Nervous System Cysts / Q000601:surgery*; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D004724:Endoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D010900:Pituitary Diseases / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013101:Sphenoid Sinus; D055815:Young Adult