title: Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery.
abstract: Postoperative cerebrospinal fluid (CSF) leak is a serious complication of transsphenoidal surgery, which can lead to meningitis and often requires reparative surgery. We sought to identify preoperative risk factors for CSF leaks and meningitis. We reviewed 98 consecutive expanded endoscopic endonasal surgeries performed from 2008-2012 and analyzed preoperative comorbidities, intraoperative techniques, and postoperative care. Univariate and multivariate analyses were performed. The most common pathologies addressed included pituitary adenoma, Rathke cyst, chordoma, esthesioneuroblastoma, meningioma, nasopharyngeal carcinoma, and squamous cell carcinoma. There were 11 CSF leaks (11%) and 10 central nervous system (CNS) infections (10%). Univariate and multivariate analysis of preoperative risk factors showed that patients with non-ideal body mass index (BMI) were associated with higher rate of postoperative CSF leak and meningitis (both p<0.01). Also, patients with increasing age were associated with increased CSF leak (p = 0.03) and the length of time a lumbar drain was used postoperatively was associated with infection in a univariate analysis. In addition, three of three endoscopic transsphenoidal surgeries combined with open cranial surgery had a postoperative CSF leak and CNS infection rate which was a considerably higher rate than for transsphenoidal surgeries alone or surgeries staged with open cases (p<0.01 and p=0.04, respectively) In this series of expanded endoscopic transsphenoidal surgeries, preoperative BMI remains the most important preoperative predictor for CSF leak and infection. Other risk factors include age, intraoperative CSF leak, lumbar drain duration, and cranial combined cases. Risks associated with complex surgical resections when combining open and endoscopic approaches could be minimized by staging these procedures.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M7, San Francisco, CA 94143-0112, USA; Center for Minimally Invasive Skull Base Surgery, University of California, San Francisco, CA, USA. Electronic address: Michaeleivan@gmail.com.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Ivan
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M7, San Francisco, CA 94143-0112, USA.
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Iorgulescu
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA; Center for Minimally Invasive Skull Base Surgery, University of California, San Francisco, CA, USA.
authors.forename: Ivan
authors.initials: I
authors.lastname: El-Sayed
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M7, San Francisco, CA 94143-0112, USA; Center for Minimally Invasive Skull Base Surgery, University of California, San Francisco, CA, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: McDermott
authors.affiliation: Department of Neurological Surgery, Northwestern University, Chicago, IL, USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA; Center for Minimally Invasive Skull Base Surgery, University of California, San Francisco, CA, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Pletcher
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M7, San Francisco, CA 94143-0112, USA.
authors.forename: Arman
authors.initials: A
authors.lastname: Jahangiri
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M7, San Francisco, CA 94143-0112, USA; Center for Minimally Invasive Skull Base Surgery, University of California, San Francisco, CA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wagner
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M7, San Francisco, CA 94143-0112, USA; Center for Minimally Invasive Skull Base Surgery, University of California, San Francisco, CA, USA.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Aghi
mesh_terms: D015992:Body Mass Index; D001932:Brain Neoplasms / Q000453:epidemiology / Q000601:surgery*; D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008581:Meningitis / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D013101:Sphenoid Sinus / Q000601:surgery*
keywords: BMI; CSF leak; Endonasal endoscopic surgery; Meningitis; Transsphenoidal surgery