title: Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery.
abstract: In patients undergoing transnasal endoscopic sellar surgery, an analysis of risk factors and predictors of intraoperative and postoperative cerebrospinal fluid leak (CSF) would provide important prognostic information.
  
  
  
  A retrospective review of patients undergoing endoscopic sellar surgery for pituitary adenomas or craniopharyngiomas between 2002 and 2014 at 7 international centers was performed. Demographic, comorbidity, and tumor characteristics were evaluated to determine the associations between intraoperative and postoperative CSF leaks. Correlations between reconstructive and CSF diversion techniques were associated with postoperative CSF leak rates. Odds ratios (OR) were identified using a multivariate logistic regression model.
  
  
  
  Data were collected on 1108 pituitary adenomas and 53 craniopharyngiomas. Overall, 30.1% of patients had an intraoperative leak and 5.9% had a postoperative leak. Preoperative factors associated with increased intraoperative leaks were mild liver disease, craniopharyngioma, and extension into the anterior cranial fossa. In patients with intraoperative CSF leaks, postoperative leaks occurred in 10.3%, with a higher postoperative leak rate in craniopharyngiomas (20.8% vs 5.1% in pituitary adenomas). Once an intraoperative leak occurred, craniopharyngioma (OR = 4.255, p = 0.010) and higher body mass index (BMI) predicted postoperative leak (OR = 1.055, p = 0.010). In patients with an intraoperative leak, the use of septal flaps reduced the occurrence of postoperative leak (OR = 0.431, p = 0.027). Rigid reconstruction and CSF diversion techniques did not impact postoperative leak rates.
  
  
  
  Intraoperative CSF leaks can occur during endoscopic sellar surgery, especially in larger tumors or craniopharyngiomas. Once an intraoperative leak occurs, risk factors for postoperative leaks include craniopharyngiomas and higher BMI. Use of septal flaps decreases this risk.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC. karnezis@gmail.com.
authors.forename: Tom T
authors.initials: TT
authors.lastname: Karnezis
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Baker
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Soler
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Wise
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.
authors.forename: Shruthi K
authors.initials: SK
authors.lastname: Rereddy
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.
authors.forename: Zara M
authors.initials: ZM
authors.lastname: Patel
authors.affiliation: Department of Neurosurgery, Emory University, Atlanta, GA.
authors.forename: Nelson M
authors.initials: NM
authors.lastname: Oyesiku
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.
authors.forename: John M
authors.initials: JM
authors.lastname: DelGaudio
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.
authors.forename: Constantinos G
authors.initials: CG
authors.lastname: Hadjipanayis
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Bradford A
authors.initials: BA
authors.lastname: Woodworth
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Kristen O
authors.initials: KO
authors.lastname: Riley
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cusimano
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, New York, NY.
authors.forename: Satish
authors.initials: S
authors.lastname: Govindaraj
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Alkis
authors.initials: A
authors.lastname: Psaltis
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Peter John
authors.initials: PJ
authors.lastname: Wormald
authors.affiliation: Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Santoreneos
authors.affiliation: Section of Rhinology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
authors.affiliation: Section of Rhinology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Samuel
authors.initials: S
authors.lastname: Trosman
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Janalee K
authors.initials: JK
authors.lastname: Stokken
authors.affiliation: Section of Rhinology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Troy D
authors.initials: TD
authors.lastname: Woodard
authors.affiliation: Section of Rhinology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Pablo F
authors.initials: PF
authors.lastname: Recinos
authors.affiliation: Department of Neurosurgery, Medical University of South Carolina, Charleston, SC.
authors.forename: W Alexander
authors.initials: WA
authors.lastname: Vandergrift
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Schlosser
mesh_terms: D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak; D003397:Craniopharyngioma / Q000453:epidemiology / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010911:Pituitary Neoplasms / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: craniopharyngioma; intraoperative leak; pituitary tumor; postoperative leak; skull base reconstruction