title: Successful repair of intraoperative cerebrospinal fluid leaks improves outcomes in endoscopic skull base surgery.
abstract: The impact of failed cerebrospinal fluid leak (CSF) leak repair in endoscopic skull base surgery has not been adequately studied.
  
  
  
  In this investigation we reviewed patients who had undergone endoscopic skull base surgery between 2002 and 2014 at 7 international centers. Demographic variables, comorbidities, tumor characteristics, and repair techniques were evaluated to determine association with successful repair of CSF leak. Postoperative complications and length of stay were compared among groups.
  
  
  
  Data were collected on 2097 patients who were divided into 3 groups: (1) those with no intraoperative leak (n = 1533); (2) those with successful repair of their intraoperative leak (n = 452); and (3) those with failed repair (n = 112). Compared with successful repair, failed repair was associated with an increased risk of intracranial infection (odds ratio [OR], 5.6; 95% confidence interval [CI], 5.3-13.15), pneumocephalus (OR, 16; 95% CI, 5.8-44.4), 30-day readmission (OR, 8.4; 95% CI, 5.3-13.5), reoperation (OR, 115.4; 95% CI, 56.3-236.8), and prolonged hospital stay (14.9 vs 7.0 days, p < 0.01). Outcomes in patients who had successful repairs of intraoperative leaks were similar to those who never had leakage. Intraoperative use of pedicled nasoseptal flaps was associated with successful repair (OR, 0.60; 95% CI, 0.34-0.92).
  
  
  
  Intraoperative CSF leaks are a frequent and expected occurrence during endoscopic skull base surgery. Failed CSF leak repair has a significant impact on patient outcomes, with increased rates of postoperative pneumocephalus, intracranial infections, reoperation, deep vein thrombosis, readmission, and prolonged hospital stay. Recognition and repair of intraoperative CSF leaks reduces postoperative complications. Use of pedicled nasoseptal flaps improves outcomes in reconstructing defects at higher risk for postoperative leak.
authors: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors: Arash
authors: A
authors: Shahangian
authors: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors: Zachary M
authors: ZM
authors: Soler
authors: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors: Andrew
authors: A
authors: Baker
authors: Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.
authors: Sarah K
authors: SK
authors: Wise
authors: Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.|Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA.
authors: Shruthi K
authors: SK
authors: Rereddy
authors: Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA.
authors: Zara M
authors: ZM
authors: Patel
authors: Department of Neurosurgery, Emory University, Atlanta, GA.
authors: Nelson M
authors: NM
authors: Oyesiku
authors: Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.
authors: John M
authors: JM
authors: DelGaudio
authors: Department of Neurosurgery, Emory University, Atlanta, GA.|Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York City, NY.
authors: Constantinos G
authors: CG
authors: Hadjipanayis
authors: Division of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors: Bradford A
authors: BA
authors: Woodworth
authors: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL.
authors: Kristen O
authors: KO
authors: Riley
authors: Department of Otolaryngology-Head & Neck Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.
authors: John
authors: J
authors: Lee
authors: Department of Neurosurgery University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.
authors: Michael D
authors: MD
authors: Cusimano
authors: Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, New York City, NY.
authors: Satish
authors: S
authors: Govindaraj
authors: Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, New York City, NY.
authors: Mohemmed N
authors: MN
authors: Khan
authors: Department of Otolaryngology-Head & Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors: Alkis
authors: A
authors: Psaltis
authors: Department of Otolaryngology-Head & Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors: Peter J
authors: PJ
authors: Wormald
authors: Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors: Stephen
authors: S
authors: Santoreneos
authors: Section of Rhinology, Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH.
authors: Raj
authors: R
authors: Sindwani
authors: Section of Rhinology, Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH.
authors: Samuel
authors: S
authors: Trosman
authors: Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, MN.
authors: Janalee K
authors: JK
authors: Stokken
authors: Section of Rhinology, Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH.
authors: Troy D
authors: TD
authors: Woodard
authors: Section of Rhinology, Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH.
authors: Pablo F
authors: PF
authors: Recinos
authors: Department of Neurosurgery, Medical University of South Carolina, Charleston, SC.
authors: W Alexander
authors: WA
authors: Vandergrift
authors: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors: Caitlin
authors: C
authors: Boling
authors: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors: Rodney J
authors: RJ
authors: Schlosser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000601:surgery; D065634:Cerebrospinal Fluid Leak / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002817:Chordoma / Q000601:surgery; D004677:Encephalocele / Q000601:surgery; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011007:Pneumocephalus / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012086:Reoperation; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: complication; intraoperative leak; postoperative leak; skull base reconstruction; skull base tumor