Can the Risks of Cerebrospinal Fluid Leak After Vestibular Schwannoma Surgery Be Predicted?

Abstract

The predictors of CSF leak after TLA for vestibular schwannoma are young age, male sex, longer duration of surgery, which adjusting for BMI. In this regard, the surgical team should adapt its management during pre- and postoperative period to decrease the likelihood of a leak.

Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma

“…Reported rates of CSF leak following VS resection in the literature are quite variable: studies reported 2.4 to 12.0% in recent literature. 2,[4][5][6][8][9][10] The rate of CSF leak was observed to be significantly higher in TL approaches for VS. 4,5 While we observed a difference in CSF leak rates between TL group and no TL group (►Table 2), that difference was not statistically significant on multivariate regression analysis controlling for age, gender, and operative time. As mentioned in our results, the operative times were longer on average for the TL group and that may have accounted for the higher risk of CSF leaks in our data.…”

“…Russel et al identified males and younger patients as demographics at greater risk in a TL approach cohort. 5 He found that surgical times had a more significant impact on CSF leaks (OR: 1.85). Our findings corroborate prior findings that prolonged surgical time increases the likelihood of CSF leak.…”

“…Our findings corroborate prior findings that prolonged surgical time increases the likelihood of CSF leak. 4,5 While no specific numbers are mentioned in prior papers, we chose the 75th percentile of operative duration for our cutoff point and found that operative time > 8 hours was associated with 1.8 times increased risk of CSF leak.…”

“…19,24 Russel et al postulated that longer operative times result in blood accumulation in the basal cisterns, leading to the problems with CSF absorption potentially contributing to hydrocephalus and CSF leak. 5 They also postulated that surgeon fatigue by the end of the longer case may lead to suboptimal closure techniques. Unlike prior studies, neither BMI, gender, nor age achieved significance in our univariate analysis for CSF leak risk factors.…”

“…[1][2][3] While the majority of reports focus on neurologic outcomes, few analyze non-neurologic morbidity and CSF leak propensity in VS. Those that do usually rely on a single institutional experience. [4][5][6] We reviewed a large multicenter patient sample to analyze potential predictors of non-neurologic morbidity, mortality, return to the operating room, and CSF leak incidence and repair strategies in patients undergoing surgery for VS resection.…”