Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment

Brennan, Jeffrey; Rowed, David W.; Nedzelski, Julian M.; Chen, Joseph M.

doi:10.3171/jns.2001.94.2.0217

Cited by 122 publications

(91 citation statements)

References 22 publications

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“…Overall, our CSF leak rate for all surgical approaches was 10.3% and within range of published rates of 6% to 11%. [7][8][9][10][11][12] We report that CSF leak incidence with preoperative LD placement is not significantly lower than without LD use. Our patient population was unique as most patients had an LD placed prior to surgery compared to those who had not.…”

Section: Discussionmentioning

confidence: 85%

Preoperative Lumbar Drain Use During Acoustic Neuroma Surgery and Effect on CSF Leak Incidence

Crowson

Cunningham

Moses

et al. 2015

Ann Otol Rhinol Laryngol

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Objective: To determine if preoperative lumbar drain (LD) use reduces the incidence of postoperative cerebrospinal fluid (CSF) leak in patients undergoing acoustic neuroma resection. Methods: Retrospective review of 282 patients presenting for acoustic neuroma resection between 2005 and 2014. Results: Two hundred and eighty-two patients had a mean tumor size of 19.1 mm ± 10.2 mm. Twenty-nine (10.3%) patients developed a postoperative CSF leak. Two hundred and twenty patients (78.0%) received a preoperative LD, and 20 (9.1%) developed a CSF leak. Sixty-two (22.0%) patients did not receive a preoperative LD, and 9 (14.5%) developed a CSF leak. No significant difference in CSF leak frequency was observed with use versus no use of a LD (P = .23). Fifteen (5.3%) patients with an LD placed had a complication related to the LD. No significant difference in CSF leak frequency was observed with patient age, neurofibromatosis type-2 diagnosis, tumor size, or sidedness. Conclusions: Postoperative CSF leaks are among the most common complications of acoustic neuroma microsurgery. No formal guidelines exist for elective placement of a preoperative LD to lower the incidence of CSF leaks. Our reported CSF leak incidence with preoperative LD placement is not significantly lower than without LD use, and there is a complication rate associated with LD use.

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Section: Discussionmentioning

confidence: 85%

Preoperative Lumbar Drain Use During Acoustic Neuroma Surgery and Effect on CSF Leak Incidence

Crowson

Cunningham

Moses

et al. 2015

Ann Otol Rhinol Laryngol

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“…Whereas factors such as age, sex, and tumor size did not correlate with the occurrence of a CSF leak in our series, other studies have reported these factors to be significant. 4,5,11,20 These factors, among others, are fixed variables and, therefore, even if believed to influence the likelihood of a postoperative CSF leak, can only be used to counsel patients with regard to their risk of this complication. The fixed nature of these variables prevents either the surgeon or the patient from altering their effect.…”

Section: Discussion Elevated Bmi As a Risk Factor For A Csf Leakmentioning

confidence: 99%

“…This is in keeping with findings reported by others, 19 although some have not experienced any difference between approaches regarding the leak rates. 3,4 Despite this difference in leak rates in our series, however, we still commonly use the TL approach. We also found a significant association between longer operative times and the development of postoperative CSF leaks.…”

Section: Other Risk Factors For a Csf Leakmentioning

confidence: 99%

Are there modifiable risk factors to prevent a cerebrospinal fluid leak following vestibular schwannoma surgery?

Copeland¹,

Mallory²,

Neff

et al. 2015

JNS

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OBJectThe following study was conducted to identify risk factors for a postoperative CSF leak after vestibular schwannoma (VS) surgery. MethODs The authors reviewed a prospectively maintained database of all patients who had undergone resection of a VS at the Mayo Clinic between September 1999 and May 2013. Patients who developed a postoperative CSF leak within 30 days of surgery were compared with those who did not. Data collected included patient age, sex, body mass index (BMI), tumor size, tumor side, history of prior tumor treatment, operative time, surgical approach, and extent of resection. Both univariate and multivariate regression analyses were performed to evaluate all variables as risk factors of a postoperative CSF leak. results A total of 457 patients were included in the study, with 45 patients (9.8%) developing a postoperative CSF leak. A significant association existed between increasing BMI and a CSF leak, with those classified as overweight (BMI 25-29.9), obese (BMI 30-39.9), or morbidly obese (BMI ≥ 40) having a 2.5-, 3-, and 6-fold increased risk, respectively. Patients undergoing a translabyrinthine (TL) approach experienced a higher rate of CSF leaks (OR 2.5, 95% CI 1.3-4.6; p = 0.005), as did those who had longer operative times (OR 1.04, 95% CI 1.02-1.07; p = 0.0006). The BMI, a TL approach, and operative time remained independent risk factors on multivariate modeling. cONclusiONs Elevated BMI is a risk factor for the development of a postoperative CSF leak following VS surgery. Recognizing this preoperatively can allow surgeons to better counsel patients regarding the risks of surgery as well as perhaps to alter perioperative management in an attempt to decrease the likelihood of a leak. Patients undergoing a TL approach or having longer operative times are also at increased risk of developing a postoperative CSF leak.http://thejns.org/doi/abs/10.3171/2014.10.JNS14432 Key WOrDs cerebrospinal fluid leak; vestibular schwannoma; acoustic neuroma; predictors; risk factors; oncology aBBreviatiONs BMI = body mass index; ICP = intracranial pressure; MF = middle fossa; RS = retrosigmoid; TL = translabyrinthine; VS = vestibular schwannoma.

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“…These findings are consistent with a large body of experience describing CSF leak rates following infratentorial procedures of 8%-17%. 5,9,10,16 Infratentorial surgery predisposes a patient to CSF leak because the hydrostatic pressure of the fluid column places additional stress upon the suture line. The association between prolonged postoperative steroid duration and CSF leak likely comes from the immunosuppressive properties of corticosteroids that can interfere with normal wound healing.…”

Section: Discussionmentioning

confidence: 99%

The incidence of complications in elective cranial neurosurgery associated with dural closure material

Walcott

Neal

Sheth

et al. 2014

JNS

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Object. Dural closure with synthetic grafts has been suggested to contribute to the incidence of infection and CSF leak. The objective of this study was to assess the contribution of choice of dural closure material, as well as other factors, to the incidence of infection and CSF leak.Methods. A retrospective, consecutive cohort study of adult patients undergoing elective craniotomy was established between April 2010 and March 2011 at a single center. Exclusion criteria consisted of trauma, bur hole placement alone, and temporary CSF fluid diversion.Results. Three hundred ninety-nine patients were included (mean follow-up 396.6 days). Nonautologous (synthetic) dural substitute was more likely to be used (n = 106) in cases of reoperation (p = 0.001). Seventeen patients developed a surgical site infection and 12 patients developed a CSF leak. Multivariate logistic regression modeling identified estimated blood loss (OR 1.002, 95% CI 1.001-1.003; p < 0.001) and cigarette smoking (OR 2.198, 95% CI 1.109-4.238; p = 0.019) as significant predictors of infection. Synthetic dural graft was not a predictor of infection in multivariate analysis. Infratentorial surgery (OR 4.348, 95% CI 1.234-16.722; p = 0.024) and more than 8 days of postoperative corticosteroid treatment (OR 3.886, 95% CI 1.052-16.607; p = 0.048) were significant predictors for the development of CSF leak. Synthetic dural graft was associated with a lower likelihood of CSF leak (OR 0.072, 95% CI 0.003-0.552; p = 0.036).Conclusions. The use of synthetic dural closure material is not associated with surgical site infection and is associated with a reduced incidence of CSF leak. Modifiable risk factors exist for craniotomy complications that warrant vigilance and further study. (http://thejns.org/doi/abs/10.3171/2013.8.JNS13703) Key WorDS • dura • pericranium • infection • complication • cerebrospinal fluid • craniotomy • surgical techniqueAbbreviations used in this paper: ASA = American Society of Anesthesiologists; BMI = body mass index; EBL = estimated blood loss; ECoG = electrocorticography; ICU = intensive care unit.

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Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment

Cited by 122 publications

References 22 publications

Preoperative Lumbar Drain Use During Acoustic Neuroma Surgery and Effect on CSF Leak Incidence

Preoperative Lumbar Drain Use During Acoustic Neuroma Surgery and Effect on CSF Leak Incidence

Are there modifiable risk factors to prevent a cerebrospinal fluid leak following vestibular schwannoma surgery?

The incidence of complications in elective cranial neurosurgery associated with dural closure material

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