CSF leaks after cranial surgery — a prospective multicenter analysis

Kehler, Uwe; Hirdes, C.; Weber, Clemens; Spuck, Sebastian; Tronnier, V.; Kundt, Guenther

doi:10.1515/ins-2012-0002

Cited by 15 publications

(16 citation statements)

References 14 publications

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“…Inadequate dura closure as well as increased CSF pressure can contribute to CSF leaks, and postoperative radiation and chemotherapy may also play a role by preventing adequate dural regrowth ( 32 , 33 ). In this study, 9.9% (72 out of 726) of patients had a CSF leak, consistent with previous reports ( 30 , 31 , 34 ). 31.9% of these patients developed CH, and CSF leak was identified as another independent risk factor for CH with an OR of 2.3.…”

Section: Discussionsupporting

confidence: 93%

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Postoperative communicating hydrocephalus following glioblastoma resection: Incidence, timing and risk factors

et al. 2022

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IntroductionGlioblastoma (GBM) is the most common malignant primary brain tumor. Treatment includes maximally safe surgical resection followed by radiation and/or chemotherapy. However, resection can lead to ventricular opening, potentially increasing the risk for development of communicating hydrocephalus (CH). Complications such as rebleeding and infection may also lead to CH and, eventually, the need for cerebrospinal fluid (CSF) diversion surgery. In this study, we evaluated the incidence of different types of hydrocephalus and potential risk factors for the development of CH following glioblastoma resection.Methods726 GBM patients who underwent tumor resection at our department between 2006 and 2019 were analyzed retrospectively. Potential risk factors that were determined for each patient were age, sex, tumor location, the number of resection surgeries, ventricular opening during resection, postoperative CSF leak, ventriculitis, and rebleeding. Uni- as well as multivariate analyses were performed to identify associations with CH and independent risk factors.Results55 patients (7.6%) needed CSF diversion surgery (implantation of a ventriculoperitoneal or ventriculoatrial shunt) following resection surgery. 47 patients (6.5%) had CH, on median, 24 days after the last resection (interquartile range: 17-52 days). 3 patients had obstructive hydrocephalus (OH) and 5 patients had other CSF circulation disorders. Ventricular opening (odds ratio (OR): 7.9; p=0.000807), ventriculitis (OR 3.3; p=0.000754), and CSF leak (OR 2.3; p=0.028938) were identified as significant independent risk factors for the development of post-resection CH. Having more than one resection surgery was associated with CH as well (OR 2.1; p=0.0128), and frontal tumors were more likely to develop CH (OR 2.4; p=0.00275), while temporal tumors were less likely (OR 0.41; p=0.0158); However, none of those were independent risk factors. Age, sex, or rebleeding were not associated with postoperative CH.ConclusionPostoperative CH requiring CSF shunting is not infrequent following GBM resection and is influenced by surgery-related factors. It typically occurs several weeks after resection. If multiple risk factors are present, one should discuss the possibility of postoperative CH with the patient and maybe even consider pre-emptive shunt implantation to avoid interruption of adjuvant tumor therapy. The incidence of CH requiring shunting in GBM patients could rise in the future.

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Section: Discussionsupporting

confidence: 93%

“…Postoperative CSF leak is a well-known and frequent complication after cranial surgery with a prevalence of 3-11% ( 30 , 31 ). Inadequate dura closure as well as increased CSF pressure can contribute to CSF leaks, and postoperative radiation and chemotherapy may also play a role by preventing adequate dural regrowth ( 32 , 33 ).…”

Section: Discussionmentioning

confidence: 99%

Postoperative communicating hydrocephalus following glioblastoma resection: Incidence, timing and risk factors

et al. 2022

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“…The CSF leak is very difficult to be avoided after craniectomy with dura mater plasty. In a prospective multicenter analysis study, the frequency of CSF leak is 7.7% [45]. Most of them respond to external lumbar drainage from 48 hours up to 10 days and only 2% require surgery.…”

Section: Discussionmentioning

confidence: 99%

“…After the CSF leak subsides, is recommended to keep the drainage another 3 to 5 days in order to provide time for the fistula to heal [46]. Craniotomy, CSF leak and the effusion found in the frontal sinus during surgery are risk factors for meningitis [45,47].…”

Section: Discussionmentioning

confidence: 99%

Invasive basosquamous cell carcinoma of the head treated with wide excision and reconstruction with fascia lata graft and two muscle flaps. Case report

Chelmuș¹,

Dobreanu²,

Tripa³

et al. 2015

Arch Clin Cases

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Background: Basosquamous carcinoma (BSC) is a variant of basal cell carcinoma subtype that is locally aggressive with high tendency for recurrence and metastasis and a poor prognosis. Up to 95% are located in head and neck area. Treatment for invasive BSC with aggressive growth pattern is wide excision and reconstruction. Complex defects require free tissue transfer to protect underlying structures and to sustain the adjuvant radiotherapy.Case report: A 57 year-old male presented with ulcerated, bleeding tumors in frontal and periauricular area, identified as BSC on biopsy. CT-scan revealed contact to dura mater. Wide excision included frontal bone and dura mater, frontal sinus, lateral orbital wall and exenteration, ear en-bloc with parotid gland. Dura mater was replaced with fascia lata graft, frontal sinus was filled with pedicled temporalis muscle and 20/25 cm soft tissue defect was covered with free Latissimus dorsi muscle anastomosed to superior thyroid artery and internal jugular vein branch, respectively. The muscle was skin grafted 14 days later.Results: Postoperative recovery was complicated: cerebrospinal fluid leak, extradural hematoma, posthemorrhagic anemia, pneumonia, and withdrawal syndrome, remitted under specific treatment. Muscle flap survived entirely with skin graft fully integrated. Positive margins on dura mater and mastoid bone required radiotherapy.Conclusions: Wide excision of head invasive BSC resulted in complex defect reconstructed with fascia lata graft, temporalis muscle and Latissimus dorsi free flap grafted secondarily. Short-term evaluation showed no recurrence and good life-quality; follow-up is needed to evaluate long-term results. Interdisciplinary approach is the key for patient's successful treatment.

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“…кори мозку і витіканню ліквору [2]. Частота виникнення ліквореї після краніотомії становить 7-10 % [3][4][5]. Вважають, що герметичне закрит тя ТМО асоціюється зі зниженням частоти ліквореї і меншою кількістю локальних інфекційних ускладнень [6,7].…”

Section: теоретическое обоснование эффективности применения биополимеunclassified

Theoretical substantiation of the efficiency of biopolymers application in experimental TBI (literature review and own results)

et al. 2019

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CSF leaks after cranial surgery — a prospective multicenter analysis

Cited by 15 publications

References 14 publications

Postoperative communicating hydrocephalus following glioblastoma resection: Incidence, timing and risk factors

Postoperative communicating hydrocephalus following glioblastoma resection: Incidence, timing and risk factors

Invasive basosquamous cell carcinoma of the head treated with wide excision and reconstruction with fascia lata graft and two muscle flaps. Case report

Theoretical substantiation of the efficiency of biopolymers application in experimental TBI (literature review and own results)

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