Exploration of the causes of cerebrospinal fluid leakage after endoscopic endonasal surgery for sellar and suprasellar lesions and analysis of risk factors

Abstract

ObjectivePostoperative cerebrospinal fluid (CSF) leakage following endoscopic endonasal surgery (EES) is a frequent complication. This study aims to identify potential risk factors of postoperative CSF leakage.MethodsA retrospective review of 360 patients who underwent EES was included. The associations between postoperative CSF leakage and patient demographics, medical history, tumor characteristics, and intraoperative repair techniques were analyzed; the diagnosis and repair of postoperative CSF leakage were also introduced.ResultsPostoperative CSF leakage occurred in 14 patients (3.9%), 2 of them cured by lumbar cistern drainage, 12 underwent endoscopic repair. Among these 12 cases, 3 were repaired twice, and the rest were cured the first time. During the repair surgery, insufficient embedded fat was detected in one case detected, seven with breached inner artificial dura, three had vascularized pedicle nasoseptal flap (VP-NSF) displacement, two with VP-NSF perforation, two with VP-NSF inactivation, and one with imperfect adherence to VP-NSF to the skull base. Eight cases had intracranial infections. Excluding one case who died of severe intracranial infection, the rest were cured and discharged without obvious sequelae. Multivariate analysis revealed that the suprasellar lesion, subarachnoid invasion, and intraoperative grade 3 flow CSF leakage were the risk factors of CSF leakage after operation, while the bone flap was a protective factor.ConclusionBone flap combined with VP-NSF and iodoform gauze for skull base reconstruction is recommended in high-risk patients, while postoperative lumbar cistern drain remains dispensable.

Application of lumbar drainage based on flow control in patients with intracranial infection after craniocerebral surgery

“…On the basis of previous research, the observation group of this article implemented nursing care based on flow control theory for patients with intracranial infection after cerebral hemorrhage surgery. By adjusting the height of the drainage bag at any time to control the drainage flow rate, it was controlled at 10-15ml per hour [9] . There was no significant difference in average drainage speed, drainage time, and total drainage flow rate.Compared with the conventional drainage mode, the fluctuation of drainage speed was small, ensuring a slow and uniform flow rate, and avoiding the formation of a large pressure gradient due to excessive drainage flow rate per unit time, Therefore, the incidence of complications was lower, which is consistent with the research results of scholars such as Zhou Xiaoxiao [10][11][12] .…”

Reducing CSF complications by a recycled Hadad’s flap combined with autologous mucosa in secondary endoscope transsphenoidal surgery

“…In the past, the rate of postoperative CSF complications was >20% until the introduction of the Hadad-Bassagasteguy flap (HBF) for expanded EEA (1). Currently, it has dramatically decreased to only <5% (2)(3)(4)(5)(6), which is comparable with that of the traditional transcranial approach (7). However, along with the ubiquitous utilization of expanded EEA worldwide, for some selected but not rare patients, CSF complications are still a huge challenge.…”