Factors affecting postoperative cerebrospinal fluid leaks after retrosigmoidal craniotomy for vestibular schwannomas

Stieglitz, Lennart; Wrede, Karsten H.; Gharabaghi, Alireza; Gerganov, Venelin M.; Samii, Amir; Samii, M.; Luedemann, Wolf

doi:10.3171/2009.2.jns081380

Cited by 35 publications

(35 citation statements)

References 40 publications

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“…2,3,5,7,9,25,26,28 We found that the CSF leakage rate was higher in older patients, in those with a longer duration of symptoms, those with polycyclic VSs, those with tumors that had an inhomogeneous internal structure, and in cases of severe hydrocephalus. A slower VS growth rate, frequently observed in the elderly patients, could possibly increase the period of exposure to the VS-related elevated protein level, thereby leading to irreversible alterations in CSF circulation and resorption.…”

Section: Predictive Factors For Csf Leaksmentioning

confidence: 65%

Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome

Gerganov

Pirayesh

Nouri

et al. 2011

JNS

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Object The current, generally accepted optimal management for hydrocephalus related to vestibular schwannomas (VSs) is primary tumor removal, with further treatment reserved only for patients who remain symptomatic. Previous studies have shown, however, that this management can lead to an increase in surgery-related complications. In this study, the authors evaluated their experience with the treatment of such patients, with the aim of identifying the following: 1) the parameters correlating to the need for specific hydrocephalus treatment following VS surgery; and 2) patients at risk for developing hydrocephalus-related complications. Methods This was a retrospective study of a 400-patient series. The complication rates and outcomes following primary hydrocephalus treatment versus primary VS removal were compared. Patients undergoing primary tumor removal were further subdivided on the basis of the need for subsequent hydrocephalus treatment. The 3 categories of parameters tested for correlation with the need for such subsequent treatment as well as with heightened risk for developing complications were patient-, tumor-, and hydrocephalus-related. Results Of the entire series, 53 patients presented with hydrocephalus. Forty-eight of 53 patients underwent primary VS surgery, of whom 42 (87.5%) did not require additional hydrocephalus treatment. Of the 6 patients who did require additional hydrocephalus treatment, only 3 ultimately required a VP shunt. Factors correlating to the need of hydrocephalus treatment after VS removal were large tumor size, irregular tumor surface, and severe preoperative hydrocephalus. Patients with a longer symptom duration prior to surgery, those with polycyclic tumors, or with inhomogeneous VS, were at heightened risk for the development of CSF leaks. The general and functional outcome of surgery showed no correlation to the presence of preoperative hydrocephalus. Conclusions Primary tumor removal is the optimum management of disease in patients with VS with associated hydrocephalus; it leads to resolution of the hydrocephalus in the majority of cases, and the outcome is similar to that of patients without hydrocephalus. Certain factors may aid in identifying patients at risk for developing persistent hydrocephalus as well as those at risk for CSF leaks.

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Section: Predictive Factors For Csf Leaksmentioning

confidence: 65%

Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome

Gerganov

Pirayesh

Nouri

et al. 2011

JNS

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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%

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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“…A large mono-institutional experience has recently reported an 11% of incidence of postoperative CSF leaks among those patients in the neurosurgical population who are characterised by a high risk for developing postoperative fistulas. 2 In our experience before using TPD high risk patients (p-fossa surgery, revision surgery, BCNU wafers implant, old patients) presented a CSF leak incidence around 5%. A CSF fistula can actually occur with dural closure at risk.…”

Section: Discussionmentioning

confidence: 97%

Use of a new absorbable sealing film for preventing postoperative cerebrospinal fluid leaks: remarks on a new approach

Puppa¹,

Rossetto²,

Scienza³

2010

British Journal of Neurosurgery

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Cerebrospinal fluid (CSF) leak is an adverse event that can affect the postoperative course of neurosurgical patients. Despite the large intra-operative use effective strategies as well as specific devices, CSF leak post-operative occurrence has been recently reported in up to 11% of cases. TissuePatchDural is a new sealant that is now available in neurosurgery in order to repair dural defects and, consequently, to prevent the postoperative formation of CSF fistulas. The device is a synthetic absorbable film that can actively create a firm temporary connection with the external dural surface and thus favour a satisfactory healing of the wound. The authors report a preliminary experience about the use of such device in 12 selected patients.

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Factors affecting postoperative cerebrospinal fluid leaks after retrosigmoidal craniotomy for vestibular schwannomas

Abstract: Surgery for recurrent tumors is a significant risk factor for the development of CSF leaks.

Cited by 35 publications

References 40 publications

Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome

Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome

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

Use of a new absorbable sealing film for preventing postoperative cerebrospinal fluid leaks: remarks on a new approach

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