Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery

Tom T. Karnezis, Andrew B. Baker, Zachary M. Soler, Sarah K. Wise, Shruthi K. Rereddy, Zara M. Patel, Nelson M. Oyesiku, John M. DelGaudio, Constantinos G. Hadjipanayis, Bradford A. Woodworth, Kristen O. Riley, John Lee, Michael D. Cusimano, Satish Govindaraj, Alkis Psaltis, Peter John Wormald, Steve Santoreneos, Raj Sindwani, Samuel Trosman, Janalee K. StokkenTroy D. Woodard, Pablo F. Recinos, W. Alexander Vandergrift, Rodney J. Schlosser

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


Background: In patients undergoing transnasal endoscopic sellar surgery, an analysis of risk factors and predictors of intraoperative and postoperative cerebrospinal fluid leak (CSF) would provide important prognostic information. Methods: A retrospective review of patients undergoing endoscopic sellar surgery for pituitary adenomas or craniopharyngiomas between 2002 and 2014 at 7 international centers was performed. Demographic, comorbidity, and tumor characteristics were evaluated to determine the associations between intraoperative and postoperative CSF leaks. Correlations between reconstructive and CSF diversion techniques were associated with postoperative CSF leak rates. Odds ratios (OR) were identified using a multivariate logistic regression model. Results: Data were collected on 1108 pituitary adenomas and 53 craniopharyngiomas. Overall, 30.1% of patients had an intraoperative leak and 5.9% had a postoperative leak. Preoperative factors associated with increased intraoperative leaks were mild liver disease, craniopharyngioma, and extension into the anterior cranial fossa. In patients with intraoperative CSF leaks, postoperative leaks occurred in 10.3%, with a higher postoperative leak rate in craniopharyngiomas (20.8% vs 5.1% in pituitary adenomas). Once an intraoperative leak occurred, craniopharyngioma (OR = 4.255, p = 0.010) and higher body mass index (BMI) predicted postoperative leak (OR = 1.055, p = 0.010). In patients with an intraoperative leak, the use of septal flaps reduced the occurrence of postoperative leak (OR = 0.431, p = 0.027). Rigid reconstruction and CSF diversion techniques did not impact postoperative leak rates. Conclusion: Intraoperative CSF leaks can occur during endoscopic sellar surgery, especially in larger tumors or craniopharyngiomas. Once an intraoperative leak occurs, risk factors for postoperative leaks include craniopharyngiomas and higher BMI. Use of septal flaps decreases this risk.

Original languageEnglish
Pages (from-to)1117-1125
Number of pages9
JournalInternational Forum of Allergy and Rhinology
Issue number11
StatePublished - 1 Nov 2016


  • craniopharyngioma
  • intraoperative leak
  • pituitary tumor
  • postoperative leak
  • skull base reconstruction


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