Interdisciplinary Neurosurgery (Mar 2023)
Predictors of cerebrospinal fluid leakage after elective cranial surgery
Abstract
Background: Cerebrospinal fluid (CSF) leaks are well-known and frequent complications of intracranial procedures. Numerous studies have focused on the clinical aspects of incidence, risk factors, outcome, treatment, and prevention; however, large prospective multicentre studies are missing. Dural closure seems a critical step in neurosurgical procedures to avoid CSF leakage. “Watertight” dural closure is an important adage within neurosurgery, although this is subject to debate. This study aimed to prospectively analyze the rate of CSF leaks and associated factors. Objective: To describe the frequency of postoperative CSF leak and associated factors after elective cranial procedures. Methodology: Institution-based observational cohort study was conducted from September 1, 2020, to August 2021. Patients were followed for the development of CSF leaks. Data was collected using a pretested structured questionnaire. Bivariate and multivariate correlation analysis was performed to identify associated variables. A p-value < 0.05 was considered significant. Result: A total of 289 patients were included in the study. The mean age of the study population was 36.36 ± 15.47 and 54.7 % were females. The incidence of postoperative CSF leaks was 12.8 %. Hydrocephalus, non-watertight dural closure, and degree of intraoperative blood loss were strongly associated with postoperative CSF leak (p < 0.05). Preoperative hydrocephalus treatment was a negative predictor of leaks (OR = 0.06). Patients with CSF leaks have a higher risk of developing postoperative infection (OR = 25.54) and prolonged hospital stay (OR = 2.63). Conclusion: The rate of CSF leaks in our study was (12.8%). Though this is similar to the finding in most studies, it is still high and needs additional solutions to decrease this bothersome complication. We found that watertight dural closure must be achieved whenever possible either primarily or using dural patch material. Preoperative treatment of hydrocephalus significantly decreases postoperative CSF leak. CSF leak increases the risk of postoperative infection and length of hospital stay.
