TY - JOUR
T1 - Risk Factors and Management of Incisional Cerebrospinal Fluid Leakage after Craniotomy
T2 - A Retrospective International Multicenter Study
AU - Kinaci, Ahmet
AU - Slot, Emma M.H.
AU - Kollen, Mare
AU - Germans, Menno R.
AU - Amin-Hanjani, Sepideh
AU - Carlson, Andrew P.
AU - Majeed, Kashif
AU - Depauw, Paul R.A.M.
AU - Robe, Pierre A.
AU - Regli, Luca
AU - Charbel, Fady T.
AU - van Doormaal, Tristan P.C.
N1 - Funding Information:
This study did not receive any funding or financial support. Paul R. A. M. Depauw reports funding from NIH.
Funding Information:
Andrew P. Carlson and Luca Regli report financial relationships with Polyganics (funds to institution). Ahmet Kinaci's PhD position was funded by Polyganics B.V., the Netherlands. Emma M.H. Slot's PhD position was funded by Polyganics B.V., the Netherlands. Tristan van Doormaal did consultancy work for Polyganics B.V. at the time of this research. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Publisher Copyright:
© Congress of Neurological Surgeons 2023. All rights reserved.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - BACKGROUND: Incisional cerebrospinal fluid (iCSF) leakage is a serious complication after intradural cranial surgery. OBJECTIVE: To determine the incidence and risk factors of iCSF leakage after craniotomy. Secondarily, the complications after iCSF leakage and the success rate of iCSF leakage treatment was studied. METHODS: All patients who underwent an intradural cranial surgery from 2017 to 2018 at 5 neurosurgical centers were retrospectively included. Data were retrieved from medical records with 2 months of follow-up. First, univariate regression analyses were performed. Subsequently, identified risk factors were evaluated in a multivariate regression analysis. RESULTS: In total 2310 consecutive patients were included. Total iCSF leakage rate was 7.1% (n = 165). Younger age, male, higher body mass index, smoking, infratentorial surgery, and use of a dural substitute were associated with increased iCSF leakage risk, and use of a sealant reduced that risk. The odds for developing a wound infection and/or meningitis were 15 times higher in patients with iCSF leakage compared with patients without leakage. Initial conservative iCSF leakage treatment failed in 48% of patients. In 80% of cases, external cerebrospinal fluid drainage ceased the iCSF leakage. A total of 32% of patients with iCSF leakage required wound revision surgery. CONCLUSION: iCSF leakage risk increases by younger age, higher body mass index, smoking, infratentorial craniotomy, and dural substitute use, whereas sealant use reduced the risk for iCSF leakage. The leak increases the risk of postoperative infections. When iCSF leakage occurs, immediate external cerebrospinal fluid drainage or wound revision should be considered.
AB - BACKGROUND: Incisional cerebrospinal fluid (iCSF) leakage is a serious complication after intradural cranial surgery. OBJECTIVE: To determine the incidence and risk factors of iCSF leakage after craniotomy. Secondarily, the complications after iCSF leakage and the success rate of iCSF leakage treatment was studied. METHODS: All patients who underwent an intradural cranial surgery from 2017 to 2018 at 5 neurosurgical centers were retrospectively included. Data were retrieved from medical records with 2 months of follow-up. First, univariate regression analyses were performed. Subsequently, identified risk factors were evaluated in a multivariate regression analysis. RESULTS: In total 2310 consecutive patients were included. Total iCSF leakage rate was 7.1% (n = 165). Younger age, male, higher body mass index, smoking, infratentorial surgery, and use of a dural substitute were associated with increased iCSF leakage risk, and use of a sealant reduced that risk. The odds for developing a wound infection and/or meningitis were 15 times higher in patients with iCSF leakage compared with patients without leakage. Initial conservative iCSF leakage treatment failed in 48% of patients. In 80% of cases, external cerebrospinal fluid drainage ceased the iCSF leakage. A total of 32% of patients with iCSF leakage required wound revision surgery. CONCLUSION: iCSF leakage risk increases by younger age, higher body mass index, smoking, infratentorial craniotomy, and dural substitute use, whereas sealant use reduced the risk for iCSF leakage. The leak increases the risk of postoperative infections. When iCSF leakage occurs, immediate external cerebrospinal fluid drainage or wound revision should be considered.
KW - Cerebrospinal fluid leakage
KW - Complication
KW - Craniectomy
KW - Craniotomy
KW - Dura
UR - http://www.scopus.com/inward/record.url?scp=85159737669&partnerID=8YFLogxK
U2 - 10.1227/neu.0000000000002345
DO - 10.1227/neu.0000000000002345
M3 - Article
C2 - 36688661
AN - SCOPUS:85159737669
SN - 0148-396X
VL - 92
SP - 1177
EP - 1182
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -