Abstract
Background There is little data regarding postoperative outcomes of patients with obstructive
sleep apnea (OSA) undergoing skull base surgery. The purpose of this study is to determine
an association between risk factors and proximity of cerebrospinal fluid (CSF) leak
to surgery in patients with OSA undergoing endoscopic skull base surgery.
Methods A retrospective review of neurosurgical inpatients, with and without OSA, at a tertiary
care institution from 2002 to 2015 that experienced a postoperative CSF leak after
undergoing endoscopic skull base surgery.
Results Forty patients met inclusion criteria, 12 (30%) with OSA. OSA patients had significantly
higher body mass index (BMI; median 39.4 vs. 31.7, p < 0.01) and were more likely to have diabetes (41.7 vs. 10.7%, p = 0.04) than non-OSA patients; otherwise there were no significant differences in
clinical comorbidities. No patients restarted positive pressure ventilation (PPV)
in the inpatient setting. The type of repair was not a significant predictor of the
time from surgery to leak. Patients with OSA experienced postoperative CSF leak 49%
sooner than non-OSA patients (Hazard Ratio 1.49, median 2 vs. 6 days, log-rank p = 0.20).
Conclusion Patients with OSA trended toward leaking earlier than those without OSA, and no OSA
patients repaired with a nasoseptal flap (NSF) had a leak after postoperative day
5. Due to a small sample size this trend did not reach significance. Future studies
will help to determine the appropriate timing for restarting PPV in this high risk
population. This is important given PPV's significant benefit to the patient's overall
health and its ability to lower intracranial pressure.
Keywords
cerebrospinal fluid leak - obstructive sleep apnea - endoscopic skull base surgery
- obesity
