CSF Leak, Ce N’est Pas Chic! A 14-Year Local CSF Leak Repair Experience and National Pituitary Data for 3,013 Cases

Objectives:

Part 1:

Via a francophonic titular nod to New Orleans, we present an entire experience of high- and low-flow CSF leak repairs across adult and pediatric populations in a single institution.

Part 2:

We also present pituitary surgery data for all of England including CSF leak.

Background: Cerebrospinal fluid (CSF) leak is an important condition secondary to fistulation of the subarachnoid space with the sinonasal cavities that carries high morbidity if left untreated. Causes can be spontaneous or acquired, typically following endonasal surgery or trauma. Acquired leaks are further subcategorized into low-flow (pituitary, olfactory neuroblastoma, traumatic fractures, or meningocele) or high-flow (after resection of meningioma, chordoma, or craniopharyngioma). While local experiences are important, comparison with peer operators across the country is important, especially in low volume, technical procedures such as pituitary surgery.

Methods: Local data were collected prospectively since the start of the endonasal technique in our institution. Data were also obtained from the National Hospital Episode Statistics (HES) from NHS England, for pituitary surgery in all centers in England.

Results:

Part 1:

A total of 750 skull base procedures were performed locally between 2009 and 2023 with 287 CSF leaks requiring repair. All repairs involved nasoseptal flap harvest and single-dose antibiotic administration. Repair success rate was 92% (264/287). Low-flow CSF leak repair success rate was 97.2% (174/179) and high-flow repair success rate was 83.4% (90/108).

A total of 464 endonasal pituitary procedures were performed between 2009 and 2023 with an intraoperative CSF leak of 21.6% (100/464). Repair success rate was 97% with 2 occult CSF leaks from skull base not appreciated at initial surgery, requiring subsequent repair. Postoperative CSF leak rate was 1% (5/464) and failure repair rate of known intraoperative CSF leak was 3% (3/100).

Thirty-two meningiomas were resected with intraoperative CSF leak rate of 78% (25/32) and 12% required return to theatre for CSF leak repair. Forty-two craniopharyngiomas were resected with intraoperative CSF leak of 83% (35/42) and 14% requiring postoperative repair (5/35). Twenty-one chordomas were operated with 52% (11/21) intraoperative CSF leak and 27% (3/11) requiring postoperative repair. Eighteen Rathke’s cleft cysts were operated, intraoperative CSF leak 78% (14/18) with 7% (1/14) postoperative repair incidence. Eight meningoencephaloceles were operated with 0% postoperative repair and, 10 olfactory neuroblastoma with 70% (7/10) intraoperative CSF leak, and 0% postoperative repair rate.

Part 2:

In England, data were collected over 3 years (2021–2024) and 3,013 pituitary procedures were performed nationally, of which 126 were locally performed. Emergency procedures represented 8.3% across England and 4% locally. Incidence of intraoperative CSF leak was 15.4%, compared with 4% locally over the same interval. Postoperative CSF leak rate was 2.2 and 1.6% locally. Length of stay > 3 days was 57.1% across England and 17.5% locally, with readmission for sodium abnormalities 3.3 and 5.7%, respectively.

Conclusion: We present a large local experience of CSF leak repair for high- and low-flow leaks since inception of the endoscopic technique in our institution. We also present data representative of all English centers for pituitary surgery with comparison to local data.

Publikationsverlauf

Artikel online veröffentlicht:
07. Februar 2025