Ultra-Early CT Scan (within 12 Hours) versus Early CT Scan (after 12–24 Hours) to Predict CSF Leak in Postendoscopic Skull Base Surgery

Background: CSF leak remains the primary concern of endoscopic skull base surgery. Pneumocephalus grade and location, displacement of fat or flap, and solid reconstruction seen in postoperative images have been linked to CSF leak in some reports; however, few studies have looked over the extent which indicates CSF leak. In the current study, we aim to compare the ultra early CT scan (within 12 hours) to early CT scan (after 12–24 hours) for prediction of CSF leak post endoscopic skull base surgery.

Methods: A retrospective study included patients undergoing endoscopic skull base surgery in five years. All patients underwent brain CT scan within the first 24 postoperative hours. CT scans were reviewed by a neurosurgeon and a radiologist and have been classified based on grade and location of pneumocephalus, displacement of fat, displacement of flap, or solid reconstruction. Patients were followed up in the postoperative period for clinical signs of CSF leak and managed accordingly.

Results: Out of 86 patients, 73 patients met the inclusion criteria. Eleven of 73 patients developed CSF leaks. The most common pathology in patients who had CSF leak was meningioma (3 patients out of 11) followed by craniopharyngioma and Pituitary adenoma (2 patients for each pathology). Of the 11 patients, 6 underwent a CT scan in the first 12 hours (45%) and 6 underwent a CT scan after 12 to 24 hours (55%). Three out of five patients in the ultra-early group and 3 out of 6 patients in the early group were grade 4 pneumocephalus and overall there was no significant difference in pneumocephalus grade between the two groups (p = 0.879). All patients in the ultra-early group (100%) had pneumocephalus located in multiple areas, in the early group (50%) had pneumocephalus located in multiple areas and convexity was the most common location of pneumocephalus for both groups. There is no difference between the two groups regarding displaced fat, flap, and solid reconstruction. All the patients in the ultra-early group underwent surgical repair, and four out of six patients in the early group underwent surgical repair.

Conclusion: There is no difference between ultra early CT (within 12 hours) and early CT (after 12–24 hours) as both yielded the same findings. Ultra early CT can help in making the decision of exploration and repair faster.

Publication History

Article published online:
07 February 2025