Risk factors for postoperative CSF leakage after endonasal endoscopic skull base surgery: a meta-analysis and systematic review

被引:25
作者
Kim, Jong Seung [1 ,2 ,3 ]
Hong, Sang Duk [4 ]
机构
[1] Jeonbuk Natl Univ, Dept Med Informat, Coll Med, Jeonju, South Korea
[2] Jeonbuk Natl Univ, Dept Otorhinolaryngol Head & Neck Surg, Coll Med, Jeonju, South Korea
[3] Jeonbuk Natl Univ, Res Inst Clin Med, Biomed Res Inst, Jeonbuk Natl Univ Hosp, Jeonju, South Korea
[4] Sungkyunkwan Univ, Dept Otorhinolaryngol Head & Neck Surg, Samsusng Med Ctr, Sch Med, 81 Irwon Ro, Seoul 06351, South Korea
关键词
cerebrospinal fluid leakage; skull base; obese; radiotherapy; vascularized flap; CEREBROSPINAL-FLUID LEAK; PEDICLED NASOSEPTAL FLAP; NASAL SEPTAL FLAP; TRANSSPHENOIDAL SURGERY; RETROSPECTIVE ANALYSIS; SELLAR RECONSTRUCTION; REPAIR; GRAFT; OUTCOMES; SERIES;
D O I
10.4193/Rhin20.145
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Background: Cerebrospinal fluid (CSF) leakage is a complication that any surgeon working in the field of skull base surgery does not wish to encounter. The surgical approach to the skull base often varies, and the various sizes and locations of skull base lesions make it difficult to determine the cause of CSF leakage. However, it is useful to investigate which factors contribute to postoperative CSF leakage. Methods: Related studies were identified by searching the following databases: PubMed/Medline, Embase, and Web of Sciences through December 2019. Random-effects models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). The Newcastle-Ottawa scale was used to evaluate the quality of observational studies. Results: Our search yielded 56 retrospective cohort studies involving a total of 11,826 skull base surgical procedures. The overall rate of postoperative CSF leakage was 7.2%. The effect of obesity on postoperative CSF leakage had an OR of 1.88, and the effect of perioperative radiotherapy on postoperative CSF leakage yielded an OR of 1.87. High intraoperative CSF flow rate also had a significant OR of 2.98. On the other hand, a pedicled vascularized flap efficiently reduced the risk of postoperative CSF leakage. Defect size and the presence or absence of a lumbar drain had no effect on postoperative CSF leakage. Conclusions: This comprehensive quantitative assessment of postoperative CSF leakage showed that obesity, perioperative radiotherapy, and high intraoperative CSF flow rate raised the risk of CSF leakage; however, a pedicled vascularized flap can effectively reduce the risk of postoperative CSF leakage.
引用
收藏
页码:10 / 19
页数:10
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