Case-specific protocol to reduce cerebrospinal fluid leakage after endonasal endoscopic surgery

Kunal S. Patel, Ricardo J. Komotar, Oszkar Szentirmai, Nelson Moussazadeh, Daniel M. Raper, Robert M. Starke, Vijay K. Anand, Theodore H. Schwartz

Research output: Contribution to journalArticle

59 Scopus citations

Abstract

Object . Endoscopic transsphenoidal surgery is expanding in acceptance, yet postoperative CSF leak rates remain a concern. This study presents the Cornell closure protocol, which has yielded significantly lower postoperative CSF leak rates compared with prior reports, as an algorithm that can be used by centers having difficulty with CSF leak. Methods. A single closure algorithm for endoscopic surgery has been used since January 2010 at Weill Cornell Medical College. A prospective database noting intraoperative CSF leak, closure technique, and postoperative CSF leak was reviewed. The authors used a MEDLINE search to identify similar studies and compared CSF leak rates to those of patients treated using the Cornell algorithm. Results. The retrospective study of a prospectively acquired database included 209 consecutive patients. In 84 patients (40%) there was no intraoperative CSF leak and no postoperative CSF leak. In the 125 patients (60%) with an intraoperative CSF leak, 35 of them with high-flow leaks, there were 0 (0%) postoperative CSF leaks. Conclusions. It is possible to achieve a CSF leak rate of 0% by using this closure protocol. With proper experience, endoscopic skull base surgery should not be considered to have a higher CSF leak rate than open transcranial or microscopic transsphenoidal surgery.

Original languageEnglish (US)
Pages (from-to)661-668
Number of pages8
JournalJournal of neurosurgery
Volume119
Issue number3
DOIs
StatePublished - Sep 1 2013

Keywords

  • Cerebrospinal fluid leak repair
  • Endoscopic endonasal approach
  • Endoscopic transsphenoidal surgery
  • Meningitis
  • Outcome
  • Skull base

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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    Patel, K. S., Komotar, R. J., Szentirmai, O., Moussazadeh, N., Raper, D. M., Starke, R. M., Anand, V. K., & Schwartz, T. H. (2013). Case-specific protocol to reduce cerebrospinal fluid leakage after endonasal endoscopic surgery. Journal of neurosurgery, 119(3), 661-668. https://doi.org/10.3171/2013.4.JNS13124