Risk factors associated with CSF leakage and complications after retrosigmoid surgery

Abstract

© 2020 The Author(s) Objective: Cerebrospinal fluid (CSF) leakage is a common complication of retrosigmoid surgery that may cause dehiscence of the surgical wound or infection. We sought to identify risk factors associated with CSF leakage and accompanying complications. Methods: Charts from patients who underwent a retrosigmoid approach surgery at Ramathibodi Hospital between 2007 and 2019 were retrospectively reviewed. Data from patients who did and did not have CSF leakage were compared to define the patient characteristics, factors related to CSF leakage, types of leakage, and complications encountered after CSF leakage. Multiple logistic regression analyses were conducted to determine the variable factors associated with CSF leakage and accompanying complications. Results: CSF leakage occurred in 40 of 286 patients (14%). The risk factors associated with CSF leakage were age and body mass index (BMI). Patients with stage I obesity and stage II obesity had a significantly increased risk of CSF leakage. Subgroup analysis revealed that hydrocephalus and radiation were risk factors for pseudomeningocele. Wound dehiscence and CSF wound leakage were associated with pseudomeningocele. All types of CSF leakage, i.e., pseudomeningocele, wound leakage, CSF rhinorrhea, and CSF otorrhea, were risk factors for wound infection and meningitis. Conclusions: Age and BMI were related to CSF leakage. Specifically, younger patients were more likely to have CSF leakage and obese patients had higher CSF leakage rates compared with patients with a normal BMI. Wound infection and meningitis frequently occurred when these complications occurred.