CSF leaks after cranial surgery — a prospective multicenter analysis

Abstract

Background: Cerebrospinal fluid (CSF) leaks are well-known and frequent complications of intracranial procedures. Numerous studies have focused on the clinical aspects of incidence, risk factors, outcome, treatment, and prevention; however, large prospective multicenter studies are missing. The aim of this study was to prospectively analyze the rate of CSF leaks and their causes. Method: A total of 545 patients with a variety of intracranial procedures (elective and trauma) were recruited in a multicenter, prospective, observational study over a 12-month period. Results: In 545 cranial surgeries, we observed a CSF leak rate of 7.7% (n=42) at the time of discharge from the hospital. Significant risk factors for CSF leaks were posterior fossa surgery, opened pneumatized spaces, patients younger than 66 years, size of craniotomies, craniectomies rather than craniotomies, remaining dura defects larger than 1 cm, and wound closure without using muscle sutures, continuous locked, or unlocked sutures. Non-significant risk factors for CSF leaks were revision craniotomies, craniotomies for different pathologies, previous radiotherapy and/or systemic chemotherapy, augmentation of dura sutures with various materials, and wound drains as well as temporary CSF drains. Conclusion: Despite the number of techniques and developments for dural closure, the problem of CSF leaks remains evident and further improvement has to be made.