Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
J Neurosurg. 2012 Jun;116(6):1311-7. doi: 10.3171/2012.2.JNS111837. Epub 2012 Mar 23.
Postoperative CSF leakage can be a serious complication after a transsphenoidal surgical approach. An elevated body mass index (BMI) is a significant risk factor for spontaneous CSF leaks. However, there is no evidence correlating BMI with postoperative CSF leak after transsphenoidal surgery. The authors hypothesized that patients with elevated BMI would have a higher incidence of CSF leakage complications following transsphenoidal surgery.
The authors conducted a retrospective review of 121 patients who, between August 2005 and March 2010, underwent endoscopic endonasal transsphenoidal surgeries for resection of primarily sellar masses. Patients requiring extended transsphenoidal approaches were excluded. A multivariate statistical analysis was performed to investigate the association of BMI and other risk factors with postoperative CSF leakage.
In 92 patients, 96 endonasal endoscopic transsphenoidal surgeries were performed that met inclusion criteria. Thirteen postoperative leaks occurred and required subsequent treatment, including lumbar drainage and/or reoperation. The average BMI of patients with a postoperative CSF leak was significantly greater than that in patients with no postoperative CSF leak (39.2 vs 32.9 kg/m(2), p = 0.006). Multivariate analyses indicate that for every 5-kg/m(2) increase in BMI, patients undergoing a transsphenoidal approach for a primarily sellar mass have 1.61 times the odds (95% CI 1.10-2.29, p = 0.016, by multivariate logistic regression) of having a postoperative CSF leak.
Elevated BMI is an independent predictor of postoperative CSF leak after an endonasal endoscopic transsphenoidal approach. The authors recommend that patients with BMI greater than 30 kg/m(2) have meticulous sellar reconstruction at surgery and close monitoring postoperatively.
经蝶窦手术（transsphenoidal surgical approach）后，脑脊液漏（CSF leakage）可能是一种严重的并发症。身体质量指数（BMI）升高是自发性脑脊液漏的一个重要危险因素。然而，目前尚无证据表明 BMI 与经蝶窦手术后的脑脊液漏之间存在相关性。作者假设，BMI 升高的患者在接受经蝶窦手术后发生脑脊液漏并发症的几率更高。
作者对 2005 年 8 月至 2010 年 3 月间因主要鞍内肿块而行内镜经鼻蝶窦手术的 121 例患者进行了回顾性研究。排除了需要扩展经蝶窦入路的患者。采用多变量统计分析方法来研究 BMI 及其他危险因素与术后脑脊液漏之间的关系。
在符合纳入标准的 92 例患者中，共进行了 96 例经鼻内镜下经蝶窦手术。术后发生 13 例漏液，需要进一步治疗，包括腰椎引流和/或再次手术。术后发生脑脊液漏的患者平均 BMI 明显高于未发生脑脊液漏的患者（39.2kg/m2 与 32.9kg/m2，p=0.006）。多变量分析表明，BMI 每增加 5-kg/m2，行经蝶窦手术切除主要鞍内肿块的患者发生术后脑脊液漏的几率增加 1.61 倍（95%CI，1.10-2.29，p=0.016，多变量逻辑回归）。
BMI 升高是内镜经鼻蝶窦入路术后发生脑脊液漏的独立预测因素。作者建议 BMI 大于 30kg/m2 的患者在手术时进行细致的鞍底重建，并在术后密切监测。
