Sun Ira, Lim Jia Xu, Goh Chun Peng, Low Shiong Wen, Kirollos Ramez W, Tan Chuen Seng, Lwin Sein, Yeo Tseng Tsai
Division of Neurosurgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore.
Division of Neurosurgery, Department of General Surgery, National University Hospital, Singapore.
Singapore Med J. 2018 May;59(5):257-263. doi: 10.11622/smedj.2016159. Epub 2016 Sep 22.
Postoperative cerebrospinal fluid (CSF) leak is a serious complication following transsphenoidal surgery for which elevated body mass index (BMI) has been implicated as a risk factor, albeit only in two recent North American studies. Given the paucity of evidence, we sought to determine if this association holds true in an Asian population, where the BMI criteria for obesity differ from the international standard.
A retrospective study of 119 patients who underwent 123 transsphenoidal procedures for sellar lesions between May 2000 and May 2012 was conducted. Univariate and multivariate logistic regression analyses were performed to investigate the impact of elevated BMI and other risk factors on postoperative CSF leak.
10 (8.1%) procedures in ten patients were complicated by postoperative CSF leak. The median BMI of patients with postoperative leak following transsphenoidal procedures was significantly higher than that of patients without postoperative CSF leak (27.0 kg/m vs. 24.6 kg/m; p = 0.018). Patients categorised as either moderate or high risk under the Asian BMI classification were more likely to suffer from a postoperative leak (p = 0.030). Repeat procedures were also found to be significantly associated with postoperative CSF leak (p = 0.041).
Elevated BMI is predictive of postoperative CSF leak following transsphenoidal procedures, even in an Asian population, where the definition of obesity differs from international standards. Thus, BMI should be considered in the clinical decision-making process prior to such procedures.
术后脑脊液漏是经蝶窦手术的一种严重并发症，尽管最近仅有两项北美研究表明，体重指数（BMI）升高是其危险因素。鉴于证据不足，我们试图确定这种关联在亚洲人群中是否成立，因为亚洲的肥胖BMI标准与国际标准不同。
对2000年5月至2012年5月期间因鞍区病变接受123例经蝶窦手术的119例患者进行回顾性研究。进行单因素和多因素逻辑回归分析，以研究BMI升高和其他危险因素对术后脑脊液漏的影响。
10例患者的10次（8.1%）手术出现术后脑脊液漏并发症。经蝶窦手术后出现脑脊液漏的患者的中位BMI显著高于未出现术后脑脊液漏的患者（27.0kg/m²对24.6kg/m²；p=0.018）。根据亚洲BMI分类被归类为中度或高风险的患者术后更易出现脑脊液漏（p=0.030）。还发现再次手术与术后脑脊液漏显著相关（p=0.041）。
即使在肥胖定义与国际标准不同的亚洲人群中，BMI升高也可预测经蝶窦手术后的脑脊液漏。因此，在进行此类手术前的临床决策过程中应考虑BMI。
