Department of Medical Informatics, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea;Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea;Research Institute of Clinical Medicine of Jeonbuk National University â€" Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Rhinology. 2021 Feb 1;59(1):10-20. doi: 10.4193/Rhin20.145.
Cerebrospinal fluid (CSF) leakage is a complication that any surgeon working in the field of skull base surgery does not wish to encounter. The surgical approach to the skull base often varies, and the various sizes and locations of skull base lesions make it difficult to determine the cause of CSF leakage. However, it is useful to investigate which factors contribute to postopera- tive CSF leakage.
Related studies were identified by searching the following databases: PubMed/Medline, Embase, and Web of Sciences through December 2019. Random-effects models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). The Newcastle-Ottawa scale was used to evaluate the quality of observational studies.
Our search yielded 56 retrospective cohort studies involving a total of 11,826 skull base surgical procedures. The overall rate of postoperative CSF leakage was 7.2%. The effect of obesity on postoperative CSF leakage had an OR of 1.88, and the effect of perioperative radiotherapy on postoperative CSF leakage yielded an OR of 1.87. High intraoperative CSF flow rate also had a significant OR of 2.98. On the other hand, a pedicled vascularized flap efficiently reduced the risk of postoperative CSF leakage. Defect size and the presence or absence of a lumbar drain had no effect on postoperative CSF leakage.
This comprehensive quantitative assessment of postoperative CSF leakage showed that obesity, perioperative radiotherapy, and high intraoperative CSF flow rate raised the risk of CSF leakage; however, a pedicled vascularized flap can ef- fectively reduce the risk of postoperative CSF leakage.
脑脊液（CSF）漏是任何从事颅底外科手术的外科医生都不希望遇到的并发症。颅底手术的入路往往不同，颅底病变的各种大小和位置使得难以确定 CSF 漏的原因。然而，调查哪些因素导致术后 CSF 漏是有用的。
通过搜索以下数据库确定相关研究：PubMed/Medline、Embase 和 Web of Sciences，截至 2019 年 12 月。使用随机效应模型计算比值比（OR）和 95%置信区间（CI）。纽卡斯尔-渥太华量表用于评估观察性研究的质量。
我们的搜索共产生了 56 项回顾性队列研究，涉及 11826 例颅底手术。术后 CSF 漏的总体发生率为 7.2%。肥胖对术后 CSF 漏的影响的 OR 为 1.88，围手术期放疗对术后 CSF 漏的影响的 OR 为 1.87。术中 CSF 流量高也有显著的 OR 为 2.98。另一方面，带蒂血管化皮瓣有效地降低了术后 CSF 漏的风险。缺损大小和是否存在腰大池引流对术后 CSF 漏无影响。
这项术后 CSF 漏的综合定量评估表明，肥胖、围手术期放疗和术中 CSF 流量高会增加 CSF 漏的风险；然而，带蒂血管化皮瓣可有效降低术后 CSF 漏的风险。
