Can the Risks of Cerebrospinal Fluid Leak After Vestibular Schwannoma Surgery Be Predicted?

OBJECTIVE: Identifying predictive factors of cerebrospinal fluid (CSF) leak after translabyrinthine approach (TLA) for vestibular schwannoma.

DESIGN: Retrospective study.

SETTING: Tertiary care center.

PATIENTS: All patients (n = 275) operated for a vestibular schwannoma by TLA between 2004 and 2013 were included.

INTERVENTION: Vestibular schwannoma surgery by TLA.

MAIN OUTCOMES AND MEASURES: The rate of postoperative CSF leak considering the age, sex, body mass index (BMI), tumor staging, and duration of surgical procedure. A logistic regression model was used to identify the predictors and compute a biometric predictive model of CSF leak.

RESULTS: Thirty-three patients (12.0%) developed a CSF leak after surgery. In a multivariable model, an increased risk of CSF leak was found for younger patients (OR 0.95, 95% CI 0.92-0.98), longer duration of surgery (OR 1.85, 95% CI 1.12-3.05), and the male sex (0 = male; 1 = female; OR 0.22, 95% CI 0.09-0.54), while also adjusting for BMI. The probability of developing a CSF leak after vestibular schwannoma surgery was calculated using a statistical prediction model, with a percentage of false negative of 7.0% and an overall correct prediction of 88.4%.

CONCLUSION: The predictors of CSF leak after TLA for vestibular schwannoma are young age, male sex, longer duration of surgery, which adjusting for BMI. In this regard, the surgical team should adapt its management during pre- and postoperative period to decrease the likelihood of a leak.