• Ahmet Kinaci, Emma M H Slot, Mare Kollen, Menno R Germans, Sepideh Amin-Hanjani, Andrew P Carlson, Kashif Majeed, Paul R A M Depauw, Pierre A Robe, Luca Regli, Fady T Charbel, and van DoormaalTristan P CTPCDepartment of Neurosurgery, Brain Center, University Medical Centre Utrecht, Utrecht, the Netherlands.Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
• Department of Neurosurgery, Brain Center, University Medical Centre Utrecht, Utrecht, the Netherlands.
• Neurosurgery. 2023 Jun 1; 92 (6): 117711821177-1182.

BackgroundIncisional cerebrospinal fluid (iCSF) leakage is a serious complication after intradural cranial surgery.ObjectiveTo determine the incidence and risk factors of iCSF leakage after craniotomy. Secondarily, the complications after iCSF leakage and the success rate of iCSF leakage treatment was studied.MethodsAll patients who underwent an intradural cranial surgery from 2017 to 2018 at 5 neurosurgical centers were retrospectively included. Data were retrieved from medical records with 2 months of follow-up. First, univariate regression analyses were performed. Subsequently, identified risk factors were evaluated in a multivariate regression analysis.ResultsIn total 2310 consecutive patients were included. Total iCSF leakage rate was 7.1% (n = 165). Younger age, male, higher body mass index, smoking, infratentorial surgery, and use of a dural substitute were associated with increased iCSF leakage risk, and use of a sealant reduced that risk. The odds for developing a wound infection and/or meningitis were 15 times higher in patients with iCSF leakage compared with patients without leakage. Initial conservative iCSF leakage treatment failed in 48% of patients. In 80% of cases, external cerebrospinal fluid drainage ceased the iCSF leakage. A total of 32% of patients with iCSF leakage required wound revision surgery.ConclusioniCSF leakage risk increases by younger age, higher body mass index, smoking, infratentorial craniotomy, and dural substitute use, whereas sealant use reduced the risk for iCSF leakage. The leak increases the risk of postoperative infections. When iCSF leakage occurs, immediate external cerebrospinal fluid drainage or wound revision should be considered.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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