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The incidence of postoperative cerebrospinal fluid leakage after elective cranial surgery: a systematic review

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A Correction to this article was published on 06 May 2022

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Abstract

Cerebrospinal fluid (CSF) leakage is a major complication after elective neurosurgical procedures. The aim of this systematic literature review is to summarize the incidence rates of postoperative cerebrospinal fluid leakage for neurosurgical procedures, classified by surgical approach. The Pubmed, Cochrane, Embase, and Web of Science databases were searched for studies reporting the outcome of patients undergoing elective neurosurgical procedures. The number of patients, surgical approach, and indication for surgery were recorded for each study. Outcomes related to CSF leakage such as clinical manifestation and treatment were reported as well. One hundred and thirteen studies were included, reporting 94,695 cases. Overall, CSF leaks were present in 3.8% of cases. Skull base surgery had the highest rate of CSF leakage with 6.2%. CSF leakage occurred in 5.9% of anterior skull base procedures, 6.4% of middle fossa, and 5.2% of transpetrosal surgeries. 5.8% of reported infratentorial procedures were complicated by CSF leakage versus 2.9% of supratentorial surgeries. CSF leakage remains a common serious adverse event after cranial surgery. There exists a need for standardized procedures to reduce the incidence of postoperative CSF leakage, as this serious adverse event may lead to increased health care costs.

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Acknowledgements

This work was supported by a FWO-TBM project grant of the Flemish government, Belgium (T003018N).

Author information

Authors and Affiliations

  1. Department of Neurosciences, Laboratory for Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute (LBI), KU Leuven, Herestraat 49 3000, Box 811, Leuven, Belgium

    Birgit Coucke, Steven De Vleeschouwer, Frank Van Calenbergh, Johannes van Loon & Tom Theys

  2. Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium

    Birgit Coucke & Laura Van Gerven

  3. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium

    Laura Van Gerven

  4. Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium

    Steven De Vleeschouwer, Frank Van Calenbergh, Johannes van Loon & Tom Theys

  5. Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium

    Laura Van Gerven

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  1. Birgit Coucke
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  2. Laura Van Gerven
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Correspondence to Birgit Coucke.

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The original online version of this article was revised: The authors regret that one of the author names in the original article appears incorrectly.

In addition, they also found another mistake that appeared in the original article:

Line 177-179: “While certain authors [44, 81, 92]reported CSF leakage as cases that required surgical revision or CSF shunting, others [102] [110] did not specify the treatment for CSF leakage.”

Was incorrectly shown in the final published article as :

“While certain authors [44, 81, 92] reported CSF leakage asincisional leak and fcases that required surgical revision or CSF shunting, others [102] [110] did not specify the treatment for CSF leakage.”

The original article has been corrected.

Appendix. Search strategy

Appendix. Search strategy

PUBMED

Concept 1: cranial surgery.

((“surgery” [Subheading] OR “Surgical Procedures, Operative”[Mesh:NoExp] OR surgery[tiab] OR surgeries[tiab] OR surgical[tiab] OR operati*[tiab] OR resect*[tiab]) AND (“Skull”[Mesh] OR skull[tiab] OR ‘head skeleton’[tiab] OR Skulls[tiab] OR crania[tiab] OR cranial[tiab] OR cranium[tiab] OR cranii[tiab] OR frontal-bone*[tiab] OR os-frontale [tiab] OR occipital-bone*[tiab] OR os-occipitale[tiab] OR parietal-bone*[tiab] OR os-parietale[tiab] OR temporal-bone*[tiab] OR os-temporale[tiab] OR sphenoid* [tiab] OR sella*[tiab])).

OR “Neurosurgical Procedures”[Mesh:NoExp] OR neurosurg*[tiab] OR skull-surg*[tiab] OR brain-surg*[tiab] OR Craniotomy[Mesh] OR craniotom*[tiab] OR Trephin*[tiab] OR Trepanation*[tiab] OR Trepanning*[tiab] OR “Decompression, Surgical”[Mesh:NoExp] OR decompressi*[tiab] OR decompression-surg*[tiab] OR decompressive-surg*[tiab] OR “Microvascular Decompression Surgery”[Mesh] OR “Dura Mater”[Mesh] OR Dura-Mater[tiab] OR duratom*[tiab] OR Dura-repair[tiab] OR Duraplast*[tiab].

Concept 2: postoperative complication.

‘wound healing’[tiab] OR ‘wound regeneration’[tiab] OR ‘Wound repair’[tiab] OR “Postoperative complications”[Mesh:NoExp] OR “Postoperative Period”[Mesh:NoExp] OR postop*[tiab] OR post-operat*[tiab] OR after-surgery[tiab] OR postsurgery[tiab] OR after-surgical[tiab] OR post-surgical[tiab] OR postsurgery OR complication*[tiab] OR adverse-event*[tiab] OR “adverse effects” [Subheading] OR adverse-effect*[tiab].

Concept 3: CSF leak.

“Cerebrospinal Fluid Leak”[Mesh] OR cerebro-spinal [tiab] OR cerebrospinal[tiab] OR CSF[tiab] OR Liquorrhea[tiab] OR Liquorhea[tiab] OR Liquorrea[tiab] OR Liquorea[tiab] OR Liquorrhoea[tiab] OR Pseudomeningocele*[tiab] OR Pseudomeningocoele*[tiab] OR “Intracranial Hypotension”[Mesh] OR intracranial-hypotension[tiab] OR meningocele*[tiab] OR meningocoele*[tiab].

Concept: study type.

“Clinical Trial” [Publication Type] OR randomized[tiab] OR randomised[tiab] OR ‘RCT’[tiab] OR review*[tiab] OR “case–control”[tiab] OR retrospective[tiab].

OR prospective[tiab] OR clinical-trial*[tiab] OR intervention-stud*[tiab].

OR “Observational Study”[Publication Type] OR observational-stud*[tiab] OR “epidemiologic studies”[Mesh] OR epidemiolog*[tiab] OR “cohort studies”[Mesh] OR cohort* [tiab] OR incidence[tiab] OR epidemiology [subheading] OR etiology [subheading] OR etiolog*[tiab] OR pathogenesis [tiab].

Cochrane Library (CENTRAL)

Concept 1

#1: ([mh ^ “Surgical Procedures, Operative”] OR [mh “General Surgery”] OR [mh /SU]).

#2: (surgery OR surgeries OR surgical OR operati* OR resect*):ti,ab,kw.

#3: #1 OR #2

#4: [mh “Skull”].

#5: (Skull OR skulls OR cranium OR crania OR cranial OR cranii OR “head skeleton” (frontal NEXT bone*) OR (os frontale) OR (occipital NEXT bone*) OR (os occipitale) OR (parietal NEXT bone*) OR (os parietale) OR sphenoid* OR sella* OR (temporal NEXT bone*) OR (os temporale) OR sella*):ti,ab,kw.

#6: #4 OR #5

#7: #3 AND #6

#8: [mh ^ “Neurosurgical Procedures”] OR [mh “Craniotomy”] OR [mh ^ “Decompression, Surgical”] OR [mh “Microvascular Decompression Surgery”] OR [mh “Dura Mater”].

#9: (neurosurg* OR (skull NEXT surg*) OR (brain NEXT surg*) OR craniotom* OR Trephin* OR Trepanation* OR Trepanning* OR decompressi* OR (decompression NEXT surg*) OR (decompressive NEXT surg*) OR (Microvascular NEXT Decompression*) OR “Dura Mater” OR duratom* OR “Dura repair” OR Duraplast*):ti,ab,kw.

#10: #8 OR #9 OR #7

Concept 2

#11: [mh ^ “Postoperative complications”] OR [mh “Postoperative Period”] OR [mh /AE].

#12: (“wound healing” OR “wound regeneration” OR “wound repair” OR postop* OR (post NEXT operat*) OR “after surgery” OR “after surgical” OR complication* OR (adverse NEXT event*) OR (adverse NEXT effect*)):ti,ab,kw.

#13: #11 OR #12

Concept 3

#14: [mh “Cerebrospinal Fluid Leak”] OR [mh “Intracranial Hypotension”].

#15: ((cerebro NEXT spinal) OR cerebrospinal OR CSF OR Liquorrhea OR Liquorhea OR Liquorrea OR Liquorea OR Liquorrhoea OR Pseudomeningocele* OR Pseudomeningocoele* OR “intracranial hypotension” OR meningocele* OR meningocoele*):ti,ab,kw.

#16: #14 OR #15

#17: #10 AND #13 AND #16

EMBASE

Concept 1: cranial surgery.

((‘surgery’ OR ‘surgeries’ OR ‘surgical’ OR ‘operati*’ OR ‘resect*’) NEAR/6 (‘skull’ OR ‘skulls’ OR ‘crania’ OR ‘cranial’ OR ‘cranium’ OR ‘cranii’ OR ‘head skeleton’ OR ‘frontal bone’ OR ‘os frontale’ OR ‘occipital bone’ OR ‘os occipitale’ OR ‘parietal bone’ OR ‘os parietale’ OR ‘temporal bone’ OR ‘os temporale’ OR ‘sphenoid*’ OR ‘sella*’)):ti,ab,kw.

OR ‘skull surgery’/exp OR ‘neurosurgery’/exp OR ‘neurosurg*’:ti,ab,kw OR ‘brain surg*’:ti,ab,kw OR ‘craniotomy’/exp OR ‘craniotom*’:ti,ab,kw OR ‘Trephin*’:ti,ab,kw OR ‘Trepanation*’:ti,ab,kw OR ‘Trepanning*’:ti,ab,kw OR ‘decompression surgery’/de OR decompressi*: ti,ab,kw OR ‘microvascular decompression’/exp OR ‘dura mater’/exp OR ‘dura mater’:ti,ab,kw OR ‘duratom*’:ti,ab,kw OR ‘dura repair’:ti,ab,kw OR ‘duraplast*’:ti,ab,kw OR ‘duraplasty’/exp.

Concept 2: postoperative complication.

‘wound healing’:ti,ab,kw OR ‘wound regeneration’:ti,ab,kw OR ‘Wound repair’:ti,ab,kw OR ‘postoperative complication’/de OR ‘postoperative period’/de OR ‘postop*’:ti,ab,kw OR ‘post-operat*’:ti,ab,kw OR ‘after-surgery’:ti,ab,kw OR ‘postsurgery’:ti,ab,kw OR ‘after-surgical’:ti,ab,kw OR ‘post-surgical’:ti,ab,kw OR ‘complication*’:ti,ab,kw OR ‘adverse effect*’:ti,ab,kw OR ‘adverse-event*’:ti,ab,kw OR ‘adverse event’/de.

Concept 3: CSF leak.

‘liquorrhea’/exp OR ‘cerebro-spinal’:ti,ab,kw OR ‘Cerebrospinal’:ti,ab,kw OR ‘CSF’:ti,ab,kw OR ‘Liquorhea’:ti,ab,kw OR ‘Liquorrea’:ti,ab,kw OR ‘liquorrhea’:ti,ab,kw OR ‘Liquorrhoea’:ti,ab,kw OR ‘Pseudomeningocele*’:ti,ab,kw OR ‘Pseudomeningocoele*’:ti,ab,kw OR ‘Intracranial Hypotension’:ti,ab,kw OR ‘intracranial hypotension’/exp OR ‘meningocele’/exp OR ‘meningocele*’:ti,ab,kw OR ‘meningocoele*’:ti,ab,kw.

Concept study design.

‘randomi?ed’:ti,ab,kw OR ‘clinical trial*’:ti,ab,kw OR ‘clinical trial’/de OR ‘RCT’:ti,ab,kw OR ‘review*’:ti,ab,kw OR ‘case–control’:ti,ab,kw OR ‘controlled clinical trial’/exp OR ‘case control study’/exp OR ‘case–control’:ti,ab,kw OR ‘retrospective’:ti,ab,kw OR ‘prospective’:ti,ab,kw OR ‘observational study’/exp OR ‘intervention$stud*’:ti,ab,kw.

WOS core collection

Concept 1: cranial surgery.

((“surgery” OR “surgeries” OR “surgical” OR “operati*” OR “resect*”) NEAR/6 (“skull” OR “skulls” OR “crania” OR “cranial” OR “cranium” OR “cranii” OR “head skeleton” OR “frontal bone” OR “os frontale” OR “occipital bone” OR “os occipitale” OR “parietal bone” OR “os parietale” OR “temporal bone” OR “os temporale” OR “sphenoid*” OR “sella*”)).

OR “neurosurg*” OR “brain surg*” OR “craniotom*” OR “Trephin*” OR “Trepanation*” OR “Trepanning*” OR “decompressi*” OR “dura mater” OR “duratom*” OR “dura repair” OR “duraplast*”.

Concept 2: postoperative complication.

“wound healing” OR “wound regeneration” OR “Wound repair” OR “postop*” OR “post-operat*” OR “after-surgery” OR “postsurgery” OR “after-surgical” OR “post-surgical” OR “complication*” OR “adverse effect*” OR “adverse-event*”

Concept 3: CSF leak.

“cerebro-spinal” OR “Cerebrospinal” OR “CSF” OR “Liquorhea” OR “Liquorrea” OR “liquorrhea” OR “Liquorrhoea” OR “Pseudomeningocele*” OR “Pseudomeningocoele*” OR “Intracranial Hypotension” OR “meningocele*” OR “meningocoele*”

Concept study design.

“clinical trial*” OR “randomi?ed” OR “RCT” OR “review*” OR “case control study” OR “case-control” OR “retrospective” OR “prospective” OR “observational stud*” OR “intervention stud*” OR “cohort*” OR “incidence*” OR “epidemiolog*” OR “etiolog*” OR “pathogenesis”

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Coucke, B., Van Gerven, L., De Vleeschouwer, S. et al. The incidence of postoperative cerebrospinal fluid leakage after elective cranial surgery: a systematic review. Neurosurg Rev 45, 1827–1845 (2022). https://doi.org/10.1007/s10143-021-01641-y

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  • DOI: https://doi.org/10.1007/s10143-021-01641-y

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