2026 Poster Presentations
P246: POSTOPERATIVE CEREBROSPINAL FLUID LEAK FOLLOWING CRANIOPHARYNGIOMA RESECTION: REVIEW OF A MULTICENTER EXPERIENCE AND SURVEY OF CURRENT PRACTICE
Sandhya R Palit, MD1; Yuki Shinya, MD, PhD1,2; Maria Peris Celda, MD, PhD1; Andrew S Little, MD3; Ildiko Torok, MD4; Spiros Blackburn, MD5; Charles Christenson5; Kyle C Wu, MD6; Daniel M Prevedello, MD, MBA6; Varun R Kshettry, MD7; Paul Gardner, MD8; Georgios Zenonos, MD8; Robert C Rennert, MD9; William T Couldwell, MD, PhD9; Albert Kim, MD10; Julie M Silverstein, MD11; Won Kim, MD11,2; Marvin Bergsneider, MD11,2; Nathan Zwagerman, MD13; Michael Karsy, MD, PhD14; Garni Barkhoudarian, MD15; James Evans, MD16; Jamie J Van Gompel, MD1; 1Department of Neurologic Surgery, Mayo Clinic, Minnesota, USA; 2Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA; 3Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA; 4Bioinformatics, Barrow Neurological Institute, Phoenix, Arizona, USA; 5University of Texas Houston Health Science Center, Houston, TX, USA; 6Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA; 7Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA; 8Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; 9Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA; 10Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA; 11Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine, St. Louis, Missouri; 11,2Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA; 13Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA; 14Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA; 15Department of Neurosurgery, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, CA, USA; 16Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
Background: Postoperative cerebrospinal fluid (CSF) leak is a significant complication following endoscopic transsphenoidal surgery (ETS) for craniopharyngioma. This study aimed to identify risk factors associated with CSF leak in patients undergoing craniopharyngioma resection.
Methods: A retrospective review was conducted on 363 patients who underwent ETS for craniopharyngioma. Preoperative and intraoperative factors, including tumor consistency, tumor size, and repair techniques, were analyzed. Univariate analyses were performed to compare these variables between patients with and without postoperative CSF leak. A multivariate logistic regression model was used to identify significant independent risk factors.
Results: Out of 363 patients, 50 experienced a postoperative CSF leak (14%). Primarily cystic tumors had a significantly higher (p = 0.022) leak rate than mixed or solid tumors. Larger tumors (>5.1 cm) were associated with a higher (p = 0.026) CSF leak rate (5/15 patients, 33%) compared to smaller tumors (Figure 1). The inclusion of a nasoseptal flap (NSF) in the preferred layered approaches was associated with a lower CSF leak rate compared to iother materials, though this was not a statistically significant finding (p=0.052) (Figure 1). A multivariate logistic regression model found cystic tumor consistency (OR=2.25, p = 0.021) and a tumor diameter >5.1 cm (OR=3.31, p = 0.048) to be significant independent risk factors.
Conclusions: Cystic tumor consistency and larger tumor diameter are significant independent risk factors for postoperative CSF leak following ETS for craniopharyngioma. These findings underscore the importance of tumor characteristics as predictors of complication risk, demonstrating that both the consistency of the tumor and its absolute size independently increase the risk of CSF leakage. This data can be used to improve pre-operative risk stratification and inform tailored intraoperative repair strategies.
