Risk factors for postoperative cerebrospinal fluid leak following endoscopic transsphenoidal surgery for craniopharyngioma: a multicenter cohort study with a contemporary surgeon practice survey.
Publication Title
Journal of neuro-oncology
Document Type
Article
Publication Date
5-21-2026
Keywords
Humans; Craniopharyngioma; Female; Cerebrospinal Fluid Leak; Pituitary Neoplasms; Risk Factors; Male; Postoperative Complications; Retrospective Studies; Middle Aged; Adult; Surveys and Questionnaires; Adolescent; Young Adult; Neuroendoscopy; Follow-Up Studies; Aged; CSF leak; Craniopharyngioma; Endoscopic transsphenoidal surgery; Skull base reconstruction; Surgeon survey; Surgical practice.; california; santa monica; pni
Abstract
PURPOSE: This multicenter, multi-surgeon retrospective study aimed to identify risk factors for postoperative cerebrospinal fluid (CSF) leak following endonasal resection of craniopharyngioma, while evaluating the "perception gap" through a surgeon survey.
METHODS: A retrospective review was conducted on 416 patients who underwent endoscopic transsphenoidal surgery (ETS) for craniopharyngioma from 20 institutions. Factors were compared between patients with and without postoperative CSF leak, and between Early (2007-2015) and Late (2016-2025) Epochs. Complementing the clinical data, a survey of 19 neurosurgeons captured expert perspectives on risk stratification and management strategies.
RESULTS: Overall postoperative CSF leak rate was 13.5% (56/416 patients). Univariate analysis identified predominantly cystic tumors (34% vs. 21%, p = 0.034) and intraoperative lumbar drain (LD) use (p < 0.028) as associated with postoperative CSF leak. BMI (p = 0.587), prior surgery (p = 0.576), and tumor size (p = 0.363) were not significant. In the multivariable analysis, LD use was associated with a higher postoperative CSF leak rate (OR 1.91, 95% CI 1.06-3.46; p = 0.030). Between Epochs, nasoseptal flap (NSF) utilization increased from 70.7% to 87.6% (p < 0.001). NSF was protective (OR 0.28, 95% CI 0.07-0.92; p = 0.037) in the Early Epoch; no factors were significant in the Late Epoch. The surgeons' survey identified prior surgery and intraoperative high flow leaks as primary risks; however, their LD protocols diverged from clinical data.
CONCLUSION: Postoperative CSF leak in Craniopharyngioma has evolved. The study highlights a significant divergence between expert perception and clinical data regarding lumbar drains.
Area of Special Interest
Neurosciences (Brain & Spine)
Area of Special Interest
Cancer
Specialty/Research Institute
Neurosciences
Specialty/Research Institute
Oncology
Specialty/Research Institute
Surgery
DOI
10.1007/s11060-026-05627-y
