The Impact of Preoperative Frailty on Endoscopic Cerebrospinal Fluid Leak Repair Outcomes in the Anterior Skull Base

Document Type

Conference Proceeding

Publication Date


Publication Title

J Neurol Surg B Skull Base


Background: Measurements of surgical frailty estimate a patient's ability to withstand the physiologic stress of a procedure. There is limited data regarding the impact of frailty on endoscopic cerebrospinal fluid (CSF) leak repair.

Methods: Patients undergoing CSF leak repair at two tertiary academic skull base programs were retrospectively reviewed. Demographic, treatment, and postoperative outcomes data were recorded. Frailty was calculated using validated indexes, including the American Society of Anesthesiologists (ASA) classification, Charlson Comorbidity Index (CCI), and the Modified 5-Item Frailty Index (mFI-5). Outcomes included 30-day medical and surgical complications and readmission.

Results: A total of 185 patients were included with 128 (69.2%) female patients and average age of 54 ± 14 years. The average BMI was 34.6 ± 8.5. The most common identified etiology was idiopathic intracranial hypertension (IIH) in 64 patients (34.6%). The average duration of leak was 9.31 ± 22.14 months. 125 patients (68%) underwent perioperative lumbar drain placement (primarily to measure intracranial pressures and definitively diagnose IIH). Most patients were ASA class 3 (48.6%) with mean CCI 2.14 ± 2.23 and mFI-5 0.97 ± 0.90. Three patients had postoperative CSF leaks, with an overall repair success rate of 98.4%. There was no association between increased frailty and 30-day medical outcomes (myocardial infarction, cerebrovascular accident, pneumonia, pulmonary embolism/deep vein thrombosis, and meningitis), surgical outcomes (bleeding requiring transfusion, postoperative CSF leak), or readmission (all p > 0.05).

Discussion: Endoscopic CSF leak repair in a frail population, including lumbar drain placement and postoperative bedrest, did not have an increased rate of complications. Previous data suggests there are increased complications in open craniotomy procedures in patients with significant comorbidities. Our preliminary data suggests that the endoscopic approach to CSF leak repair may be better tolerated in the frail population.