{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:58:34Z","timestamp":1788562714371,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Postoperative cerebrospinal fluid (CSF) leakage remains a significant complication following endoscopic endonasal skull base surgery (EES), leading to increased morbidity. This study aimed to identify factors and interventions predicting postoperative CSF leaks after EES for intradural skull base tumors and their clinical outcomes. Methods: We retrospectively reviewed data from 542 patients who underwent EES for intradural skull base pathology at the Ottawa Hospital between October 2001 and October 2023. Patient demographics, pre-operative, intraoperative (including reconstruction type), postoperative data, and patient outcomes were collected. Results: A total of 40 patients (7.4%) developed a postoperative CSF leak. The highest rate was in patients with suprasellar lesions (5.9%), followed by anterior cranial fossa lesions (1.1%). Significant predictors included a higher mean Body Mass Index (BMI) (30.4 vs. 26.1, p = 0.001). The use of a nasoseptal flap for reconstruction was associated with a significantly lower incidence of CSF leaks (p = 0.001). Tumor location, approach type, and dural sealants were not independent factors for the development of CSF leaks. Patients with CSF leaks had significantly longer lengths of stay (16.7 vs. 9.21 days, p &lt; 0.001), higher 30-day readmission rates (p &lt; 0.001), and increased postoperative sepsis (p = 0.021) and diabetes insipidus (p &lt; 0.001). Conclusion: This retrospective study shows that higher preoperative BMI is associated with a significant risk of postoperative CSF leaks after EES. Conversely, using a pedicled vascularized flap reduces the risk. Postoperative CSF leaks are linked to increased morbidity, including diabetes insipidus and sepsis, prolonged hospitalization, and higher readmission rates.<\/jats:p>","DOI":"10.3390\/brainsci16010019","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T09:58:34Z","timestamp":1766570314000},"page":"19","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Predictors, Complications, and Clinical Outcomes of Cerebrospinal Fluid Leak Post Endoscopic Endonasal Skull Base Surgery"],"prefix":"10.3390","volume":"16","author":[{"given":"Alejandro","family":"Vargas-Moreno","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3120-3412","authenticated-orcid":false,"given":"Sami","family":"Khairy","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mouaz","family":"Saymeh","sequence":"additional","affiliation":[{"name":"The Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa, ON K1Y 4E9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damanpreet Kaur","family":"Lang","sequence":"additional","affiliation":[{"name":"The Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa, ON K1Y 4E9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara K.","family":"Dabbour","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Rabski","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun","family":"Kilty","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, University of Ottawa, Ottawa, ON K1Y 1J8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahad","family":"Alkherayf","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada"},{"name":"The Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa, ON K1Y 4E9, Canada"},{"name":"Division of Neurosurgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1007\/s11102-017-0839-1","article-title":"Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: A systematic review","volume":"21","author":"Lobatto","year":"2018","journal-title":"Pituitary"},{"key":"ref_2","first-page":"10","article-title":"Risk factors for postoperative CSF leakage after endonasal endoscopic skull base surgery: A meta-analysis and systematic review","volume":"59","author":"Kim","year":"2021","journal-title":"Rhinology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.3171\/2016.12.JNS1694","article-title":"Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery","volume":"128","author":"Fraser","year":"2018","journal-title":"J. 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