Cerebrospinal fluid leaks after vestibular schwannoma surgery
Reviewed by Gauri Mankekar

This study analyses 30-day readmission data after vestibular schwannoma surgery using a multicentre longitudinal State of California dataset. The authors studied risk factors, and timing of readmission in 6820 patients over 15 years. Of these, 490 readmissions were reported for cerebrospinal fluid (CSF) leak, which is a well-known complication after vestibular schwannoma removal. They found that the median time to readmission with a CSF leak was six days. Presence of a CSF leak during the first admission was one of the major predictive factors of readmission. Other independent risk factors noted during the study were male gender, first admission at a teaching hospital, obesity during the first admission and case volume of first admission hospital. Obesity/elevated basal metabolic index have been shown across several studies to contribute to elevated intracranial pressure. The authors suggest that closure of wounds by inexperienced residents at teaching hospitals may be a factor for higher readmission rates with CSF leak at teaching hospitals. Subclinical leaks during the first admission could have worsened following a sneeze or straining or nose blowing predisposing patients to a CSF leak with subsequent readmission. The authors recommend measures such as encouraging obese patients to lose weight prior to surgery or placing a lumbar drain to reduce CSF pressure, implementing standardised procedures for wound closures to reduce the risk of CSF leakage. This paper adds to the literature on CSF leaks following vestibular schwannoma surgery via the translabyrinthine, retrosigmoid and suboccipital approach. 

Risk factors for readmission with cerebrospinal fluid leakage within 30 days of vestibular schwannoma surgery.
Alattar AA, Hirschman BR, McCutcheon BA, et al.
NEUROSURGERY
2018;82:630-7.