Association of Obesity with Safety and Efficacy of Middle Cranial Fossa Repair of Spontaneous Cerebrospinal Fluid Leaks.

Objective: Determine if class 3, morbid obesity (body mass index, BMI >40 kg/m2) patients have increased risk of complications following middle cranial fossa (MCF) repairs of spontaneous cerebrospinal fluid leaks (sCSF-Ls).

Study design: Retrospective cohort.

Setting: Tertiary academic.

Patients: Adults (>18 yrs old) with temporal bone CSF leak.

Interventions: Middle fossa craniotomy CSF leak repair.

Main outcome measures: Comparison of perioperative complications according to American Surgical Association severity (grades 1-5) and rates of ipsilateral persistent leak within 90 days of initial surgery across obesity classes.

Results: A total of 124 patients (64.5% female) with a mean (SD) age of 57 (11.3) years (range, 28-81) underwent MCF repairs of 142 spontaneous temporal bone leaks. Of these, 49.2% were right sided, 36.3% were left sided, and 14.5% were bilateral. The mean (SD) BMI was 38.1 (11.9) kg/m2 [range, 23.6-85.4 kg/m2], and the distribution of BMI categories was as follows: normal (2.4%), overweight (11.3%), class 1 obese (22.5%), class 2 obese (21.8%), class 3 obese (41.9%). Successful initial surgical repair was 97.2%, the mean length of stay was 2.4 (1.2) days, and 93.0% of patients experienced no complications. There was no difference in complication rates or severity scores, length of stay, or rates of persistent CSF leak across BMI categories.

Conclusions: Of sCSF-L patients, 41.9% have class 3 obesity, and MCF repair can be performed in this population at experienced centers with high success rates and few complications.