Risk Factors and Predictors of Intraoperative Cerebrospinal Fluid Leak after Endoscopic Transnasal Transsphenoidal Surgery for Tumor Resection: A 1,088 Patients’ Prospectively Collected Series

Introduction: Cerebrospinal fluid (CSF) leak, both during or after surgery, is a risk for all patients undergoing endoscopic transnasal transsphenoidal (eTNTS) tumor resection. The following risk factors have been identified in the literature for intraoperative CSF leaks: smoking, increased BMI, older age, prior TNTS, suprasellar extension, tumor size, irregularity, or consistency, nonfunctional tumors, gonadotrophic-positive staining and preoperative gonadotrophic hormone abnormalities, concurrent hydrocephalus, craniopharyngioma, and ACTH adenomas. We performed a retrospective analysis of our large institutional series to identify clinical, radiographic, and histopathologic predictive factors of intraoperative CSF leaks during a TNTS surgery for tumor resection.