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Clinical Research
Uncorrected Proof. Available online 10 March 2025
Continuous sitting position during the postoperative period as an intervention to reduce risk of cerebrospinal fluid leak after endoscopic endonasal surgery
Posición semisedente continua en el periodo postoperatorio, como una intervención para disminuir la fístula de líquido cefalorraquídeo posterior a abordaje endonasal endoscópico
José de Jesús Martínez-Manriquea, Ricardo A. Palacios-Rodríguezb, Luis A. Rodríguez-Hernándezb, Jorge F. Aragón-Arreolab, Marcos V. Sangrador-Deitosc, Juan Luis Gómez-Amadorb,
Corresponding author
jlga@neurocirugia-innn.com

Corresponding author.
a Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
b Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
c Hospital Zambrano Hellion, Tecnológico de Monterrey, San Pedro Garza García, Mexico
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Table 1. Demographic characteristics and different variables.
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Table 2. Stratified groups.
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Abstract
Introduction/objectives

In recent decades, endoscopic endonasal surgery for skull base tumours has modified the way in which this region is approached. One of the most feared complications is the cerebrospinal fluid leak. It has been shown in different publications about CSF physiology that changes in the position modify the pressure of the CSF (pCSF). With this background, it is proposed as a viable, noninvasive, and very low-risk option, the continuous sitting position in patients during their hospital stay after endoscopic endonasal surgery as an adjuvant intervention to reduce the risk of CSF leak in patients considered to be at high risk. The objective is to demonstrate that the continuous sitting position in the postoperative period is a useful adjuvant intervention for the prevention of CSF leak in endoscopic endonasal surgery.

Methods

This is a retrospective, observational, cross-sectional, comparative study. It included patients over 18 years of either sex, intervened by endoscopic endonasal surgery with intraoperative CSF leak observed and with advanced reconstruction technique realized. A continuous sitting position (between 70 ° and 90 °) was considered when the patient remained in this position from the immediate postoperative period until the hospital discharge.

Results

A total of 60 patients were included. No statistically significant difference was found on all the variables studied, except when patients were stratified into sitting and non-sitting patients (p = 0.045). OR of 0.12 (95% CI 0.002–1.03) was observed. In the sitting group, only 1 patient (6.67%) had CSF leak, which was resolved with non-surgical treatment. The average length of hospital stay was 18 days (7–38) for sitting patients and 14 days (5–80) for non-sitting patients, with statistical significance stablished by the dispersion of the data (p = 0.023).

Conclusions

The continuous sitting position during the immediate postoperative period is an intervention that shows a decrease in the risk of CSF leak in patients intervened by endoscopic endonasal approach, included extended routes.

Keywords:
Cerebrospinal fluid leak
Endoscopic endonasal surgery
Sitting position
Resumen
Introducción/objetivos

En las últimas décadas, la cirugía endoscópica endonasal en tumores de base del cráneo ha modificado la forma de abordar esta región. Una de las complicaciones más temidas es la fístula de líquido cefalorraquídeo. Se ha demostrado en diferentes publicaciones sobre la fisiología del LCR que los cambios en la posición modifican la presión de LCR. Con estos antecedentes, se propone como una opción viable, no invasiva y de bajo riesgo, la posición sedente continua en pacientes durante su estancia hospitalaria tras cirugía endoscópica endonasal como intervención para reducir el riesgo de fuga de LCR en pacientes considerados de alto riesgo. El objetivo es demostrar que la posición sedente continua en el postoperatorio es una intervención adyuvante útil para la prevención de la fístula de LCR en la cirugía endoscópica endonasal.

Métodos

Se trata de un estudio retrospectivo, observacional, transversal y comparativo. Se incluyeron pacientes mayores de 18 años de ambos sexos, operados mediante cirugía endoscópica endonasal con fístula de LCR observada intraoperatoriamente y con técnica de reconstrucción avanzada realizada. Se consideró posición sedestación continua (entre 70 ° y 90 °) cuando el paciente permaneció en esta posición desde el postoperatorio inmediato hasta el alta hospitalaria.

Resultados

Se incluyeron 60 pacientes. No se encontró diferencia estadísticamente significativa para las variables estudiadas, excepto cuando se estratificó a los pacientes en pacientes sedentes y no sedentes (p = 0,045). Se observó un OR de 0,12 (IC 95% 0,002−1,03). Del grupo sedente sólo 1 paciente (6,67%) presentó fístula de LCR, que se resolvió con tratamiento no quirúrgico. La estancia media hospitalaria fue de 18 días (7–38) para los pacientes sedentes y de 14 días (5–80) para los no sedentes estableciéndose la significación estadística por la dispersión de los datos (p = 0,023).

Conclusiones

La sedestación continua durante el postoperatorio inmediato es una intervención que demuestra una disminución del riesgo de fístula de LCR en pacientes intervenidos por vía endoscópica endonasal con abordajes extendidos a la base del cráneo.

Palabras clave:
Fístula de líquido cefalorraquídeo
Cirugía endonasal endoscópica
Posición sedente

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