Analysis On Risk Factors Of Cerebrospinal Fluid Leakage After Endoscopic Endonasal Skull Base Tumor Resection And Construction Of Nomogram Model

Objective: To analyze the risk factors of cerebrospinal fluid(CSF)leakage after endoscopic endonasal skull base tumor resection,and construct a Nomogram prediction model,so as to verify its effectiveness.Methods: The clinical data of 151 patients who underwent endoscopic endonasal skull base tumor resectionin the Department of Neurosurgery,Affiliated Hospital of Zunyi Medical University from January 2019 to January 2021 were analyzed retrospectively.They were divided into postoperative CSF leakage group and postoperative non-CSF leakage group.Univariate and multivariate Logistic regression analysis was used to obtain the independent risk factors of postoperative CSF leakage,and Nomogram prediction model was constructed.Results: The incidence of postoperative CSF leakage was 8.6%.During the analysis on the risk factors of postoperative CSF leakage,it was found that intraoperative CSF leakage,pedicled nasal septum mucosal flap and tumor type were correlated with the occurrence of postoperative CSF leakage.The incidence of CSF leakage in patients with intraoperative CSF leakage(33.3%)was higher than that in patients without intraoperative CSF leakage(4.6%).The incidence of CSF leakage in patients without pedicled nasal septum mucosal flap(13.9%)was higher than that in patients with pedicled nasal septum mucosal flap(2.8%),and the difference was statistically significant(P<0.05).The incidence of CSF leakage after craniopharyngioma operation was 26.7%,pituitary adenoma operation was 8.4%,Rathke cyst operation was 3.70%,and the difference was statistically significant(P<0.05).However,age,gender,ASA grade and duration of operation had no correlation with the occurrence of postoperative CSF leakage(P>0.05).Multivariate Logistic regression analysis showed that CSF leakage during operation(OR=280.306,95% CI: 6.957-11293.097,P=0.003),pedicled nasal septum mucosal flap(OR=0.014,95% CI: 0.000-0.450,P=0.016),tumor types were correlated with postoperative CSF leakage(P<0.05).The ROC area of Nomogram prediction model was 0.89,and the Internal verification chart showed that the model had good prediction efficiency.Conclusion: Intraoperative CSF leakage and tumor type are independent risk factors for CSF leakage after endoscopic endonasal skull base tumor resection.Pedicled nasal septum mucosal flap is a protective factor for postoperative cerebrospinal fluid leakage.Nomogram prediction model can effectively predict the risk of postoperative CSF,and help clinical workers identify patients with high-risk postoperative CSF leakage,and take active clinical measures and treatment plans.