Incisional CSF leakage after intradural cranial surgery in children: incidence, risk factors, and complications

Emma M H Slot, Tristan P C van Doormaal, Kirsten M van Baarsen, Niklaus Krayenbühl, Luca Regli, Menno R Germans, Eelco W Hoving

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: The risk of cerebrospinal fluid (CSF) leakage after cranial surgery and its associated complications in children are unclear because of variable definitions and the lack of multicenter studies. In this study, the authors aimed to establish the incidence of CSF leakage after intradural cranial surgery in the pediatric population. In addition, they evaluated potential risk factors and complications related to CSF leakage in the pediatric population.

METHODS: The authors performed an international multicenter retrospective cohort study in three tertiary neurosurgical referral centers. Included were all patients aged 18 years or younger who had undergone cranial surgery to reach the subdural space during the period between 2015 and 2021. Patients who died or were lost to follow-up within 6 weeks after surgery were excluded. The primary outcome measure was the incidence of CSF leakage, defined as leakage through the skin, within 6 weeks after surgery. Univariable and multivariable logistic regression analyses were performed to identify risk factors for and complications related to CSF leakage.

RESULTS: In total, 759 procedures were identified, performed in 687 individual patients. The incidence of CSF leakage was 7.5% (95% CI 5.7%-9.6%). In the multivariate model, independent risk factors for CSF leakage were hydrocephalus (OR 4.5, 95% CI 2.2-8.9) and craniectomy (OR 7.6, 95% CI 3.0-19.5). Patients with CSF leakage had higher odds of pseudomeningocele (5.7, 95% CI 3.0-10.8), meningitis (21.1, 95% CI 9.5-46.8), and surgical site infection (7.4, 95% CI 2.6-20.8) than patients without leakage.

CONCLUSIONS: CSF leakage risk in children after cranial surgery, which is comparable to the risk reported in adults, is an event of major concern and has a serious clinical impact.

Original languageEnglish
Pages (from-to)313-320
Number of pages8
JournalJournal of Neurosurgery. Pediatrics
Issue number4
Publication statusPublished - 1 Apr 2023


  • Adult
  • Humans
  • Child
  • Incidence
  • Retrospective Studies
  • Neurosurgical Procedures/adverse effects
  • Cerebrospinal Fluid Leak/epidemiology
  • Risk Factors
  • Postoperative Complications/epidemiology


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