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/m 2 ) 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/m 2 [range, 23.6–85.4 kg/m 2 ], 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.