Volume 3, Issue 2, December 2019, Page: 26-31
Predictors of Cerebrospinal Fluid Leaks in Endoscopic Surgery for Pituitary Tumors
Mahmoud Saad, Department of Neurosurgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mohamed Elkahwagi, Department of Otolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Ahmed Musaad, Department of Otolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Yasser Khafagy, Department of Otolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Ahmed Nageeb Taha, Department of Neurosurgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Received: Nov. 19, 2019;       Accepted: Dec. 2, 2019;       Published: Dec. 10, 2019
DOI: 10.11648/j.ijn.20190302.13      View  562      Downloads  132
Background: Cerebrospinal fluid (CSF) leak is a serious complication of endoscopic endonasal surgery for pituitary adenoma; leading to a more serious and financial burden of the surgery. Prediction of the occurrence of such sequale and proper plaining for reconstruction can reduce its prevalence and associated morbidities. Purpose: To determine the predictors and risk factors associated with intra/and postoperative cerebrospinal fluid (CSF) leaks in endoscopic endonasal pituitary surgery. Methods: A retrospective study included 150 patients who underwent endoscopic endonasal approach for resection of pituitary adenomas between 2015 and 2018. We analyzed the association between CSF leaks (intra/post-operative) and perioperative variables including patients’ demographic data, medical comorbidities, tumor characteristics and operative data (rates of intraoperative leak, reconstructive techniques). Results: 34 patients (22.6%) out of the 150 patients had an overall, CSF leak: 26 (76.5%) patients had intraoperative leaks; 5 patients out of them continued to have a postoperative leak. 8 patients (23.5%) had postoperative leak. Based on multiple logistic regression model analysis; increased body mass index (BMI), associated hydrocephalus, suprasellar extension and recurrent tumors had a significant association with intraoperative CSF leaks, while only BMI and hydrocephalus predicted postoperative CSF leaks. Conclusion: Elevated BMI, suprasellar extension of the tumor, recurrence or previous radiation are all important risk factors that have been proved in this study to have statistically significant association with the incidence of CSF leak. In high risk patients for CSF leakage: adequate reconstruction planis advised to avoid such morbidity.
CSF, Leak, Endoscopic Endonasal, Pituitary Surgery, Predictors
To cite this article
Mahmoud Saad, Mohamed Elkahwagi, Ahmed Musaad, Yasser Khafagy, Ahmed Nageeb Taha, Predictors of Cerebrospinal Fluid Leaks in Endoscopic Surgery for Pituitary Tumors, International Journal of Neurosurgery. Vol. 3, No. 2, 2019, pp. 26-31. doi: 10.11648/j.ijn.20190302.13
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
S. K. Rereddy, Z. M. Patel, N. M. Oyesiku, et al. "Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery". Int Forum Allergy Rhino l0 (0) :1–9, 2016.
Z. M. Soler, W. A. Vandergrift, S. K. Wiseetal." Transnasal endoscopic pituitary adenoma surgery". Int Forum Allergy Rhino l6 (1): 101–7, 2016.
C. J. Farrell, A. Farag, J. J. Evansetal." Principles of Pituitary Surgery". Otolaryngol Clin North Am 13 (1), 2018.
E. C. Kuan, A. R. Sepahdari, F. Yooetal." Anatomic Variations in Pituitary Endocrinopathies: Implications for the Surgical Corridor". J Neurol Surg B Skull Base 105–11, 2017.
A. Parikh, S. E. Sullivan, E. L. Mckean." Predictive Factors, 30-Day Clinical Outcomes, and Costs Associated with Cerebrospinal Fluid Leak in Pituitary Adenoma Resection". J Neurol Surg 103-111, 2019.
C. Zhang, N. Yang, L. Muetal." The application of nasoseptal“ rescue” flap technique in endoscopic transsphenoidal pituitary adenoma resection". Acta Otorhinolaryngol Ital 37: 303-307, 2018.
A. Chern, J. B. Hunter, M. L. Bennett." Cost analysis of cerebrospinal fluid leaks and cerebrospinal fluid leak prevention in patients undergoing cerebellopontine angle surgery". Otol Neurotol 38 (01): 147-151, 2017.
C. C. Boling, T. T. Karnezis, A. B. Baker et al." Multi-institutional study of risk factors for perioperative morbidity following transnasal endoscopic pituitary adenoma surgery". Int Forum Allergy Rhinol 6 (01): 101-107, 2016.
J. Barger, M. Siow, M. Kader et al." The posterior nasoseptal flap: A novel technique for closure after endoscopic transsphenoidal resection of pituitary adenomas". Surg Neurol Int 9: 32, 2018.
J. Park, J. H. Choi, Y. Kim et al." Modified Graded Repair of Cerebrospinal Fluid Leaks in Endoscopic Endonasal Transsphenoidal Surgery". J Korean Neurosurg Soc 58 (1): 36–42, 2015.
P. Schuss. "Transsphenoidal pituitary surgery: comparison of two sellar reconstruction techniques and their effect on postoperative cerebrospinal fluid leakage". Neurosurg Rev 41 (4): 1053-1058, 2018.
H. Nishioka, J. Haraoka, Y. Ikeda. "Risk factors of cerebrospinal fluid rhinorrhea following transsphenoidal surgery". Acta Neurochir 147 (11): 1163-1166, 2005.
M. E. Ivan, J. B. Iorgulescu, I. El-Sayed et al." Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery". J Clin Neurosci 22 (1): 48–54, 2015.
A. J. Luginbuhl, P. G. Campbell, J. Evans et al." Endoscopic Repair of High-Flow Cranial Base Defects Using a Bilayer Button". Laryngoscope 876–80, 2010.
S. Fraser, P. A. Gardner, M. Koutourousiou et al." Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery". J Neurosurg 5-10, 2017.
D. Jakimovski, G. Bonci, M. Attia et al." Incidence and significance of intraoperative cerebrospinal fluid leak in endoscopic pituitary surgery using intrathecal fluorescein". World Neurosurg 82 (3-4): e513-e523, 2014.
N. R. Biermasz and W. R Furth." Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review Quality in Prognostic Studies". Pituitary 21 (1): 84–97, 2018.
P. N. Patel, A. M. Stafford, J. R Patrinely et al." Risk Factors for Intraoperative and Postoperative Cerebrospinal Fluid Leaks in Endoscopic Transsphenoidal Sellar Surgery". Otolaryngol Head Neck Surg 158 (5): 952-960, 2018.
I. Sun, J. X. Lim, C. P. Goh et al." Body mass index and the risk of postoperative cerebrospinal fluid leak following transsphenoidal surgery in an Asian population". Singapore Med J 59 (05): 257-263, 2018.
B. J. Dlouhy, K. Madhavan, J. D. Clinger et al." Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery". J Neurosurg 116 (06): 1311-1317, 2012.
G. Carrabba, M. Locatelli, L. Mattei et al." Transphenoidal surgery in acromegalic patients: Anatomical considerations and potential pitfalls". Acta Neurochir 155: 125–130, 2012.
R. Zhan, A. S. Chen, A. S. Xu et al." Postoperative Low-Flow Cerebrospinal Fluid Leak of Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenoma. Wait and See or Lumbar Drain"? J Craniofac Surg 26 (4): 1261–4, 2015.
D. A. Tien, J. K. Stokken, P. F. Recinos et al." Cerebrospinal Fluid Diversion in Endoscopic Skull Base Reconstruction An Evidence-Based Approach to the Use of Lumbar Drains". Otolaryngol Clin NA 49 (1): 119–29, 2016.
Browse journals by subject