Risk factors and management of intraoperative cerebrospinal fluid leaks in endoscopic treatment of pituitary adenoma: analysis of 492 patients.

Risk factors and management of intraoperative cerebrospinal fluid leaks in endoscopic treatment of pituitary adenoma: analysis of 492 patients.

World Neurosurg. 2017 Feb 09;:

Authors: Zhou Q, Yang Z, Wang X, Wang Z, Zhao C, Zhang S, Li P, Li S, Liu P

Abstract
OBJECTIVES: To determine risk factors and management of intraoperative cerebrospinal fluid (CSF) leakage in endoscopic endonasal transsphenoidal pituitary adenoma surgery.
METHODS: we conducted a retrospective review of 492 patients who, between April 2012 and August 2015, underwent endoscopic endonasal transsphenoidal surgeries for resection of pituitary adenoma. A multivariate statistical analysis was performed to investigate the association of some risk factors with intraoperative CSF leakage. Intraoperative CSF leaks were classified as Grade 0, no leak observed; Grade 1, small leak without obvious diaphragmatic defect; Grade 2, moderate leak; or Grade 3, large diaphragmatic defect. Repair methods were based on the CSF leak grade.
RESULTS: Intraoperative CSF leakage occurred in 86 cases (17.5%). On univariate analysis, there were three factors associated with an increased intraoperative CSF leak rate: (1) repeat surgery (repeat 30.0% vs. primary 16.4%; P =0.033), (2) consistency of the adenoma (tenacious, 27.3% vs. soft, 13.5%; P = 0.000), (3) tumor size (22.0±9.7mm vs. 25.4±11.5mm; P = 0.007). However, on multivariate analysis, only tumor consistency (P =0.001; OR = 2.379) and tumor size (P = 0.026; OR = 1.032) were independently associated with intraoperative CSF leaks. In the 86 cases with intraoperative CSF leaks, the degree of intraoperative CSF leakage was categorized grade 1 in 30 cases, grade 2 in 25 cases, and grade 3 in 31 cases. Postoperative CSF leak repair failures occurred in 6 cases (1.2%).
CONCLUSIONS: Intraoperative CSF leaks have a propensity to occur in cases with fibrous or large size tumors. Once an intraoperative leak was identified, our graded cranial base repair method is safe and reliable.

PMID: 28192266 [PubMed - as supplied by publisher]

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