Anatomical Risk Factors for Intraoperative Cerebrospinal Fluid Leaks During Transsphenoidal Surgery for Pituitary Adenomas

Campero, Álvaro; Villalonga, Juan F.; Basso, Armando

doi:10.1016/j.wneu.2018.12.094

Cited by 15 publications

(39 citation statements)

References 31 publications

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“…Similar to our previous reports, we found more frequently strong sellar barriers in the clinical cases, 73.69%; (14) (Campero et al, ; Villalonga et al, ).…”

Section: Discussionsupporting

confidence: 92%

“…The sellar barrier works as an interface between the tumor and the CSF. It is composed of three anatomical layers: arachnoid tissue (the only constant), the dura mater of the sellar diaphragm, and the pituitary glandular tissue (Campero et al, ). A complete barrier is necessary to prevent CSF leakage.…”

Section: Discussionmentioning

confidence: 99%

“…Based on their anatomical structure, initially we described two types of sellar barriers: the strong and the weak (Campero et al, ). We considered the barrier strong if it was constituted by dura and/or gland and weak if it was constituted only by arachnoid tissue.…”

Section: Discussionmentioning

confidence: 99%

“…All surgeries were performed by Senior surgeons (D.S., L.M.C., and P.C.). All patients included in the study had preoperative MRIs (1.5 or 3 Tesla) and we grouped them according to the type of the sellar barrier, based on the original classification (Campero et al, ). We defined a strong sellar if the roof was thicker than 1 mm, a weak sellar barrier if the roof was thinner than 1 mm, and a mixed sellar barrier if it had areas with less than 1 mm and areas with more than 1 mm of thickness.…”

Section: Methodsmentioning

confidence: 99%

“…Additionally, we proved an association between the different subtypes of sellar barriers and the risk of CSF leak. A strong barrier is associated with a lower risk of CSF leak, while a weak barrier significantly increases the risk of intraoperative CSF leak (Campero et al, ).…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic anatomy of the sellar barrier: From the anatomical model to the operating room

et al. 2020

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Background The sellar barrier concept reflects the association between the components of the roof of the pituitary fossa and the risk of intraoperative cerebrospinal fluid (CSF) leak in the surgery of pituitary adenomas. We based our concept in previous reports on the microsurgical anatomy of the pituitary fossa's superior wall. However, proof of the usefulness of this concept in endoscopic approaches is yet missing. The aim of this study was to describe the endoscopic anatomy of the sellar barrier and its subtypes in a laboratory setting and to provide evidence of its clinical usefulness. Methods We provided anatomical models in six fresh‐frozen head and neck specimens. We performed an endoscopic endonasal approach and recreated a pathological model of each possible subtype of sellar barrier. To demonstrate the usefulness of this model in clinical practice, we conducted a prospective study including all patients with pituitary adenoma operated by an endoscopic approach between June and July 2019. Results We successfully recreated the models for each subtype of sellar barrier. When analyzing the clinical cases, we found that intraoperatively, 73.69% (14) had a strong sellar barrier; 21.05% (4) had mixed sellar barrier, and 5.26% (1) had weak sellar barrier. We recorded one case of intraoperative CSF leak in a patient with a weak sellar barrier by magnetic resonance imaging. Conclusion We described the endoscopic anatomy of the sellar barrier and we recreated the three subtypes in anatomical models. We also identified these subtypes in a series of clinical cases, proving its clinical usefulness.

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“…Similar to our previous reports, we found more frequently strong sellar barriers in the clinical cases, 73.69%; (14) (Campero et al, ; Villalonga et al, ).…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic anatomy of the sellar barrier: From the anatomical model to the operating room

et al. 2020

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Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery

et al. 2022

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Background: Most pituitary adenomas (PAs) are considered to have a soft tumor consistency. However, there is a non-negligible percentage (5-13%) of tumors presenting or exhibiting a brous consistency that would entail a more di cult and complicated surgical excision with higher surgical morbidity and mortality rates.Purpose: To analyze the clinical consequences of PA tumor consistency on the surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal (EET) pituitary surgery.Methods: An ambispective study of patients with PAs operated on through an EET approach in two Spanish tertiary hospitals over the last 12 years. A total of 226 consecutive interventions were carried out in the Neurosurgery Departments of the Hospital Universitario Ramón y Cajal (HURC) and the Hospital Universitario Puerta del Sur by the same neurosurgeon. PAs were grouped into soft (n = 150) and brous (n = 76). All patients underwent hormonal and magnetic resonance imaging (MRI) studies before and after surgery. In addition, neurosurgical complications were recorded in each patient.Results: Fibrous adenomas were independently associated with lower resection rates compared to soft adenomas ( brous gross total resection [GTR] rate 48.7% vs. 76.3%, p < 0.001), even in those adenomas without invasion of the cavernous sinus (Knosp grades 0, I, and II). There were more intraoperative cerebrospinal uid (CSF) leaks in patients with brous PAs. Moreover, brous PAs showed higher rates of postoperative hypopituitarism, permanent diabetes insipidus (DI) and postoperative treatments (hormonal treatment and radiotherapy). The excision of a brous PA required a longer surgical time (22.5 minutes more than soft PAs, p = 0.014), regardless of other factors.

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Clinical evaluation of the sellar mass patient

Rincon-Torroella,

Liu,

Ishii

et al. 2024

Cerebrospinal Fluid Rhinorrhea

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Anatomical Risk Factors for Intraoperative Cerebrospinal Fluid Leaks During Transsphenoidal Surgery for Pituitary Adenomas

Cited by 15 publications

References 31 publications

Endoscopic anatomy of the sellar barrier: From the anatomical model to the operating room

Endoscopic anatomy of the sellar barrier: From the anatomical model to the operating room

Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery

Clinical evaluation of the sellar mass patient

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