Incidence, Etiology, and Management of Cerebrospinal Fluid Leaks Following Trans‐Sphenoidal Surgery

Shiley, Samuel G.; Limonadi, Farhad M.; Delashaw, Johnny B.; Barnwell, Stanley L.; Andersen, Peter E.; Hwang, Peter H.; Wax, Mark K.

doi:10.1097/00005537-200308000-00003

Cited by 144 publications

(120 citation statements)

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“…Previous radiotherapy causes secondary alterations, such as poor vascularization and tissue necrosis, including the thinning of the bone at the base of the skull and thus, predisposes to CSF fistula, according to Nishioka 2 ; a relationship that was not found in this study. In the article of Shiley et al 4 , there is an association between intra and postoperative CSF fistula. The intraoperative CSF fistula index is described in the literature to be between 18.1 and 53.2% 4 .…”

Section: Discussionmentioning

confidence: 98%

“…This allows the resection of many tumors without the risk of disrupting the arachnoid 4 . Postoperative CSF fistula rates after microscopic or endoscopic transsphenoidal methods range between 0.5 to 15% 4,6 . Therefore, the rate of 8.2% of CSF fistula from the present study is documented in these reports.…”

Section: Discussionmentioning

confidence: 99%

“…Cappabianca et al describe an incidence of postendoscopic transsphenoidal CSF fistula around 2% in 170 surgeries 8,9 . Potential morbidities associated with CSF fistula after transsphenoidal surgery include: prolonged hospitalization, reintervention, bacterial meningitis, abscess 7 , subdural hematoma and pneumoencephalus of tension 4 . According to Hegazy et al conditions that increase intracranial pressure like hydrocephalus are an important cause of CSF fistula and its recurrence even after the initial treatment 7 .…”

Section: Discussionmentioning

confidence: 99%

“…Shiley et al, on the other hand, describe an increase in CSF fistula rate in patients with nonadenomatous disease, for example, craniopharingioma 4 . Nevertheless, in these situations, no association was found between the factors mentioned in our analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Schloffer and Harvey Cushing proposed a transseptal transsphenoidal approach to the pituitary gland in the beginning of 1900s. After removing the tumor, a strategy is needed to avoid the postoperative cerebrospinal fluid (CSF) fistula and related complications like meningitis, abscess, subdural hematoma and pneumoencephalus 3,4 . The postoperative CSF fistula remains the most serious complication after transsphenoidal surgery 5 .…”

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Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Romero

Nora

Topczewski

et al. 2010

Arq. Neuro-Psiquiatr.

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background: Postoperative cerebrospinal fluid (CSF) fistula is the most serious complication after transsphenoidal surgery. Objective: To analyze the incidence of CSF fistula after endoscopic transsphenoidal surgery for tumor removal in sellar region; to discuss associated factors and methods used for sellar closure. Method: Retrospective study of 67 patients (73 surgeries) operated via transsphenoidal endoscopy at Hospital Vall D'Hebron and Hospital Clinic of the Universidad de Barcelona, Spain. The data collected included: age, sex, hospitalization stay, suprasellar extension of the lesion, type of tumor, evidence of intraoperative CSF fistula, complications of postoperative CSF fistula, previous surgery and radiotherapy. results: Six patients (8.2%) had postoperative CSF fistula, and their average hospitalization was 5 days longer with resulting complications: two of whom had pneumoencephalus and two with meningitis. No association was found between the data collected and postoperative CSF fistula. conclusion: The rate of CSF fistula after endoscopic transsphenoidal surgery from the present study is contained within the literature. Unlike other reports, no association between the variables and postoperative CSF fistula was found in this report. Key words: cerebrospinal rhinorrhea, endoscopy, pituitary neoplasms.Fístula liquórica após cirurgia transesfenoidal endoscópica: experiência de um centro espanhol resuMO A fístula liquórica pós-operatória é a complicação mais séria após cirurgia transesfenoidal. Objetivo: Analisar a incidência de fístula liquórica após cirurgia endoscópica transesfenoidal para remoção de tumores selares, discutir fatores associados e método utilizado para fechamento selar. Método: Estudo retrospectivo de 67 pacientes (73 cirurgias) operados via endoscopia transesfenoidal no Hospital Vall D'Hebron e Hospital Clínic da Universidad de Barcelona, Espanha. Os dados coletados foram: idade, sexo, dias de internação, extensão supra-selar da lesão, tipo de tumor, evidência de fístula liquórica intra-operatória, complicações da fístula liquórica pós-operatória, cirurgia e radioterapia prévias. resultados: Seis pacientes (8.2%) tiveram fístula liquórica pós-operatória. Nestes a média de internação hospitalar foi 5 dias maior e tendo complicações decorrentes: dois com pneumoencéfalo e dois com meningite. Não se encontrou associação entre os dados coletados e fístula liquórica pós-operatória. conclusão: A taxa de fistula liquórica após cirurgia transesfenoidal endoscópica do presente estudo está dentro da literatura. Ao contrário de outros relatos, nesta pesquisa não foi encontrada associação entre as variáveis e fístula liquórica pós-operatória. Palavras-chave: endoscopia, neoplasias hipofisárias, rinorreia de líquido cefalorraquidiano.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Romero

Nora

Topczewski

et al. 2010

Arq. Neuro-Psiquiatr.

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Buried free flaps in head and neck surgery: Outcome analysis

2012

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Complications following primary and revision transsphenoidal surgeries for pituitary tumors

et al. 2014

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Objective This study aimed to determine the incidence of major complications following both primary and revision transsphenoidal pituitary surgery. Major complications included endocrinopathic, skull base, orbital, hemorrhagic and thromboembolic complications, respiratory failure, and death. Secondarily, this study aimed to examine factors associated with the occurrence of complications. Study Design Retrospective cohort analysis of California and Florida all-payer databases from 2005-2008. Methods The major complication rate following both primary and revision transsphenoidal pituitary surgery was calculated. Bivariate analyses were performed to investigate the relationship of patient characteristics with complication occurrence, and a multivariate model was constructed to determine risk factors associated with these complications. Results 5,277 primary cases and 192 revision cases met inclusion criteria. There was a non-significant absolute difference of 3.09% (95% CI −11.00 to 16.14) between the rate of complications following primary (n=443; 8.39%) and revision (n=22; 11.46%) surgeries. Multivariate analyses showed that patients with Medicare (OR=1.74; 95% CI 1.17 to 2.61), Medicaid (OR=2.13; 95% CI 1.59 to 2.86), or a malignant neoplasm (OR=3.10; 95% CI 1.62 to 5.93) were more likely to have complications. Conclusions The rate of major complications following transsphenoidal pituitary surgery is lower than earlier retrospective reports. The overall complication rate following revision surgery was not significantly different from primary surgery. Insurance status and a diagnosis of a malignant neoplasm were associated with a higher rate of complications.

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Incidence, Etiology, and Management of Cerebrospinal Fluid Leaks Following Trans‐Sphenoidal Surgery

Cited by 144 publications

References 23 publications

Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Buried free flaps in head and neck surgery: Outcome analysis

Complications following primary and revision transsphenoidal surgeries for pituitary tumors

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