Lower airway disease and pituitary surgery: Is there an association with postoperative cerebrospinal fluid leak?

Hanba, Curtis; Svider, Peter F.; Jacob, Jeffrey T.; Guthikonda, Murali; Liu, James K.; Eloy, Jean Anderson; Folbe, Adam J.

doi:10.1002/lary.26364

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…The increased intrathoracic pressure leading to a decreased blood ow of the jugular vein resulting in an increased intracranial pressure may cause herniation of the repaired material from the sellar base and CSF leakage. Two other studies 11,12 had proven the mechanism of an increased intracranial pressure playing an important role in the occurrence of postoperative CSF leakage or a spontaneous CSF leakage. Hanba et al 12 discovered that patients with asthma are more likely to have CSF leakage than patients without asthma after transnasal surgery; further, the rate of postoperative CSF leakage in these two groups was 4.7% and 2.7%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Two other studies 11,12 had proven the mechanism of an increased intracranial pressure playing an important role in the occurrence of postoperative CSF leakage or a spontaneous CSF leakage. Hanba et al 12 discovered that patients with asthma are more likely to have CSF leakage than patients without asthma after transnasal surgery; further, the rate of postoperative CSF leakage in these two groups was 4.7% and 2.7%, respectively. Fleischman et al 11 found that patients with obstructive sleep apnea are more likely to develop a spontaneous CSF leakage.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors Impacting Intra- and Postoperative Cerebrospinal Fluid Rhinorrhea on the Endoscopic Treatment of Pituitary Adenomas: Retrospective Experience From 250 Patients

Wang

Cai

Jiang

et al. 2020

Preprint

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Aim: We aimed to identify the risk factors associated with intra- and postoperative cerebrospinal fluid leakage in pituitary adenomas treated by endoscopic transsphenoidal surgery. Material and methods: A retrospective analysis of 250 pituitary adenoma cases from January 2017 to December 2019 at our hospital was conducted; all patients underwent endoscopic endonasal transsphenoidal surgeries. A univariate analysis and multivariate analysis was performed to investigate the risk factors associated with intra- and postoperative CSF rhinorrhea.Results: Eighty(32.0%) and nine(3.6%) patients had intraoperative and postoperative CSF leakages, respectively. Tumor size was an independent risk factor for intraoperative CSF leakage (OR, 1.229; 95% CI, 1.133–1.334; P<0.001); intraoperative CSF leakage was an independent risk factor for postoperative CSF leakage (OR, 7.707; 95% CI, 1.336–44.455; P=0.022). Chronic respiratory disease (OR, 57.500; 95% CI, 8.031–411.682; P<0.001) was also an independent risk factor for postoperative CSF leakage; vascularized septal mucosal flap was a protective factor for such (OR, 0.107; 95% CI, 0.013–0.894; P=0.039).Conclusion: Intraoperative CSF leakages are more likely to occur in large pituitary adenomas; in the presence of intraoperative CSF leakages, postoperative CSF rhinorrhea is very likely to occur. Patients with chronic respiratory disease are also more likely to develop postoperative CSF leakages. However, the sellar base reconstructed using vascularized nasal septal flaps can significant decrease the risk for such. Knosp grade, degree of tumor resection, postoperative lumbar subarachnoid drain use did not seem to have effect on the postoperative CSF rhinorrhea.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk Factors Impacting Intra- and Postoperative Cerebrospinal Fluid Rhinorrhea on the Endoscopic Treatment of Pituitary Adenomas: Retrospective Experience From 250 Patients

Wang

Cai

Jiang

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The increased intrathoracic pressure leading to decreased blood flow in the jugular vein, resulting in increased intracranial pressure, may cause herniation of the repaired material from the sellar base and thus, CSF leakage. Two other studies [ 11 , 12 ] have shown that an increased intracranial pressure plays an important role in the occurrence of postoperative CSF leakage or spontaneous CSF leakage. Hanba et al [ 12 ] discovered that patients with asthma are more likely to have CSF leakage than patients without asthma after transnasal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Two other studies [ 11 , 12 ] have shown that an increased intracranial pressure plays an important role in the occurrence of postoperative CSF leakage or spontaneous CSF leakage. Hanba et al [ 12 ] discovered that patients with asthma are more likely to have CSF leakage than patients without asthma after transnasal surgery. Furthermore, the rates of postoperative CSF leakage in these two groups were 4.7% and 2.7%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Risk factors impacting intra- and postoperative cerebrospinal fluid rhinorrhea on the endoscopic treatment of pituitary adenomas

Wang¹,

Cai²,

Jiang³

et al. 2021

Medicine

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We aimed to identify the risk factors associated with intra- and postoperative cerebrospinal fluid (CSF) leakage in pituitary adenomas treated with endoscopic transsphenoidal surgery. This study is a retrospective analysis of 250 pituitary adenoma cases from January 2017 to December 2019 at our hospital. All patients underwent endoscopic endonasal transsphenoidal surgeries. Univariate and multivariate analyses were performed to investigate the risk factors associated with intra- and postoperative CSF rhinorrhea. Eighty (32.0%) and nine (3.6%) patients had intra- and postoperative CSF leakage, respectively. Tumor size was an independent risk factor for intraoperative CSF leakage (odds ratio [OR], 1.229; 95% confidence interval [CI], 1.133–1.334; P < .001); intraoperative CSF leakage was an independent risk factor for postoperative CSF leakage (OR, 7.707; 95% CI, 1.336–44.455; P = .022). Chronic respiratory disease (OR, 57.500; 95% CI, 8.031–411.682; P < .001) was also an independent risk factor for postoperative CSF leakage. Vascularized septal mucosal flap was a protective factor (OR, 0.107; 95% CI, 0.013–0.894; P = .039). Intraoperative CSF leakage is more likely to occur in large pituitary adenomas. In the presence of intraoperative CSF leakage, postoperative CSF rhinorrhea is very likely to occur. Patients with chronic respiratory disease are also more likely to develop postoperative CSF leakage. The sellar base reconstructed using vascularized nasal septal flaps can significantly decrease the risk. The Knosp grade, degree of tumor resection, and postoperative use of a lumbar subarachnoid drain did not have any effects on postoperative CSF rhinorrhea.

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Evaluating pituitary adenomas using national research databases: systematic review of the quality of reporting based on the STROBE scale

Khan

Yost

et al. 2022

Neurosurg Rev

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Lower airway disease and pituitary surgery: Is there an association with postoperative cerebrospinal fluid leak?

Abstract: 2c. Laryngoscope, 127:1543-1550, 2017.

Cited by 4 publications

References 24 publications

Risk Factors Impacting Intra- and Postoperative Cerebrospinal Fluid Rhinorrhea on the Endoscopic Treatment of Pituitary Adenomas: Retrospective Experience From 250 Patients

Risk Factors Impacting Intra- and Postoperative Cerebrospinal Fluid Rhinorrhea on the Endoscopic Treatment of Pituitary Adenomas: Retrospective Experience From 250 Patients

Risk factors impacting intra- and postoperative cerebrospinal fluid rhinorrhea on the endoscopic treatment of pituitary adenomas

Evaluating pituitary adenomas using national research databases: systematic review of the quality of reporting based on the STROBE scale

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