Risk factors for postoperative cerebrospinal fluid leakage after transsphenoidal surgery for pituitary adenoma: a meta-analysis and systematic review

Abstract

Objective Postoperative cerebrospinal fluid (CSF) leakage represents a challenge even for experienced pituitary surgeons. We aimed to quantitatively synthesize data from studies regarding the risk factors for postoperative CSF leakage after transsphenoidal surgery (TSS) for pituitary adenoma (PA). Methods PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case–control and cohort studies, focusing on the risk factors associated with postoperative CSF leakage after TSS for PA. Pooled odds ratios (ORs) and 95% confidence intervals were calculated to determine the risk factors. Results A total of 34 case–control and cohort studies involving a total of 9,144 patients with PA were included in this systematic review. The overall rate of postoperative CSF leakage after TSS for PA was 5.6%. Tumor size, adenoma consistency, revision surgery, and intraoperative CSF leakage were independent risk factors for postoperative CSF leakage (ORs, 3.18–6.33). By contrast, the endoscopic approach showed a slight protective benefit compared with the microscopic approach in TSS (OR, 0.69). Conclusions This review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative CSF leakage after TSS for PA. More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis.

Factors Influencing Cerebrospinal Fluid Leaking following Pituitary Adenoma Transsphenoidal Surgery: A Meta-Analysis and Comprehensive Review

“…At present, according to known reports, the incidence of postoperative CSF Leak after endoscopic treatment of pituitary adenoma is between 0.5% and 14% [ 25 , 26 ]. In this study, the incidence of postoperative CSF Leak was 6.79%, close to 5.6% reported in the literature [ 9 , 26 ].…”

“…Although we found in this meta-analysis that age was not a risk factor for CSF Leak, it remains to be further determined because too few articles were included. In our study results, it was determined that BMI, tumor size, reoperation, and occurrence of intraoperative CSF Leak were related factors of postoperative CSF Leak, which were different from 4 related factors of tumor size, adenoma consistency, reoperation, and intraoperative CSF Leak obtained in the meta-analysis [ 9 ], which may be related to different literatures included in the two meta-analyses.…”

“…Studying the effect of preoperative and intraoperative factors on the occurrence of postoperative CSF Leak can help to foresee the occurrence and development of CSF Leak after transsphenoidal surgery in advance and carry out prevention or treatment in time. In the meta-analysis by Zhou et al [ 9 ], 34 observational studies and 9144 patients were included; gender, age and body mass index, tumor size and scope, tumor texture, and experience level of surgeons were summarized as the main factors of postoperative CSF Leak. However, most of the included studies were Chinese articles, with great implementation bias.…”

Endoscopic pituitary surgery: National database review

“…A recently published large meta-analysis of 34 case-control and cohort studies involving 9144 patients with pituitary adenomas revealed that giant adenoma (<4 cm) was associated with a 3Â increased odds of developing CSF leak versus macroadenoma or microadenoma. 28 In another meta-analysis, larger tumor size and volume were associated with increased complications in general. 9 There has been less consistent demonstration of increased risk of CSF leak in patients with macroadenoma (≥1 cm) versus microadenoma (<1 cm), with one single center study of 108 patients demonstrating no difference in postoperative CSF leak percentage between resection of macroadenomas (14%) and microadenomas (13%) 29 and another identifying lower risk with microadenoma (17%) compared to macroadenoma (34%).…”

“…Factoring prominently in the consideration for CSF leak risk is tumor size. A recently published large meta‐analysis of 34 case–control and cohort studies involving 9144 patients with pituitary adenomas revealed that giant adenoma (<4 cm) was associated with a 3× increased odds of developing CSF leak versus macroadenoma or microadenoma 28 . In another meta‐analysis, larger tumor size and volume were associated with increased complications in general 9 .…”