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

Abstract

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.

Risk factors and management associated with postoperative cerebrospinal fluid leak after endoscopic endonasal surgery for pituitary adenoma

“…Consistent with reports in the literature ( 13 , 18 ), our study showed that intraoperative CSF leak increases postoperative CSF leak rate. In this study, 107 (26.8%) patients developed intraoperative CSF leak.…”

“…In the current study, 3.5% of patients with pituitary adenomas developed cerebrospinal fluid leakage after EES. Similar to other studies ( 4 , 13 ), there was no statistically significant difference in age, gender, and Knosp grade between those with and without postoperative CSF leaks in the present study.…”

Risk factors of cerebrospinal fluid leakage after neuroendoscopic transsphenoidal pituitary adenoma resection: a systematic review and meta-analysis

“…The destruction of the anatomical structure of the skull base is the direct cause of CSF leakage. Considering the factors of the operation itself, we got that intraoperative CSF leakage and multiple operations were associated with postoperative CSF leakage ( Figure 4 ) ( 11 , 12 , 14 – 16 , 18 – 20 , 26 ). There was significant statistical significance (respectively, OR = 5.61,95% CI (3.53, 8.90), P<0.00001, and OR = 2.27, 95% CI (1.60, 3.23), P < 0.00001) with no heterogeneity.…”

“…There were not enough studies to evaluate the influence of age ( 10 , 25 , 26 , 28 ), tumor pathological type ( 18 , 29 ), and experience of the surgeon ( 18 ), combined with other intracranial diseases ( 23 , 30 ), albumin level ( 17 ), chronic respiratory disease ( 16 ), and diabetes mellitus ( 10 ).We can only conduct qualitative analysis based on the literature (detailed information shown in Table 3 ).There was no significant statistical difference in the impact of gender on postoperative CSF leakage.…”

Upright CT-based evaluation of the effects of posture on skull-base reconstruction after endoscopic endonasal surgery

“…The bi-nostril approach was used for EESBS at our institution. We performed graded skull-base reconstruction based on the surgeon's preference by predicting the risk of postoperative CSF leakage, considering the reported risk factors such as dural defect and intraoperative CSF leakage [7][8][9][10].Multilayered reconstruction using fat, fascia, and a nasoseptal ap was performed for patients with several risk factors, while simple coverage of the sphenoid sinus mucosa was performed for patients without risk factors. Rigid reconstruction was not performed at our institution.…”