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

Abstract

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.

Endoscopic endonasal surgery for skull base tumours: technique and preliminary results in a consecutive case series report

“…Indeed, in the early stages of endoscopic surgery for sellar lesions, the highest percentage of CSF leak occurred during the rst 60 cases (36) . The same level of incidence has been observed with the present series.…”

Cranial Base Repair with Combined Vascularized Nasal Septal Flap and Autologous Tissue Graft Following Expanded Endonasal Endoscopic Neurosurgery

“…[1][2][3][4][5][6][7] Similarly, standard endoscopy-assisted transsphenoidal surgery is associated with a postoperative CSF leak rate of 0.5 to 10%. [8][9][10][11][12][13][14] The expanded endonasal endoscopic approach to the skull base provides the surgeon with excellent visualization and wide access to the cranial base but at the expense of a relatively high rate (5 to 30%) of postoperative CSF leaks. [15][16][17][18][19][20][21][22][23][24][25][26] Despite this potential drawback, the expanded endoscopic endonasal approach has garnered much attention for the resection of midline skull base lesions due to the unparalleled visualization that it provides.…”

Endoscopic combined “transseptal/transnasal” approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases

“…There have been many reports describing methods and strategies for reconstruction of a dural defect in the sellar floor and the skull base 2,3,4,5,6,7,8 . The utility of a pedicled nasoseptal flap 9 for the reconstruction of a large dural defect has recently become more widely accepted, but reports have included a variety of pathologies, approaches and reconstruction techniques 6,8,10 .…”

“…Various reports have demonstrated good results for prevention of postoperative CSF fistula using an endoscopic approach 2,3,4,5,7,14 . However, most of the reports included various pathologies and origins of the CSF leak; for example, pituitary adenomas, craniopharyngiomas, meningiomas and malignant tumors, which were operated through different surgical approaches, and various strategies were applied for prevention of CSF fistula 2,4,5,7 . Furthermore no studies have directly compared these strategies.…”