Difference in the incidence of cerebrospinal fluid leakage and residual tumors between functional and nonfunctional pituitary adenomas treated by endoscopic transsphenoidal pituitary adenomectomy

Abstract

ObjectiveThis study compared the incidence of cerebrospinal fluid (CSF) leakage and residual tumors between functional and nonfunctional pituitary adenomas treated with the endoscopic endonasal transsphenoidal approach (EETA).MethodsAll patients underwent endocrine examinations and brain magnetic resonance imaging before and after surgery. The length of admission, incidence of central diabetes insipidus, incidence of CSF leakage, symptom relief, and presence of residual tumors were compared between patients with functional and nonfunctional pituitary adenomas.ResultsThirty-eight patients were enrolled, among whom 12 and 26 had functional and nonfunctional pituitary adenomas, respectively. The incidence of CSF leakage was significantly higher in patients with nonfunctional adenomas; a hard or elastic tumor character accounted for the difference. A large tumor size and cavernous sinus invasion were risk factors for residual tumors. No significant differences were found in sex, length of admission, operative times, incidence of diabetes insipidus, or number of residual tumors between the two groups. The hormone levels were lower postoperatively than preoperatively in patients with nonfunctional adenomas.ConclusionNonfunctional pituitary macroadenomas resulted in more CSF leakage. Use of the rescue nasoseptal flap reduced unnecessary nasal destruction. Cooperation between a neurosurgeon and otolaryngologist was safer and more effective when using the EETA.

Remission, complications, and overall survival in transsphenoidal pituitary surgery—a Swedish single-center experience of 578 patients

“…The rates of postoperative CSF leakage in our study seem to be high from an international perspective. However, the frequency of CSF leak varied over the years and in more recent years, our rates were comparable to those published from other high-volume centers [12,24]. Several studies have indicated an advantage of using a multidisciplinary team consisting of rhinologists and neurosurgeons when performing endoscopic approach to the sellar region [23].…”

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

“…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.…”

“…Hannan proposed that adrenocorticotropic hormone adenoma is a risk factor for cerebrospinal fluid leakage, due to centripetal obesity and higher BMI in patients with Cushing’s disease ( 18 ).While, Lee believed that nonfunctional pituitary macroadenoma was a risk factor, for the large tumor size. We need more clinical studies to confirm it ( 29 ).…”