J Neurol Surg B Skull Base 2018; 79(S 01): S1-S188
DOI: 10.1055/s-0038-1633619
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Risk Factors Associated with Intraoperative Cerebrospinal Fluid Leak in Endoscopic Pituitary Surgery

Karam W. Badran
1   Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, United States
,
Satvir Saggi
1   Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, United States
,
Edward C. Kuan
2   Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
David Hsu
1   Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, United States
,
Marvin Bergsneider
3   Department of Neurosurgery, University of California, Los Angeles, California, United States
,
Marilene B. Wang
1   Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
02 February 2018 (online)

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Objective Cerebrospinal fluid (CSF) leakage is the leading cause of morbidity following transsphenoidal surgery. Few studies have investigated the perioperative factors which are associated with intraoperative CSF leaks during pituitary skull base surgery.

Methods A retrospective chart review at a tertiary care academic medical center of all patients, who underwent endonasal transsphenoidal surgery for resection of a pituitary tumor, from 2008 to 2017 was performed. A univariate and multivariate statistical analysis was performed. The type of reconstruction is described for all patients. The factors included for univariate analysis were: age, sex, tumor size, consistency, revision surgery, skull base radiation, diabetes mellitus, body mass index, capsular dissection, total resection.

Results Of 492 identified cases (332 nonfunctional pituitary adenomas), intraoperative CSF leak occurred in 33.3% of cases (n = 164). Patient demographics included 52% male, 16% diabetes mellitus, 15.8% revision surgery, and 1.2% skull base radiation. Tumor characteristics included size (23.00 ± 10.56 mm, p = 0.07) and infrasellar invasion (48%, p = 0.35). Following univariate analysis, multivariate analysis was performed on pathology type, tumor size, presence of diabetes, cavernous sinus invasion, suprasellar extension, and revision surgery. Revision surgery (p = 0.006, OR: 10.1) was the only factor significantly associated with intraoperative CSF leak, resulting in a 10-fold increase in the chance of leakage.

Conclusion Revision surgery is the only statistically significant factor of intraoperative CSF leak when undergoing transnasal transsphenoidal pituitary surgery, with an attributable 10-fold increase in the likelihood of leakage.