Risk factors of cerebrospinal fluid rhinorrhea following transsphenoidal surgery.
OBJECTIVE
Cerebrospinal fluid (CSF) rhinorrhea is a potentially life-threatening complication following transsphenoidal surgery (TSS).


METHODS
To elucidate the risk factors that may affect the incidence of postoperative CSF rhinorrhea, we retrospectively reviewed 200 consecutive cases of TSS performed by a single surgeon for 168 adenomas and 32 other sellar and parasellar lesions.


RESULTS
Intra-operative CSF leakage was encountered in 38 cases (19.0%). Its incidence did not correlate to tumor size. Among 4 microadenoma cases with CSF leak, 3 were ACTH adenomas. In contrast, postoperative CSF rhinorrhea was observed in 5 cases (2.5%), all following TSS for adenomas. It was frequently noted in cases with prior TSS (3/40, 7.5%, p = 0.0235) and prior radiotherapy (2/7, 28.6%, p < 0.0001). Two cases who required surgical intervention had received TSS and radiotherapy previously.


CONCLUSIONS
The risk of postoperative CSF rhinorrhea is significantly increased in cases with prior TSS or radiotherapy or both. In addition, these cases tended to show delayed CSF leaks and require sellar reconstruction for its treatment. When a CSF leak was encountered during TSS in these high-risk cases, thorough sellar reconstruction and long-term follow-up is necessary.
Nishioka
H
H
Department of Neurosurgery, Tokyo Medical University, Japan. nishioka@tokyo-med.ac.jp
Haraoka
J
J
Ikeda
Y
Y
D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D003397:Craniopharyngioma / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D011878:Radiotherapy / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000592:standards; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012658:Sella Turcica / Q000473:pathology / Q000528:radiation effects / Q000601:surgery*; D013101:Sphenoid Sinus / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed