Cerebrospinal fluid rhinorrhea following trans-sphenoidal pituitary macroadenoma surgery: experience from 592 patients.
OBJECTIVE
To determine the incidence, risk factors, diagnostic procedures, and management of cerebrospinal fluid (CSF) leaks following trans-sphenoidal pituitary macroadenoma surgery.


METHODS
Retrospective analysis of 592 patients.


RESULTS
Intra- and post-operative CSF leaks occurred in 14.2 and 4.4% of patients, respectively. Surgical revision, tumor consistency, and tumor margins were independently associated with intra-operative leaks, while the tumor size, consistency, and margins were risk factors of post-operative leaks. The intra-operative leak rate of ACTH adenomas was greater than all other types combined; the incidence of post-operative CSF leaks was highest for FSH adenomas. There were no significant differences among various techniques and we achieved an initial repair success rates of 83.3 and 92.9% for intra- and post-operative CSF leaks, respectively. Of the 26 patients with post-operative CSF leaks, five were complicated by meningitis and four by post-infectious hydrocephalus which required ventriculoperitoneal shunts.


CONCLUSIONS
CSF leaks have a propensity to occur in cases with fibrous tumors or tumors with indistinct margin and may have some relationship with the tumor type. Endoscopic and microscopic repairs were shown to be effective techniques in managing these types of leaks. Post-infectious hydrocephalus may influence the outcome of the repair and ventriculoperitoneal shunts were necessary in some cases.
Han
Zong-Li
ZL
Department of Neurosurgery of the First Affiliated Hospital, Sun Yat-sen University, China.
He
Dong-Sheng
DS
Mao
Zhi-Gang
ZG
Wang
Hai-Jun
HJ
D000236:Adenoma / Q000134:cerebrospinal fluid / Q000473:pathology / Q000601:surgery*; D004322:Drainage; D006801:Humans; D007431:Intraoperative Complications / Q000134:cerebrospinal fluid*; D008279:Magnetic Resonance Imaging; D009296:Nasal Cavity / Q000502:physiology; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000134:cerebrospinal fluid / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000134:cerebrospinal fluid*; D012086:Reoperation; D012307:Risk Factors; D013100:Sphenoid Bone / Q000601:surgery*