Postoperative Low-Flow Cerebrospinal Fluid Leak of Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenoma

The detailed surgical procedure of the transsphenoidal surgery for pituitary abscess has scarcely been described previously because it is a very rare clinical entity. The authors reported two cases of primary pituitary abscess. In case 1, the anterior wall of the sella turcica was reconstructed with the vomer bone after irrigating the abscess cavity, but the sella was not packed by fat for fear of the persistent infection by devascularized tissues. This led to the postoperative meningocele, the cerebrospinal fluid leak, and bacterial meningitis despite the successful abscess drainage. In case 2, tight sellar packing and reconstruction of the sellar wall were performed to avoid these postoperative complications, which resulted in complete drainage and uneventful postoperative course. Although accumulation of more cases is obviously needed to establish the definitive surgical technique in pituitary abscess surgery, our experience might suggest that packing of the sella is not impeditive for postoperative sufficient drainage.

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The endoscopic endonasal approach for cerebrospinal fluid leak repair in the elderly

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2015.02.013 ◽

2015 ◽

Vol 132 ◽

pp. 21-25 ◽

Cited By ~ 7

Author(s):

Enzo Emanuelli ◽

Laura Milanese ◽

Marta Rossetto ◽

Diego Cazzador ◽

Elena d’Avella ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Cerebrospinal Fluid Leak ◽

The Elderly ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Fluid Leak

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Endoscopic endonasal transpterygoid approach for reduction of a lateral recess encephalocele with postoperative cerebrospinal fluid leak

BMJ Case Reports ◽

10.1136/bcr-2020-235877 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235877

Author(s):

Adham M Khalafallah ◽

Omar G Ahmed ◽

Nicholas R Rowan ◽

Debraj Mukherjee

Keyword(s):

Cerebrospinal Fluid ◽

Cerebrospinal Fluid Leak ◽

Endoscopic Endonasal ◽

Lateral Recess ◽

Fluid Leak

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Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1692639 ◽

2019 ◽

Vol 81 (05) ◽

pp. 553-561

Author(s):

Gülpembe Bozkurt ◽

Mario Turri-Zanoni ◽

Elisa Coden ◽

Federico Russo ◽

Hassan Ahmed Elhassan ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Dry Eye ◽

Sphenoid Sinus ◽

Cerebrospinal Fluid Leak ◽

Significant Morbidity ◽

Endoscopic Endonasal ◽

Lateral Recess ◽

Fluid Leak ◽

Extensive Surgery

Background Lesions affecting sphenoid sinus lateral recess (SSLR) are difficult to visualize and manipulate through the transnasal routes, especially when the sinus is highly pneumatized. External approaches to this area involve extensive surgery and are associated with significant morbidity. The aims of this study are to present our experience with the endoscopic transpterygoid approach as a method for approaching lesions of the SSLR and to evaluate the outcomes of this procedure.Methods Clinical charts of patients who had lesions in the SSLR and who were treated at our institution from September 1998 to June 2018 were retrospectively reviewed. All these patients were managed by the endoscopic endonasal transpterygoid approach.Results Thirty-nine patients were identified. No cerebrospinal fluid leak recurrences were observed during follow-up (range: 1–19.7 years; median: 2.3 years). Hypoesthesia (temporary, 1; persistent, 4) in the region innervated by the maxillary branch of the trigeminal nerve was detected in five (12.8%) patients, while symptoms due to the Vidian nerve damage (dry eye, 3; dry nasal mucosa, 1) were present in four (10%) patients.Conclusions Although the endoscopic endonasal transpterygoid approach is an excellent corridor for dealing with lesions of the SSLR, limited rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention should be discussed during preoperative counselling.

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Predictive Factors, 30-Day Clinical Outcomes, and Costs Associated with Cerebrospinal Fluid Leak in Pituitary Adenoma Resection

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1679896 ◽

2019 ◽

Vol 81 (01) ◽

pp. 043-055 ◽

Cited By ~ 1

Author(s):

Adish Parikh ◽

Arjun Adapa ◽

Stephen E. Sullivan ◽

Erin L. McKean

Keyword(s):

Cerebrospinal Fluid ◽

Multivariate Analysis ◽

Pituitary Adenoma ◽

Demographic Data ◽

Cerebrospinal Fluid Leak ◽

Hospital Charges ◽

Csf Leak ◽

Endoscopic Endonasal ◽

Financial Variables ◽

Clinical Complications

AbstractCerebrospinal fluid (CSF) leak is a complication of endoscopic endonasal pituitary adenoma resection. Previous studies examining complications of pituitary adenoma resection have not examined associations of an exhaustive list of clinical and financial variables with CSF leak. We designed a retrospective analysis of 334 consecutive patients that underwent endoscopic endonasal pituitary adenoma resection at a single institution over 5 years, analyzing associations between CSF leak and demographic data, operative data, comorbidities, clinical complications and outcomes, costs, charges, and payments. Of the 20 preoperative variables studied, none were positively associated with CSF leak in between-groups comparison, although multivariate analysis revealed an association with a history of radiation to the skull base (odds ratio [OR], 8.67; 95% confidence interval [CI], 0.94–57.03; p < 0.05). CSF leak was associated with a significantly higher rate of postoperative diabetes insipidus (Δ = 33.4%, p = 0.040) and increased length of stay after operation in between-groups comparison. Multivariate analysis on postoperative variables revealed significant associations between CSF leak and intracerebral hemorrhage (OR, 17.44; 95% CI, 0.65–275.3; p < 0.05) and postoperative intracranial infection (OR, 28.73; 95% CI, 2.04–438.7; p < 0.05). Also, CSF leak was associated with significantly higher costs (Δ = $15,643, p < 0.05) and hospital charges (Δ = $46,026, p < 0.05). Operating room time, room and board, and supplies and implants were the strongest cost drivers. This study highlights the difficulty of utilizing preoperative variables to predict CSF leak, the clinical complications and outcomes of leak, and the financial subcategories that drive the costs, charges, and payments associated with this complication.

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