Intraoperative lumbar drainage can prevent cerebrospinal fluid leakage during transsphenoidal surgery for pituitary adenomas: a systematic review and meta-analysis

Abstract Background Cerebrospinal fluid (CSF) leakage is a common complication after neurosurgical intervention. It is associated with substantial morbidity and increased healthcare costs. The current systematic review and meta-analysis aim to quantify the incidence of cerebrospinal fluid leakage in the pediatric population and identify its risk factors. Methods The authors followed the PRISMA guidelines. The Embase, PubMed, and Cochrane database were searched for studies reporting CSF leakage after intradural cranial surgery in patients up to 18 years old. Meta-analysis of incidences was performed using a generalized linear mixed model. Results Twenty-six articles were included in this systematic review. Data were retrieved of 2929 patients who underwent a total of 3034 intradural cranial surgeries. Surprisingly, only four of the included articles reported their definition of CSF leakage. The overall CSF leakage rate was 4.4% (95% CI 2.6 to 7.3%). The odds of CSF leakage were significantly greater for craniectomy as opposed to craniotomy (OR 4.7, 95% CI 1.7 to 13.4) and infratentorial as opposed to supratentorial surgery (OR 5.9, 95% CI 1.7 to 20.6). The odds of CSF leakage were significantly lower for duraplasty use versus no duraplasty (OR 0.41 95% CI 0.2 to 0.9). Conclusion The overall CSF leakage rate after intradural cranial surgery in the pediatric population is 4.4%. Risk factors are craniectomy and infratentorial surgery. Duraplasty use is negatively associated with CSF leak. We suggest defining a CSF leak as “leakage of CSF through the skin,” as an unambiguous definition is fundamental for future research.

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Closure of Cerebrospinal Fluid Leakage after Transsphenoidal Surgery

Neurosurgery ◽

10.1097/00006123-199412000-00033 ◽

1994 ◽

Vol 35 (6) ◽

pp. 1189

Author(s):

Jules Hardy ◽

Richard M. Lehman

Keyword(s):

Cerebrospinal Fluid ◽

Transsphenoidal Surgery ◽

Cerebrospinal Fluid Leakage ◽

Fluid Leakage

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Delayed Cerebrospinal Fluid Leakage 10 Years After Transsphenoidal Surgery and Gamma Knife Surgery

Neurologia medico-chirurgica ◽

10.2176/nmc.47.483 ◽

2007 ◽

Vol 47 (10) ◽

pp. 483-485 ◽

Cited By ~ 11

Author(s):

Yoshikazu OGAWA ◽

Teiji TOMINAGA

Keyword(s):

Cerebrospinal Fluid ◽

Gamma Knife ◽

Transsphenoidal Surgery ◽

Gamma Knife Surgery ◽

Cerebrospinal Fluid Leakage ◽

Fluid Leakage

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Risk Factors For Postoperative Cerebrospinal Fluid Leakage After Transsphenoidal Surgery For Pituitary Adenoma: A Meta-Analysis And Systematic Review

10.21203/rs.3.rs-601428/v1 ◽

2021 ◽

Author(s):

Zhihuan Zhou ◽

Feifei Zuo ◽

Xiaoqun Chen ◽

Qinqin Zhao ◽

Mengna Luo ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cerebrospinal Fluid ◽

Pituitary Adenoma ◽

Cohort Studies ◽

Transsphenoidal Surgery ◽

Case Control ◽

Cochrane Library ◽

Cerebrospinal Fluid Leakage ◽

Csf Leakage

Abstract Objective: Postoperative cerebrospinal fluid (CSF) leakage represents a challenge even for experienced pituitary surgeons. We aimed to quantitatively synthesize data from studies regarding the risk factors for postoperative CSF leakage after transsphenoidal surgery (TSS) for pituitary adenoma (PA).Methods: PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case–control and cohort studies, focusing on the risk factors associated with postoperative CSF leakage after TSS for PA. Pooled odds ratios (ORs) and 95% confidence intervals were calculated to determine the risk factors.Results: A total of 34 case–control and cohort studies involving a total of 9,144 patients with PA were included in this systematic review. The overall rate of postoperative CSF leakage after TSS for PA was 5.6%. Tumor size, adenoma consistency, revision surgery, and intraoperative CSF leakage were independent risk factors for postoperative CSF leakage (ORs, 3.18–6.33). By contrast, the endoscopic approach showed a slight protective benefit compared with the microscopic approach in TSS (OR, 0.69).Conclusions: This review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative CSF leakage after TSS for PA. More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis.

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Efficacy of Transsphenoidal Surgery in Achieving Biochemical Cure of Growth Hormone-secreting Pituitary Adenomas Among Patients with Cavernous Sinus Invasion: A Systematic Review and Meta-analysis

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1600650 ◽

2017 ◽

Vol 78 (S 01) ◽

pp. S1-S156

Author(s):

Vanessa Briceno ◽

Hasan Zaidi ◽

Joanne Doucette ◽

Kaho Onomichi ◽

Amer Alreshidi ◽

...

Keyword(s):

Systematic Review ◽

Growth Hormone ◽

Cavernous Sinus ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Meta Analysis ◽

Cavernous Sinus Invasion ◽

Biochemical Cure

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Effect of repeated transsphenoidal surgery in recurrent or residual pituitary adenomas: A systematic review and meta-analysis

Surgical Neurology International ◽

10.4103/2152-7806.175896 ◽

2016 ◽

Vol 7 (1) ◽

pp. 14 ◽

Cited By ~ 5

Author(s):

MatheusFernandes de Oliveira ◽

LindolfoCarlos Heringer ◽

JoséMarcus Rotta ◽

RicardoVieira Botelho

Keyword(s):

Systematic Review ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Meta Analysis

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Risk factors for postoperative cerebrospinal fluid leakage after transsphenoidal surgery for pituitary adenoma: a meta-analysis and systematic review

BMC Neurology ◽

10.1186/s12883-021-02440-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhihuan Zhou ◽

Feifei Zuo ◽

Xiaoqun Chen ◽

Qinqin Zhao ◽

Mengna Luo ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cerebrospinal Fluid ◽

Pituitary Adenoma ◽

Cohort Studies ◽

Transsphenoidal Surgery ◽

Case Control ◽

Cochrane Library ◽

Cerebrospinal Fluid Leakage ◽

Csf Leakage

Abstract Objective Postoperative cerebrospinal fluid (CSF) leakage represents a challenge even for experienced pituitary surgeons. We aimed to quantitatively synthesize data from studies regarding the risk factors for postoperative CSF leakage after transsphenoidal surgery (TSS) for pituitary adenoma (PA). Methods PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case–control and cohort studies, focusing on the risk factors associated with postoperative CSF leakage after TSS for PA. Pooled odds ratios (ORs) and 95% confidence intervals were calculated to determine the risk factors. Results A total of 34 case–control and cohort studies involving a total of 9,144 patients with PA were included in this systematic review. The overall rate of postoperative CSF leakage after TSS for PA was 5.6%. Tumor size, adenoma consistency, revision surgery, and intraoperative CSF leakage were independent risk factors for postoperative CSF leakage (ORs, 3.18–6.33). By contrast, the endoscopic approach showed a slight protective benefit compared with the microscopic approach in TSS (OR, 0.69). Conclusions This review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative CSF leakage after TSS for PA. More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis.

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