Endoscopic Endonasal Resection of Symptomatic Rathke Cleft Cysts: Total Resection or Partial Resection

Objective: Rathke cleft cysts (RCC) are benign sellar lesions, and endoscopic endonasal surgery (EES) for symptomatic RCC is becoming increasingly popular, but total resection or partial resection (TR or PR) of the cyst wall is still inconclusive. The aim of this study was to review the complications and clinical prognoses associated with total and partial resection of the cyst wall by EES.Methods: We retrospectively analyzed a series of 72 patients with symptomatic RCC treated by EES from -January 2011 to June 2019 at Shenzhen University First Affiliated Hospital. For these 72 cases, 30 were treated with TR and 42 were treated with PR. Intra- and post-operative complications and clinical prognosis were investigated.Results: All 72 patients underwent a pure EES. In the TR group, 10 patients (33.3%) had intraoperative cerebrospinal fluid leakage (CSF leak), three patients (10%) had postoperative CSF leak, eight patients (26.7%) had postoperative diabetes insipidus (DI), eight patients (26.7%) had postoperative electrolyte disturbance, and 12 patients (40%) had temporary hypopituitarism postoperatively. While in the PR group, three patients (7.1%) had intraoperative CSF leak, two patients (4.8%) had postoperative DI, three patients (7.1%) had postoperative electrolyte disturbance, four patients (9.5%) had temporary hypopituitarism postoperatively, and no cases experienced postoperative CSF leak. The intra- and post-operative complications were significantly higher in TR group then PR group (P IntraoperativeCSFleak = 0.004, P Post−operativeCSFleak =0.036, P TransientDI = 0.008, P Temporaryhypopituitarism = 0.002, P Permanenthypopituitarism = 0.036, P Electrolytedisturbance = 0.023). No significant differences in post-operative improvement and recurrence.Conclusions: EES is a safe and effective approach for the treatment of symptomatic RCC. Complete sucking out the cyst contents and partial resection of the cyst wall may be sufficient for treatment, and total resection of the cyst wall is associated with a higher incidence of complications.

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Endoscopic Endonasal Approaches to the Clival Region

Acta Medica Academica ◽

10.5644/ama2006-124.306 ◽

2021 ◽

Vol 49 (1, 2, 3) ◽

pp. 45

Author(s):

Janez Ravnik ◽

Borut Hribernik ◽

Boštjan Lanišnik

Keyword(s):

Cerebrospinal Fluid Leak ◽

Csf Leak ◽

Neurenteric Cyst ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Transnasal Approach ◽

Endoscopic Endonasal ◽

Post Operative Period ◽

Operative Complications ◽

Post Operative Complications

Objective. Our main objectives were to analyze and determine the safety, risk of post-operative complications, and surgical outcome of the endoscopic endonasal approach to the clival region.Methods. From May 2011 to May 2019, we operated on 19 patients using the endoscopic endonasal approach to the clival region. Their pathologies were diverse: pituitary macroadenoma, craniopharyngioma, metastasis, and a prepontine neurenteric cyst. The first operations were supervised by an experienced center using telementoring. We explained our surgical technique and analyzed the patients’ data, which were included in our study.Results. We managed to achieve complete removal of the pathological process in 14 patients. There were no deaths in the perioperative and early post-operative period. The most common complication was a cerebrospinal fluid leak, which was successfully managed in all of the cases. There were no deaths or significant morbidities in the post-operative period.Conclusion. An endoscopic transnasal approach to the clival region is safe and effective. It provides better visualization of that region compared to other transcranial approaches. The risk of post-operative complications is significantly lower with the help of modern reconstructive techniques. CSF leak is the most frequent complication.

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The learning curve in endoscopic endonasal resection of craniopharyngiomas

Neurosurgical FOCUS ◽

10.3171/2016.9.focus16292 ◽

2016 ◽

Vol 41 (6) ◽

pp. E9 ◽

Cited By ~ 17

Author(s):

Varun R. Kshettry ◽

Hyunwoo Do ◽

Khaled Elshazly ◽

Christopher J. Farrell ◽

Gurston Nyquist ◽

...

Keyword(s):

Learning Curve ◽

Diabetes Insipidus ◽

Neurological Complications ◽

Csf Leak ◽

Categorical Variables ◽

Total Resection ◽

Endoscopic Endonasal ◽

Visual Improvement ◽

Early Cohort ◽

Over Time

OBJECTIVE There is a paucity of literature regarding the learning curve associated with performing endoscopic endonasal cranial base surgery. The purpose of this study was to determine to what extent a learning curve might exist for endoscopic endonasal resection in cases of craniopharyngiomas. METHODS A retrospective review was performed for all endoscopic endonasal craniopharyngioma resections performed at Thomas Jefferson University from 2005 to 2015. To assess for a learning curve effect, patients were divided into an early cohort (2005–2009, n = 20) and a late cohort (2010–2015, n = 23). Preoperative demographics, clinical presentation, imaging characteristics, extent of resection, complications, tumor control, and visual and endocrine outcomes were obtained. Categorical variables and continuous variables were compared using a 2-sided Fisher's exact test and t-test, respectively. RESULTS Only the index operation performed at the authors' institution was included. There were no statistically significant differences between early and late cohorts in terms of patient age, sex, presenting symptoms, history of surgical or radiation treatment, tumor size or consistency, hypothalamic involvement, or histological subtype. The rate of gross-total resection (GTR) increased over time from 20% to 65% (p = 0.005), and the rate of subtotal resection decreased over time from 40% to 13% (p = 0.078). Major neurological complications, including new hydrocephalus, meningitis, carotid artery injury, or stroke, occurred in 6 patients (15%) (8 complications) in the early cohort compared with only 1 (4%) in the late cohort (p = 0.037). CSF leak decreased from 40% to 4% (p = 0.007). Discharge to home increased from 64% to 95% (p = 0.024). Visual improvement was high in both cohorts (88% [early cohort] and 81% [late cohort]). Rate of postoperative panhypopituitarism and permanent diabetes insipidus both increased from 50% to 91% (p = 0.005) and 32% to 78% (p = 0.004), which correlated with a significant increase in intentional stalk sacrifice in the late cohort (from 0% to 70%, p < 0.001). CONCLUSIONS High rates of near- or total resection and visual improvement can be achieved using an endoscopic endonasal approach for craniopharyngiomas. However, the authors did find evidence for a learning curve. After 20 cases, they found a significant decrease in major neurological complications and significant increases in the rates of GTR rate and discharge to home. Although there was a large decrease in the rate of postoperative CSF leak over time, this was largely attributable to the inclusion of very early cases prior to the routine use of vascularized nasoseptal flaps. There was a significant increase in new panhypopituitarism and diabetes insipidus, which is attributable to increase rates of intentional stalk sacrifice.

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Endoscopic endonasal resection of a clival chordoma with massive brainstem compression

Neurosurgical Focus: Video ◽

10.3171/2020.4.focusvid.19942 ◽

2020 ◽

Vol 2 (2) ◽

pp. V12

Author(s):

Mostafa Shahein ◽

Thiago Albonette-Felicio ◽

Giuliano Silveira-Bertazzo ◽

Rafael Martinez-Perez ◽

Marcus Zachariah ◽

...

Keyword(s):

Cranial Nerves ◽

Csf Leak ◽

Facial Weakness ◽

Panoramic View ◽

Total Resection ◽

Endoscopic Endonasal ◽

Clival Chordoma ◽

Brainstem Compression ◽

History Of ◽

Brain Retraction

Chordomas are rare tumors that occur at an incidence rate of 0.8 per 100,000. Thirty-five percent of chordomas occur in the spheno-occipital region. We present a case of a clival chordoma that had severe brainstem compression. The patient had a 1-year history of slurred speech and left facial weakness (House-Brackmann 3). The endoscopic endonasal transclival approach gave a panoramic view of the region without the necessity of brain retraction or manipulation of the surrounding cranial nerves. Gross-total resection was achieved and no CSF leak was encountered postoperatively. The left facial weakness improved to House-Brackmann 1.The video can be found here: https://youtu.be/DzW9Q6ckTHw.

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Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base

Journal of Neurosurgery ◽

10.3171/2017.12.jns172575 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1599-1608

Author(s):

Jonathan A. Forbes ◽

Matei Banu ◽

Kurt Lehner ◽

Malte Ottenhausen ◽

Emanuele La Corte ◽

...

Keyword(s):

Cranial Nerves ◽

Cranial Base ◽

Csf Leak ◽

Nasoseptal Flap ◽

Total Resection ◽

Endoscopic Endonasal ◽

Epidermoid Cysts ◽

Flap Coverage ◽

Csf Leakage ◽

The Impact

OBJECTIVEEpidermoid cysts (ECs) commonly extend to involve the ventral cisterns of the cranial base. When present, symptoms arise due to progressive mass effect on the brainstem and adjacent cranial nerves. Historically, a variety of open microsurgical approaches have been used for resection of ECs in this intricate region. In recent years, the endoscopic endonasal approach (EEA) has been proposed as an alternative corridor that avoids crossing the plane of the cranial nerves. To date, there is a paucity of data in the literature regarding the safety and efficacy of the EEA in the treatment of ECs of the ventral cranial base.METHODSThe authors reviewed a prospectively acquired database of EEAs for resection of ECs over 8 years at Weill Cornell, NewYork-Presbyterian Hospital. All procedures were performed by the senior authors. Standardized clinical and radiological parameters were assessed before and after surgery. Statistical tests were used to determine the impact of previous surgery and tumor volume on extent of resection and recurrence as well as the method of closure on rate of CSF leak.RESULTSBetween January 2009 and February 2017, 7 patients (4 males and 3 females; age range 16–70 years) underwent a total of 8 surgeries for EC resection utilizing the EEA. Transplanum and transclival extensions were performed in 3 and 5 patients, respectively. Methods of closure incorporated a gasket seal in 6 of 8 procedures and a nasoseptal flap in 7 of 8 procedures. Gross-total resection (GTR) was achieved in 43% of patients, and near-total resection (> 95%) was obtained in another 43%. Complications included diabetes insipidus (n = 2), postoperative CSF leak (n = 2), transient third cranial nerve palsy (n = 1), and epistaxis (n = 1). With a mean follow-up of 43.5 months, recurrence has been observed in 2 of 7 patients. In 1 case, reoperation for recurrence was required 71 months following the initial surgery. Use of the gasket-seal technique with nasoseptal flap coverage significantly correlated with the absence of postoperative CSF leakage (p = 0.018). GTR was achieved in 25% of the patients who had prior surgeries and in 50% of patients without previous resections. The mean volume of cysts in which GTR was achieved (4.3 ± 1.8 cm3) was smaller than that in which subtotal or near-total resection was achieved (12.2 ± 11 cm3, p = 0.134).CONCLUSIONSThe EEA for resection of ECs of the ventral cranial base is a safe and effective operative strategy that avoids crossing the plane of the cranial nerves. In the authors’ experience, gasket-seal closure with nasoseptal flap coverage has been associated with a decreased risk of postoperative CSF leakage.

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Prevalence of Early Post-Operative Complications in Patients Undergoing Surgical Treatment for Meningomyelocele

10.53350/pjmhs211592770 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2770-2772

Author(s):

Muhammad Pervez Khan ◽

Naeem ul Haq

Keyword(s):

Surgical Treatment ◽

Descriptive Study ◽

Defect Size ◽

Accurate Diagnosis ◽

Cerebrospinal Fluid Leakage ◽

Patients Âgés ◽

Early Postoperative Complications ◽

Operative Complications ◽

Complications Rate ◽

Post Operative Complications

Objective: To determine the prevalence of early postoperative complications in patients undergoing surgical treatment for meningomyelocele. Study Design: Descriptive study Place & Duration: Department of Neurosurgery, Saidu Teaching Hospital, Saidu Sharif, Swat for duration of three years from November 2017 to October 2020. Methods: Total one hundred and thirty six patients of both genders presented with meningomycele were included in this study. Patients’ ages were ranging from 5 to 120 days. All the patients were undergoing surgical treatment for meningomyelocele. Early post-operative complications were recorded after surgery Results: There were 76 (55.88%) males and 60 (44.12%) females. Forty (29.41%) patients were ages <1 month, 59 (43.38%) patients were ages 1 to 2 months 37 (27.21%) were ages above 2 months. Majority of patients 70 (51.47%) had defect size <5 cm. Post-operative complications such as surgical site infection, pyrexia, hydrocephalus and cerebrospinal fluid leakage in 20 (14.71%), 115 (84.56%, 29 (21.32%) and 33 (24.26%) patients respectively. Conclusion: Early and accurate diagnosis and better management may reduce the complications rate Keywords: Prevalence, Complications, Meningomvelocele

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Reoperative endoscopic endonasal surgery for residual or recurrent pituitary adenomas

Journal of Neurosurgery ◽

10.3171/2016.8.jns152709 ◽

2017 ◽

Vol 127 (2) ◽

pp. 397-408 ◽

Cited By ~ 18

Author(s):

Hazem M. Negm ◽

Rafid Al-Mahfoudh ◽

Manish Pai ◽

Harminder Singh ◽

Salomon Cohen ◽

...

Keyword(s):

Endoscopic Surgery ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Residual Tumor ◽

Csf Leak ◽

Categorical Variables ◽

Recurrent Tumor ◽

Total Resection ◽

Endoscopic Endonasal ◽

Endonasal Endoscopic Surgery

OBJECTIVERegrowth of the lesion after surgical removal of pituitary adenomas is uncommon unless subtotal resection was originally achieved in the first surgery. Treatment for recurrent tumor can involve surgery or radiotherapy. Locations of residual tumor may vary based on the original approach. The authors evaluated the specific sites of residual or recurrent tumor after different transsphenoidal approaches and describe the surgical outcome of endoscopic endonasal transsphenoidal reoperation.METHODSThe authors analyzed a prospectively collected database of a consecutive series of patients who had undergone endoscopic endonasal surgeries for residual or recurrent pituitary adenomas after an original transsphenoidal microscopic or endoscopic surgery. The site of the recurrent tumor and outcome after reoperation were noted and correlated with the primary surgical approach. The chi-square or Fisher exact test was used to compare categorical variables, and the Mann-Whitney U-test was used to compare continuous variables between surgical groups.RESULTSForty-one patients underwent surgery for residual/recurrent pituitary adenoma from 2004 to 2015 at Weill Cornell Medical College. The previous treatment was a transsphenoidal microscopic (n = 22) and endoscopic endonasal (n = 19) surgery. In 83.3% patients (n = 30/36) there was postoperative residual tumor after the initial surgery. A residual tumor following endonasal endoscopic surgery was less common in the sphenoid sinus (10.5%; 2/19) than it was after microscopic transsphenoidal surgery (72.7%; n =16/22; p = 0.004). Gross-total resection (GTR) was achieved in 58.5%, and either GTR or near-total resection was achieved in 92.7%. Across all cases, the average extent of resection was 93.7%. The rate of GTR was lower in patients with Knosp-Steiner Grade 3–4 invasion (p < 0.0005). Postoperative CSF leak was seen in only one case (2.4%), which stopped with lumbar drainage. Visual fields improved in 52.9% (n = 9/17) of patients and were stable in 47% (n = 8/17). Endocrine remission was achieved in 77.8% (n = 14/18) of cases, 12 by surgery alone and 2 by adjuvant medical (n = 1) and radiation (n = 1) therapy. New diabetes insipidus occurred in 4.9% (n = 2/41) of patients—in one of whom an additional single anterior hormonal axis was compromised—and 9.7% (n = 4/41) of patients had a new anterior pituitary hormonal insufficiency.CONCLUSIONSEndonasal endoscopic reoperation is extremely effective at removing recurrent or residual pituitary adenomas that remain after a prior surgery, and it may be preferable to radiation therapy particularly in symptomatic patients. Achievement of GTR is less common when lateral cavernous sinus invasion is present. The locations of residual/recurrent tumor were more likely sphenoidal and parasellar following a prior microscopic transsphenoidal surgery and sellar following a prior endonasal endoscopic surgery.

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Long-Term Outcome of Total and Near-Total Resection of Spinal Cord Lipomas and Radical Reconstruction of the Neural Placode, Part II

Neurosurgery ◽

10.1227/01.neu.0000363598.81101.7b ◽

2010 ◽

Vol 66 (2) ◽

pp. 253-273 ◽

Cited By ~ 73

Author(s):

Dachling Pang ◽

John Zovickian ◽

Angelica Oviedo

Keyword(s):

Spinal Cord ◽

Free Probability ◽

Partial Resection ◽

The Other ◽

Nonsurgical Treatment ◽

Predictor Variables ◽

Cerebrospinal Fluid Leakage ◽

Total Resection ◽

Patient Profile

Abstract OBJECTIVE To show the long-term benefits of total and near-total resection of complex spinal cord lipomas and reconstruction of the neural placode. METHODS We analyzed 238 patients with dorsal, transitional, and chaotic lipomas who had total resection as described in part I for overall progression-free survival probability (PFS, Kaplan-Meier analysis) over 16 years. We also analyzed subgroup proportional recurrence hazard (Cox analysis) of 6 outcome predictors of sex, lipoma type, age, preoperative symptoms, previous surgery, and postoperative cord-sac ratio. These results were compared with an age-matched, lesion-matched series of 116 patients followed for 11 years after partial lipoma resection and with the Parisian series of nonsurgical treatment. RESULTS The immediate effects of surgery were similar between total and partial resection: both achieved greater than 95% symptom stabilization or improvement rate. The neuro-urologic complication rates for the groups were also similar, 4.2% and 5.2% for total and partial resection, respectively. The combined cerebrospinal fluid leakage and wound complication rate of total resection was much lower at 2.5% than the 6.9% for partial resection, but both were better than published rates. The overall PFS for total resection was 82.8% at 16 years, comparing much more favorably with 34.6% for partial resection at 10.5 years (P < .0001). Culling only the asymptomatic patients with virgin (previously unoperated) lipomas to match the patient profile of the Parisian series, the PFS for prophylactic total resection for this subgroup increased to 98.4% at 16 years, versus 67% at 9 years for no surgery and 43.3% at 10.5 years for our own partial resection series, with a remarkable statistical difference between total and partial resection (P = .00001). Subgroup analyses showed that sex and lipoma type did not affect outcome. For the other predictor variables, while univariate analyses showed that young age, absence of symptom, and virgin lipomas correlated with better statistical PFS than older age, symptoms, and redo lipomas, these effects vanished with multivariate analyses. Cord-sac ratio stood alone as the only influential outcome predictor in multivariate analysis, with a 96.6% PFS for a low ratio of <30% and an 80.6% progression-free probability for a high ratio of >50%, and a 3-fold increase in recurrence hazard for high ratios (P = .0009). This suggested that all the individual effects of the other predictor variables could be reduced to whether a low cord-sac ratio could be achieved with total lipoma resection and placode reconstruction. Cord-sac ratio was the obvious factor that differentiated the outcomes between total and partial resection, the latter associated with a >90% chance of having a high cord-sac ratio. CONCLUSION Total and near-total resection of lipomas and complete reconstruction of the neural placode produced a much better long-term progression-free probability than partial resection and nonsurgical treatment. The perioperative complications for total resection were low and compared favorably with published results. A low postoperative cord-sac ratio and well-executed placode neurulation were strongly correlated with good outcome. The ideal preoperative patient profile with early disease stabilization and the best recurrence-free probability is an asymptomatic child less than 2 years without previous lipoma surgery. There are strong indications that partial resection in many cases produces worse scarring on the neural placode and worse prognosis than no surgery.

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Endoscopic endonasal pituitary adenoma surgery: our surgical experience in 116 patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204626 ◽

2020 ◽

Vol 6 (11) ◽

pp. 2029

Author(s):

Krishna Vikas Potdukhe ◽

Kalpesh Patel ◽

Rajesh Vishwakarma

Keyword(s):

Pituitary Adenoma ◽

Visual Outcome ◽

Primary Objective ◽

Partial Resection ◽

High Rate ◽

Endocrine Function ◽

Gross Total Resection ◽

Imaging Data ◽

Total Resection ◽

Endoscopic Endonasal

Background: The primary objective of this study was to evaluate the outcome of excision in terms of gross and partial resection rates compared to the grades of pituitary adenoma (based on Hardy-Vezina classification). We also evaluated the post-operative complications and the effect of resection on visual outcomes and endocrinological remission.Methods: We retrospectively analysed 116 patients who underwent surgical resection of pituitary adenoma via endonasal trans-sphenoidal approach at Civil Hospital (Ahmedabad) between March 2013 and March 2019 and collected pre-operative and post-operative data in terms of imaging, endocrine function and vision. Results: According to the postoperative imaging data and endocrine examination results, gross-total resection (GTR) was achieved in 79.3% (92 patients), and partial (PR) in 20.6% (24 patients) which was significant (p<0.05). Improvement in vision was seen in 62% (40 patients out of 64 patients). Out of 44 patients having endocrine dysfunction, endocrinological remission was achieved in 32 patients with functional adenomas (72.7%). Sinusitis followed by headache was the most common minor complication seen in the study.Conclusions: Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for patients having grade 3 or lower pituitary adenomas, which leads to gross total resection in comparison to patients having grade 4 adenoma. It also results in high rate of surgical decompression and better visual outcome. Partial resection may result in endocrinological response in functional tumors.

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Trends in cerebrospinal fluid leak rates following the extended endoscopic endonasal approach for anterior skull base meningioma: a meta-analysis over the last 20 years

Acta Neurochirurgica ◽

10.1007/s00701-020-04641-x ◽

2020 ◽

Author(s):

Amir H. Zamanipoor Najafabadi ◽

Danyal Z. Khan ◽

Ivo S Muskens ◽

Marike L. D. Broekman ◽

Neil L. Dorward ◽

...

Keyword(s):

Skull Base ◽

Arterial Injury ◽

Csf Leak ◽

Endoscopic Endonasal Approach ◽

Total Resection ◽

Endoscopic Endonasal ◽

Olfactory Groove ◽

Olfactory Groove Meningioma ◽

Tuberculum Sellae ◽

Over Time

Abstract Objective The extended endoscopic approach provides unimpaired visualization and direct access to ventral skull base pathology, but is associated with cerebrospinal fluid (CSF) leak in up to 25% of patients. To evaluate the impact of improved surgical techniques and devices to better repair skull base defects, we assessed published surgical outcomes of the extended endoscopic endonasal approach in the last two decades for a well-defined homogenous group of tuberculum sellae and olfactory groove meningioma patients. Methods Random-effects meta-analyses were performed for studies published between 2004 (first publications) and April 2020. We evaluated CSF leak as primary outcome. Secondary outcomes were gross total resection, improvement in visual outcomes in those presenting with a deficit, intraoperative arterial injury, and 30-day mortality. For the main analyses, publications were pragmatically grouped based on publication year in three categories: 2004–2010, 2011–2015, and 2016–2020. Results We included 29 studies describing 540 patients with tuberculum sellae and 115 with olfactory groove meningioma. The percentage patients with CSF leak dropped over time from 22% (95% CI: 6–43%) in studies published between 2004 and 2010, to 16% (95% CI: 11–23%) between 2011 and 2015, and 4% (95% CI: 1–9%) between 2016 and 2020. Outcomes of gross total resection, visual improvement, intraoperative arterial injury, and 30-day mortality remained stable over time Conclusions We report a noticeable decrease in CSF leak over time, which might be attributed to the development and improvement of new closure techniques (e.g., Hadad-Bassagasteguy flap, and gasket seal), refined multilayer repair protocols, and lumbar drain usage.

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Prevention of Intra-Operative Cerebrospinal Fluid Leaks by Lumbar Cerebrospinal Fluid Drainage during Endoscopic Endonasal Trans- Sphenoidal Surgery for Pituitary Macroadenomas

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v10i1.49162 ◽

2020 ◽

Vol 10 (1) ◽

pp. 52-56

Author(s):

Mohammad Shahnawaz Bari ◽

Shaireen Akhtar ◽

Md Shamsul Alam ◽

Md Atikur Rahman ◽

Asifur Rahman ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Transsphenoidal Surgery ◽

Csf Leak ◽

Cerebrospinal Fluid Leakage ◽

Pituitary Macroadenoma ◽

Endoscopic Endonasal ◽

Lumbar Drain ◽

Csf Drainage ◽

Csf Leaks ◽

Pituitary Macroadenomas

Aim and Objective: Postoperative cerebrospinal fluid leak is a recognized complication of endoscopic endonasal trans- sphenoidal surgery for pituitary macroadenomas. In this study we assess the utility of prophylactic use of lumbar drain in preventing intra-operative cerebrospinal fluid leakage during endscopic endonasal transsphenoidal surgery for pituitary macroadenoma which will ultimately reduce the rate of persistent post-operative cerebrospinal fluid leakage. Materials and Methods: 34 patients who underwent endscopic endonasal transsphenoidal surgery for pituitary macroadenoma were dividedd into two groups by non-probability convenient sampling technique. In one group of which lumbar subarachnoid drain were given just before induction of anesthesia named LD Group and another group went through conventional method without giving lumbar drain named No LD Group. In all patients of LD Group 20-30 ml of CSF was drawn through lumbar drain before giving dural incision. Valsalva maneuver was used in each group to identify intraoperative CSF leaks at the end of definitive surgery before repairing the sellar floor.Zero degree rigid endoscope was used in all cases. Intraoperative CSF leak was categorized as ‘Yes’ or ‘No’ which was decided by surgeon.Lumbar drains were removed within 24 hours of operation in 16 patients of LD Group and in case 1,who developed intraoperative CSF leak, lumbar drain was removed later. Results: Thirty four patients were eligible for inclusion, of which 17 were assigned to the LD Group and 17 to the no LD Group. There were no statistically significant differences in patient demographics, tumor pathology, or radiology between the two groups. In LD Group intraoperative CSF leak occurred in 1(5.9%) patient and leak did not occur in 16(94.1%) patients, in No LD Group intraoperative CSF leak occurred in 14(82.4%) patients and leak did not occur in 3(17.6%) patients. Intraoperative CSF drainage significantly reduced the incidence of intraoperative CSF leaks from 82.4% in the No LD group to 5.9% in the LD group (P < 0.001). There were no catheter related complications. Conclusion: Intraoperative CSF drainage significantly reduces the incidence of intraoperative CSF leakage in patients undergoing endoscopic endonasal transsphenoidal surgery for pituitary macroadenomas. Bang. J Neurosurgery 2020; 10(1): 52-56

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