Influencing Factors And Prevention Strategies Of CSF Leakage After Transsphenoidal Pituitary Adenomas Resection

Objective:To analyze the factors related to cerebrospinal fluid(CSF)leakage after transsphenoidal surgery for pituitary adenomas,and to explore the prevention and treatment strategies of postoperative CSF leakage.Methods:The clinical data of 178 patients with pituitary adenomas who underwent transsphenoidal microsurgery from January 2018 to January 2021 were analyzed retrospectively.The correlation between the size of the pituitary adenoma(micro adenoma,large adenoma and huge gland adenoma),type(growth hormone adenoma,prolactin hormone adenoma and other hormone adenoma),texture(soft or tenacious),invasive(The grade of Knosp),the extent of resection(total excision or subtotal resection),secondary surgery,intraoperative CSF leakage and postoperative CSF leakage were compared.Results:In this study,the incidence of intraoperative and postoperative CSF leakage was 28.7%and 11.2%,and univariate analysis showed that three factors were related to the occurrence of postoperative CSF leakage:1.Intraoperative CSF leakage:Intraoperative CSF leakage was correlated with the occurrence of CSF leakage after transsphenoidal surgery,and the results were statistically significant(P<0.05).The incidence of postoperative CSF leakage in patients with intraoperative CSF leakage(33.33%)was significantly higher than that in patients without intraoperative CSF leakage(2.36%).2.Invasiveness of pituitary adenoma:The invasiveness of pituitary adenomas was correlated with CSF leakage after transsphenoidal surgery,and the results were statistically significant(P<0.05).The incidence of CSF leakage(46.67%)in patients with invasive pituitary adenomas was significantly higher than that in patients with non-invasive pituitary adenomas(4.05%).3.Secondary surgery:Secondary surgery was correlated with CSF leakage after transsphenoidal surgery,and the results were statistically significant(P<0.05).The incidence of postoperative CSF leakage in patients undergoing secondary transsphenoidal surgery after recurrence of pituitary adenomas(69.23%)was higher than that in patients undergoing primary transsphenoidal surgery(6.67%).However,the size,type and texture of pituitary adenomas and the degree of surgical resection were uncorrelated with the occurrence of CSF leakage,the results were not statistically significant.Logistic multivariate regression analysis showed that intraoperative CSF leakage(OR 6.542,95%CI 1.416-29.392,P=0.016),Invasiveness of pituitary adenoma(OR 5.542,95%CI 1.200-27.468,P=0.029)and secondary surgery(OR 4.285,95%CI 1.078-17.042,P=0.039)were correlated with postoperative CSF leakage(P<0.05).Postoperative CSF leakage was cured by conservative postural treatment in 15%of patients,by lumbar cistern drainage in 70%of patients,and by reoperative repair in 15%of patients.Conclusion:1.Intraoperative CSF leakage,invasiveness of pituitary adenoma,and secondary surgery are the risk factors for CSF leakage after transsphenoidal surgery for pituitary adenomas.2.The key to prevention and treatment is to evaluate the risk of CSF leakage preoperatively according to the general condition of the patient and imaging data(such as the location,size and boundary of the tumor,etc.).Careful operation,the accurate location of the CSF leakage was found and the floor of the saddle was repaired and reconstructed according to the principle of graded repair when the leak occured during the operation.Postoperative CSF leakage was detected early and continued lumbar cistern drainage was performed.If necessary,resurgical repair should be performed.