Analysis Of Risk Factors Of Cerebrospinal Fluid Leakage After Endoscopic Transsphenoidal Approach For Pituitary Adenomas

Objective:To investigate the risk factors of cerebrospinal fluid leakage(CSF)after endoscopic transsphenoidal approach(EEA)in the Sellar region.Methods:The clinical data and follow-up results of patients with pituitary adenomas treated by endoscopic transsphenoidal approach in the Department of Neurosurgery of Henan people’s Hospital from January 2019 to July 2021 were analyzed retrospectively.231 patients with complete data were selected according to the inclusion / exclusion criteria.The following data were collected: sex,age,BMI(body mass index),complications(including diabetes,hypertension,lung disease,heart disease,brain disease),maximum diameter of tumor,type of tumor,previous surgery(including nasal surgery,craniotomy,gamma knife),intraoperative cerebrospinal fluid leakage,postoperative cerebrospinal fluid leakage.Univariate chi-square test showed that the clinical data of patients with postoperative cerebrospinal fluid leakage and those without postoperative cerebrospinal fluid leakage were significantly different(P < 0.05).In multivariate Logistic regression analysis,the difference was statistically significant.Result:1、General data of patients: a total of 231 patients with complete clinical data were included.There were 114 males(49.40%)and 117 females(50.60%),with an average of(52.72±14.21)years old,44 cases under 40 years old,124 cases aged 60 years old,and 63 cases over60 years old.According to the type of hormone secretion,there were 48 cases of non-functional adenoma,21 cases of growth hormone(GH)adenoma,32 cases of adrenocorticotropin(ACTH)adenoma,78 cases of gonadotropin(FSH)adenoma,26 cases of polyhormone cell adenoma and prolactin(PRL)adenoma.According to the results of pituitary MRI examination before operation,the tumors were classified as microadenoma(diameter < 10mm)in 6 cases,macroadenoma(diameter 10～30mm)in 178 cases,giant adenoma(diameter > 30mm)in 47 cases.The complications included diabetes(n = 28),hypertension(n = 74),lung disease(n = 10),heart disease(n = 13)and brain disease(n = 13).According to the reference standard of Chinese body mass index(BMI),there were 3 cases with BMI < 18.5 ㎏/㎡,74 cases with BMI < 24 ㎏/㎡,99 cases with BMI < 28 ㎏/㎡,and 55 cases with BMI ≥ 28 ㎏/㎡.2、Among the 231 patients who underwent endoscopic surgery,45 cases(19.48%)had cerebrospinal fluid leakage after operation,and 186 cases(80.52%)had no cerebrospinal fluid leakage after operation.The results of univariate analysis showed that there was no significant difference in age,sex and complications(diabetes,lung disease,heart disease,brain disease)between the two groups(P > 0.05).There were significant differences in BMI,maximum diameter of tumor,previous surgery(nasal surgery,craniotomy,gamma knife)and cerebrospinal fluid leakage during operation(P < 0.05).Multivariate Logistic regression analysis showed that abnormal BMI(obesity and overweight),giant adenoma and intraoperative cerebrospinal fluid leakage were independent risk factors for postoperative cerebrospinal fluid leakage.Conclusion:Abnormal BMI(obesity and overweight),giant adenoma and intraoperative cerebrospinal fluid leakage are the risk factors of postoperative cerebrospinal fluid leakage.Preoperative body mass index and giant adenoma are important preoperative predictors of cerebrospinal fluid leakage.Perioperative weight management for patients with abnormal weight is an important measure to reduce postoperative cerebrospinal fluid.In addition,patients with previous surgical history and giant adenomas should be operated carefully during the operation to reduce the injury of nasal mucosa and skull base structure.More active repair methods should be used for patients with cerebrospinal fluid during operation.