Cerebrospinal Fluid Leakage Repair Method During Endoscopic Pituitary Tumor Resection

Objective:To explore the repair method and surgical procedure in different types of cerebrospinal fluid(CSF)leak during transnasal neuroendoscopic pituitary tumor resection.Methods:A retrospective analysis was made on the clinical data of 63 cases with cerebrospinal fluid leakage during transnasal neuroendoscopic pitu-?itary adenoma resection from 2018 to 2019.The details were recorded:age,sex,turner size,pathological classification,repair method,have or not cerebrospinal fluid rhinorrhea(CFR)after operation.For cerebrospin-al fluid leaks clearly identified during surgery,According to the locati-on and size of the leak,choose the appropriate repair method.Repair materials include:medical gelatin sponge,surgicel fibrillar,fat,fascia,muscle,pedicled septal mucosal flap,medical biological glue,etc.Repair methods include:Extrusion method and Electrocoagulation are suitable for small cerebrospinal fluid leakage.For medium flow cerebrospinal fluid leakage,on the basis of extrusion method Paste an artificial dura film than Spray the saddle bottom with medical biological glue.For Large flow of cerebrospinal fluid leakage,use the method of Sellar reconstruction.Observe the patient has or not cerebrospinal fluid rhinorrhea aftersurgery and evaluate the effect of repair surgery.Results:in 63 patients Cerebrospinal fluid(CSF)leakage occurred after tumor resection,and the leakage was found successfully.25 cases were in grade I,21 cases were in grade II,and 17 cases were in gradeIII.Postoperative cerebrospinal fluid leakage was in 6 cases,distributed in all grades of patients.4 patients with postoperative cerebrospinal fluid rhinorrhea relieved after strict bed rest without lumbar puncture treatment.Postoperative infection was in 7 cases,which were improved all by anti—inflammatory treatment and lumbar puncture.Conclusion:Cerebrospinal fluid leakage after endoscopic pituitary tumor surgery should be given different repair methods according to different grades to ensure the repair effect,reduce the surgical trauma,andshorten the operation time.The low-flow CSF rhinorrhea occurred after the surgery can be self-healed after conservative treatment with strict bed rest,without the need for lumbar cistern drainage.The key points:the materials for repair,method of repair,properly handled can improve the success rate of operation.