Department of Neurological Surgery, University of Virginia Health System, University of Virginia, Charlottesville, Virginia 22908, USA.
J Neurosurg. 2012 Jun;116(6):1299-303. doi: 10.3171/2012.3.JNS112160. Epub 2012 Apr 6.
Cerebrospinal fluid leakage is a major complication of transsphenoidal surgery. An intraoperative CSF leak, which occurs in up to 50% of pituitary tumor cases, is the only modifiable risk factor for postoperative leaks. Although several techniques have been described for surgical repair when an intraoperative leak is noted, none has been proposed to prevent an intraoperative CSF leak. The authors postulated that intraoperative CSF drainage would diminish tension on the arachnoid, decrease the rate of intraoperative CSF leakage during surgery for larger tumors, and reduce the need for surgical repair of CSF leaks.
The results of 114 transsphenoidal operations for pituitary macroadenoma performed without intraoperative CSF drainage were compared with the findings from 44 cases in which a lumbar subarachnoid catheter was placed before surgery to drain CSF at the time of dural exposure and tumor removal.
Cerebrospinal fluid drainage reduced the rate of intraoperative CSF leakage from 41% to 5% (p < 0.001). This reduction occurred in macroadenomas with (from 57% to 5%, p < 0.001) and those without suprasellar extension (from 29% to 0%, p = 0.31). The rate of postoperative CSF leakage was similar (5% vs 5%), despite the fact that intraoperative CSF drainage reduced the need for operative repair (from 32% to 5%, p < 0.001). There were no significant catheter-related complications.
Cerebrospinal fluid drainage during transsphenoidal surgery for macroadenomas reduces the rate of intraoperative CSF leaks. This preventative measure obviated the need for surgical repair of intraoperative CSF leaks using autologous fat graft placement, other operative techniques, postoperative lumbar drainage, and/or reoperation in most patients and is associated with minimal risks.
脑脊液漏是经蝶窦手术的主要并发症。术中脑脊液漏发生于高达 50%的垂体瘤病例中，是术后漏的唯一可修正的危险因素。尽管已经描述了几种用于术中发现漏时进行手术修复的技术，但尚未提出用于预防术中 CSF 漏的方法。作者推测术中 CSF 引流可以减轻蛛网膜张力，降低大肿瘤手术中术中 CSF 漏的发生率，并减少 CSF 漏手术修复的需要。
比较了 114 例未经术中 CSF 引流的垂体大腺瘤经蝶窦手术的结果，与 44 例在手术时放置腰蛛网膜下腔导管以在硬脑膜暴露和肿瘤切除时引流 CSF 的病例结果。
CSF 引流将术中 CSF 漏的发生率从 41%降低至 5%（p < 0.001）。这种减少发生在伴有（从 57%降至 5%，p < 0.001）和不伴有鞍上扩展的大腺瘤中（从 29%降至 0%，p = 0.31）。尽管术中 CSF 引流减少了手术修复的需要（从 32%降至 5%，p < 0.001），但术后 CSF 漏的发生率相似（5%对 5%）。无明显导管相关并发症。
在经蝶窦手术治疗大腺瘤时进行 CSF 引流可降低术中 CSF 漏的发生率。这种预防措施避免了使用自体脂肪移植、其他手术技术、术后腰椎引流和/或再次手术来修复术中 CSF 漏的需要，在大多数患者中，这种方法的风险极小。
