Walton Centre for Neurology and Neurosurgery, Liverpool, England.
National Neurosurgical Centre, Beaumont Hospital, Beaumont Road, Dublin, Ireland.
Acta Neurochir (Wien). 2020 Jun;162(6):1309-1315. doi: 10.1007/s00701-020-04334-5. Epub 2020 Apr 21.
Post-operative CSF leak is the major source of morbidity following endoscopic transsphenoidal surgery. The purpose of this study was to identify factors associated with post-operative CSF leak in patients undergoing this surgery and facilitate the prospective identification of patients at higher risk of this complication.
A review of a prospectively maintained database containing details of 270 endoscopic transsphenoidal operations performed by the senior author over a 9-year period was performed. Univariate analysis was performed using the Chi-squared and Fisher's exact tests, as appropriate. A logistic regression model was constructed for multivariate analysis.
The rate of post-operative CSF leak in this series was 9%. On univariate analysis, previous surgery, resection of craniopharyngiomas, adenomas causing Cushing's disease and intra-operative CSF leaks were associated with an increased risk of post-operative CSF leak. The use of a vascularised nasoseptal flap and increasing surgical experience were associated with a decreased rate of CSF leak. On multivariate analysis, a resection of tumour for Cushing's disease (OR 5.79, 95% CI 1.53-21.95, p = 0.01) and an intra-operative CSF leak (OR 4.56, 95% CI 1.56-13.32, p = 0.006) were associated with an increased risk of post-operative CSF leak. Increasing surgical experience (OR 0.14, 95% CI 0.04-0.46, p = 0.001) was strongly associated with a decreased risk of post-operative CSF leak.
Increasing surgical experience is a strong predictor of a decreased risk of developing post-operative CSF leak following endoscopic transsphenoidal surgery. Patients with Cushing's disease and those who develop an intra-operative CSF leak should be managed with meticulous skull base repair and close observation for signs of CSF leak post-operatively.
内镜经鼻蝶窦手术后，脑脊液漏是主要的发病因素。本研究旨在明确内镜经鼻蝶窦手术术后并发脑脊液漏的相关因素，以便前瞻性识别术后易发生该并发症的高风险患者。
对作者本人在 9 年期间完成的 270 例内镜经鼻蝶窦手术患者的前瞻性数据库进行回顾性分析。采用卡方检验和 Fisher 确切概率法进行单因素分析，多因素分析采用 Logistic 回归模型。
本研究中术后脑脊液漏的发生率为 9%。单因素分析显示，既往手术史、颅咽管瘤切除、引起库欣病的腺瘤以及术中发生脑脊液漏与术后发生脑脊液漏的风险增加相关。使用带血管鼻中隔黏膜瓣以及手术经验的增加与脑脊液漏发生率降低相关。多因素分析显示，库欣病患者肿瘤切除（OR 5.79，95%CI 1.53-21.95，p=0.01）和术中发生脑脊液漏（OR 4.56，95%CI 1.56-13.32，p=0.006）与术后发生脑脊液漏的风险增加相关。手术经验的增加（OR 0.14，95%CI 0.04-0.46，p=0.001）与术后发生脑脊液漏的风险降低密切相关。
手术经验的增加是内镜经鼻蝶窦手术后发生术后脑脊液漏风险降低的强有力预测指标。库欣病患者以及术中发生脑脊液漏的患者应行精细的颅底修复，并密切观察术后有无脑脊液漏发生。
