State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China.
Department of Neurosurgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China.
BMC Neurol. 2021 Oct 27;21(1):417. doi: 10.1186/s12883-021-02440-0.
Postoperative cerebrospinal fluid (CSF) leakage represents a challenge even for experienced pituitary surgeons. We aimed to quantitatively synthesize data from studies regarding the risk factors for postoperative CSF leakage after transsphenoidal surgery (TSS) for pituitary adenoma (PA).
PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case-control and cohort studies, focusing on the risk factors associated with postoperative CSF leakage after TSS for PA. Pooled odds ratios (ORs) and 95% confidence intervals were calculated to determine the risk factors.
A total of 34 case-control and cohort studies involving a total of 9,144 patients with PA were included in this systematic review. The overall rate of postoperative CSF leakage after TSS for PA was 5.6%. Tumor size, adenoma consistency, revision surgery, and intraoperative CSF leakage were independent risk factors for postoperative CSF leakage (ORs, 3.18-6.33). By contrast, the endoscopic approach showed a slight protective benefit compared with the microscopic approach in TSS (OR, 0.69).
This review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative CSF leakage after TSS for PA. More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis.
即使对于经验丰富的垂体外科医生来说，术后脑脊液（CSF）漏也仍然是一个挑战。我们旨在定量综合有关经蝶窦手术（TSS）治疗垂体腺瘤（PA）后术后 CSF 漏风险因素的研究数据。
我们检索了 PubMed、Web of Science、The Cochrane Library、Embase、中国知网（CNKI）、万方数据库和维普数据库中关于 TSS 治疗 PA 后术后 CSF 漏相关风险因素的病例对照和队列研究，重点关注与 TSS 治疗 PA 后术后 CSF 漏相关的风险因素。计算汇总优势比（ORs）和 95%置信区间以确定风险因素。
本系统评价共纳入 34 项病例对照和队列研究，共涉及 9144 例 PA 患者。TSS 治疗 PA 后术后 CSF 漏的总体发生率为 5.6%。肿瘤大小、腺瘤质地、翻修手术和术中 CSF 漏是术后 CSF 漏的独立风险因素（ORs，3.18-6.33）。相比之下，与显微镜入路相比，内镜入路在 TSS 中显示出轻微的保护益处（OR，0.69）。
本综述全面概述了证据基础的质量，使临床医护人员认识到筛查 TSS 治疗 PA 后术后 CSF 漏风险因素的重要性。应更加关注术后 CSF 漏风险较高的 PA 患者，以减少并发症并改善预后。
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