Slot Emma M H, Sabaoglu Rengin, Voormolen Eduard H J, Hoving Eelco W, van Doormaal Tristan P C
Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Translational Neuroscience, University Medical Center, Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.
J Neurol Surg B Skull Base. 2021 Aug 20;83(Suppl 2):e501-e513. doi: 10.1055/s-0041-1733918. eCollection 2022 Jun.
Cerebrospinal fluid (CSF) leak is widely recognized as a challenging and commonly occurring postoperative complication of transsphenoidal surgery (TSS). The primary objective of this study is to benchmark the current prevalence of CSF leak after TSS in the adult population. The authors followed the PRISMA guidelines. The PubMed, Embase, and Cochrane Library databases were searched for articles reporting CSF leak after TSS in the adult population. Meta-analysis was performed using the Untransformed Proportion metric in OpenMetaAnalyst. For two between-group comparisons a generalized linear mixed model was applied. We identified 2,408 articles through the database search, of which 70, published since 2015, were included in this systematic review. These studies yielded 24,979 patients who underwent a total of 25,034 transsphenoidal surgeries. The overall prevalence of postoperative CSF leak was 3.4% (95% confidence interval or CI 2.8-4.0%). The prevalence of CSF leak found in patients undergoing pituitary adenoma resection was 3.2% (95% CI 2.5-4.2%), whereas patients who underwent TSS for another indication had a CSF leak prevalence rate of 7.1% (95% CI 3.0-15.7%) (odds ratio [OR] 2.3, 95% CI 0.9-5.7). Patients with cavernous sinus invasion (OR 3.0, 95% CI 1.1-8.7) and intraoperative CSF leak (OR 5.9, 95% CI 3.8-9.0) have increased risk of postoperative CSF leak. Previous TSS and microscopic surgery are not significantly associated with postoperative CSF leak. The overall recent prevalence of CSF leak after TSS in adults is 3.4%. Intraoperative CSF leak and cavernous sinus invasion appear to be significant risk factors for postoperative CSF leak.
脑脊液漏被广泛认为是经蝶窦手术（TSS）具有挑战性且常见的术后并发症。本研究的主要目的是确定目前成年人群经蝶窦手术后脑脊液漏的患病率。
作者遵循PRISMA指南。在PubMed、Embase和Cochrane图书馆数据库中搜索报告成年人群经蝶窦手术后脑脊液漏的文章。使用OpenMetaAnalyst中的未转换比例指标进行荟萃分析。对于两组之间的比较，应用广义线性混合模型。
通过数据库搜索，我们识别出2408篇文章，其中2015年以来发表的70篇文章被纳入本系统评价。这些研究纳入了24979例患者，他们总共接受了25034次经蝶窦手术。术后脑脊液漏的总体患病率为3.4%（95%置信区间或CI 2.8 - 4.0%）。垂体腺瘤切除患者中脑脊液漏的患病率为3.2%（95% CI 2.5 - 4.2%），而因其他适应症接受经蝶窦手术的患者脑脊液漏患病率为7.1%（95% CI 3.0 - 15.7%）（优势比[OR] 2.3，95% CI 0.9 - 5.7）。海绵窦侵犯患者（OR 3.0，95% CI 1.1 - 8.7）和术中脑脊液漏患者（OR 5.9，95% CI 3.8 - 9.0）术后脑脊液漏风险增加。既往经蝶窦手术和显微镜手术与术后脑脊液漏无显著相关性。
经蝶窦手术后成年人脑脊液漏的近期总体患病率为3.4%。术中脑脊液漏和海绵窦侵犯似乎是术后脑脊液漏的重要危险因素。
