Department of Neurosurgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Department of Neurosurgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
World Neurosurg. 2024 Sep;189:e1098-e1108. doi: 10.1016/j.wneu.2024.07.093. Epub 2024 Jul 18.
Rhinorrhea is a common complication after endoscopic endonasal transsphenoidal pituitary surgery (EETPS). This study evaluates the effectiveness of our sellar reconstruction technique in preventing rhinorrhea.
From June 2020 to March 2024, a surgical team performed 490 EETPS procedures on 458 pituitary adenoma patients. Demographic data, surgery status, and radiological and histopathological classifications were retrospectively analyzed. 4 grades for sellar reconstruction were defined based on intraoperative cerebrospinal fluid (CSF) leakage and diaphragm sella defect size. Grade 0: no CSF leakage; cavity filled with absorbable material. Grade 1: small defect; covered with fat and fascia lata grafts. Grade 2: large defect; added lumbar drainage. Grade 3: extended approach; added nasoseptal flap.
Of the 490 operations, 433 were primary and 57 recurrent. Patients were 50.2% male, mean age 49.01 years. Follow-up averaged 20.5 months. Postoperative rhinorrhea occurred in 8 cases (1.6%). In 404 surgeries (82.5%) without intraoperative CSF leakage, 3 cases (0.7%) developed postoperative rhinorrhea. CSF leakage was detected in 86 cases (17.5%), with postoperative rhinorrhea in 5 cases (5.8%). The risk of rhinorrhea was 8.3 times higher with intraoperative CSF leakage (P = 0.005). Rhinorrhea rates: 0.7% in Grade 0, 3% in Grade 1, 8.7% in Grade 2, and 0% in Grade 3 (P = 0.017). Meningitis occurred in 8 patients (1.7%) and pneumocephalus in 4 (0.9%), with one death (0.2%). The average hospital stay was 17.4 days with rhinorrhea and 5.2 without (P = 0.024).
Intraoperative CSF leakage is highly correlated with rhinorrhea. Multilayered and graded closure strategies significantly reduce postoperative rhinorrhea rates in EETPS.
经鼻内镜蝶窦垂体手术（EETPS）后，鼻漏是一种常见的并发症。本研究评估了我们的鞍底重建技术预防鼻漏的效果。
自 2020 年 6 月至 2024 年 3 月，一个手术团队对 458 例垂体腺瘤患者的 490 例 EETPS 手术进行了回顾性分析。分析了人口统计学数据、手术情况以及影像学和组织病理学分类。根据术中脑脊液（CSF）漏和鞍底缺损大小，将鞍底重建分为 4 个等级。0 级：无 CSF 漏；腔隙填充可吸收材料。1 级：小缺损；用脂肪和阔筋膜移植物覆盖。2 级：大缺损；加腰椎引流。3 级：扩展入路；加鼻中隔瓣。
490 例手术中，初次手术 433 例，复发手术 57 例。患者 50.2%为男性，平均年龄 49.01 岁。平均随访 20.5 个月。术后发生鼻漏 8 例（1.6%）。在 404 例无术中 CSF 漏的手术中，术后发生鼻漏 3 例（0.7%）。86 例（17.5%）术中发现 CSF 漏，术后 5 例（5.8%）发生鼻漏。术中 CSF 漏者发生鼻漏的风险是无术中 CSF 漏者的 8.3 倍（P=0.005）。鼻漏发生率：0 级 0.7%，1 级 3%，2 级 8.7%，3 级 0%（P=0.017）。发生脑膜炎 8 例（1.7%），发生气颅 4 例（0.9%），死亡 1 例（0.2%）。有鼻漏者的平均住院时间为 17.4 天，无鼻漏者为 5.2 天（P=0.024）。
术中 CSF 漏与鼻漏高度相关。多层分级关闭策略可显著降低 EETPS 术后鼻漏发生率。
