gms | German Medical Science

64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. - 29. Mai 2013, Düsseldorf

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Incidence and significance of intraoperative CSF leak in endoscopic pituitary surgery using intrathecal fluorescein

Meeting Abstract

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  • Dejan Jakimovski - Department of Neurosurgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA; Neurochirurgische Klinik, Universitätsklinikum Aachen, Deutschland
  • Gregory Bonci - Department of Neuroradiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA
  • Moshe Attia - Department of Neurosurgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA
  • Apostolos J. Tsiouris - Department of Neuroradiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA
  • Vijay K. Anand - Department of Otorhinolaryngology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA
  • Theodore H. Schwartz - Department of Neurosurgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA; Department of Otorhinolaryngology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA; Department of Neurology and Neuroscience, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.04.02

doi: 10.3205/13dgnc030, urn:nbn:de:0183-13dgnc0309

Veröffentlicht: 21. Mai 2013

© 2013 Jakimovski et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.

Gliederung

Text

Objective: The true rate of intraoperative (i)CSF leak during pituitary surgery is not well known since small iCSF leaks are easily missed. Our objective is to determine the rate and significance of iCSF leak in endoscopic pituitary surgery with intrathecal fluorescein administration and determine factors predictive of iCSF leak.

Method: Intrathecal fluorescein was administered in 203 consecutive endoscopic, endonasal pituitary surgeries. The rate of iCSF leak was noted prospectively and correlated with tumor diameter and volume, rate of gross total resection (GTR) and the learning curve. Post-operative CSF leak rate, complications and nasoseptal (NS) flap utility were also investigated.

Results: The rate of iCSF leak was 61% overall, 44% for tumors <2 cm compared to 72% for tumors ≥2 cm and 35% for tumors <1.5 cm3 compared to 68% for those ≥1.5 cm3 (p<0.001). GTR and the learning curve did not influence iCSF leak rates. Re-operations had a higher rate of iCSF leak only for tumors > 2 cm. Post-operative CSF leak was significantly lower after the learning curve was completed (0.7% versus 10%; p<0.005). For tumors >2 cm, the introduction of NS flap reduced the rate of post-operative CSF leak from 5.6% to 1.4%. We did not find any complications clearly related with the use of intrathecal fluorescein.

Conclusions: The rate of iCSF leak during endoscopic pituitary surgery using intrathecal fluorescein is higher than previously reported. Tumor diameter and volume are best predictors of the risk of iCSF leak. Based on this knowledge and a closure algorithm which includes NS flap for larger tumors (>2.5 cm), the post-operative CSF leak rate remains exceptionally low, particularly once the learning curve is overcome.