Article
Postoperative cerebrospinal rhinorrhoea after transsphenoidal resection of sellar pathologies – benefit of lumbar drainage
Postoperative Liquorfistel nach transsphenoidaler Resektion sellärer Pathologien: Nutzen der lumbalen Drainage
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Authors
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Bernardo Reyes Medina
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg a. d. Saar, Deutschland
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Stefan Linsler
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg a. d. Saar, Deutschland
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Sebastian Senger
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg a. d. Saar, Deutschland
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Joachim Oertel
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg a. d. Saar, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: Ever since the early nineties, endoscopic surgical techniques have become the gold standard in transnasal transsphenoidal approaches for pathologies of the sellar region. However, postoperative complications include cerebrospinal rhinorrhoea as one of the most frequent complications after transsphenoidal approaches. The incidence lays between 0,5 and 15% in the literature. In this study, the authors present their results and experience on cases with intraoperative cerebrospinal rhinorrhoea after a transsphenoidal approach and its treatment with lumbare drainage.
Methods: All endoscopic procedures performed via endonasal approach at the Department of Neurosurgery Homburg University hospital between March 2011 and April 2020 were analysed. The patients were retrospectively followed. A total of 293 Patients were analysed. The exclusion criteria were Patients younger than 18 years, traumatic CSF leak.
Results: Out of the analysed cohort, 87 patients (29%) had intraoperatively identified CSF leakage. The closure of the diaphragm and dura performed with autologous fat graft in 51 cases (62%) and in stand alone technique with Duragen and Tachosil in 36 patients (38%). The authors did not use a Hadard flap in these cases. Ten patients (3.4%) had a postoperative CSF leak and they were treated with lumbal CSF drainage for 7 days. From those patients with postoperative persistend CSF leakage, 6 needed a revision surgery with reclosure of the fistula.
Conclusion: Our study correlated with the literature. The postoperative CSF leak was found in 3,4% of all cases. The use of a lumbar drainage for a persistend CSF leakage with rhinoliquorrhoe after endoscopic endonasal surgery was only effective in the minority of the cases. Therefore, the authors suggest using a lumbar drainage only directly after surgery after surgical closure of a CSF leakage. In cases of persistent rhinoliquorrhoe after endonasal sellar surgery, the indication for revision surgery should be discussed with the patients directly.
