Risk factors and repair strategy of intraoperative cerebrospinal fluid leakage by neuroendoscopic transnasal resection of pituitary tumor

Objective To explore the risk factors of intraoperative cerebrospinal fluid leakage and repair strategy of skull base defects during neuroendoscopic transnasal resection of pituitary tumor. Methods A total of 186 patients with pituitary adenoma who underwent neuroendoscopic transnasal resection of pituitary tumor in the Affiliated Hospital of Xuzhou Medical University form January 2018 to December 2019 were enrolled. Their clinical data were analyzed, and the relationships between tumor size, type, texture, invasion, degree of resection and secondary operation with intraoperative cerebrospinal fluid leakage were compared. The risk factors of intraoperative cerebrospinal fluid leakage were discussed through multivariate analysis. According to the classification of cerebrospinal fluid leakage during operation, the corresponding repair strategy of skull base was adopted. Results There were 34 (18.3%) patients with intraoperative cerebrospinal fluid leakage. Tumor size, texture and secondary operation were the independent risk factors for intraoperative cerebrospinal fluid leakage. However, the type of pituitary tumor, Knosp grade, and surgical resection degree were not clearly related with the occurrence of intraoperative cerebrospinal fluid leakage. Among the 34 patients with intraoperative cerebrospinal fluid leakage, 18 cases were grade 1, 10 cases were grade 2, and 6 cases were grade 3. There were 6 cases of postoperative cerebrospinal fluid leakage, in which 5 cases were cured by conservative treatment, and only 1 case was repaired through skull base reconstruction. No cerebrospinal fluid leakage was observed during postoperative follow-up of 3 months to 1 year. Conclusions Cerebrospinal fluid leakage during neuroendoscopic transnasal resection of pituitary tumor is related to tumor size, texture and secondary operation. Once cerebrospinal fluid leakage occurs during the operation, graded repair of skull base repair is safe and effective.