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J Neurol Surg B Skull Base 2022; 83(S 02): e501-e513
DOI: 10.1055/s-0041-1733918
Original Article

Cerebrospinal Fluid Leak after Transsphenoidal Surgery: A Systematic Review and Meta-analysis

Emma M.H. Slot‡   *
1   Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
2   Department of Translational Neuroscience, University Medical Center, Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
,
Rengin Sabaoglu‡   *
1   Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
Eduard H.J. Voormolen
1   Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
Eelco W. Hoving
1   Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
3   Department of Neuro-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
,
Tristan P.C. van Doormaal
1   Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
2   Department of Translational Neuroscience, University Medical Center, Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
4   Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
› Author Affiliations Funding E.M.H.S. receives a research grant through Polyganics B.V.
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Abstract

Background 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.

Methods 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.

Results 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.

Conclusion 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.

Keywords

complications - CSF leak - endonasal - liquorrhea - pituitary adenoma surgery - skull base

Authors' Contributions

E.M.H.S., R.S., E.H.J.V. and T.P.C.v.D. contributed to the study conception and design. E.M.S.H. and R.S. performed the literature search and data collection. The first draft of the manuscript was written by E.M.H.S. and R.S. Supervision was done by T.P.C.v.D., E.H.J.V., and E.W.H. All authors critically revised the final manuscript.


* The authors contributed equally to this manuscript.


Supplementary Material



Publication History

Received: 24 March 2021

Accepted: 01 July 2021

Article published online:
20 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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