J Neurol Surg B Skull Base 2018; 79(06): 554-558
DOI: 10.1055/s-0038-1635257
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Lumbar Puncture for the Injection of Intrathecal Fluorescein: Should It Be Avoided in a Subset of Patients Undergoing Endoscopic Endonasal Resection of Sellar and Parasellar Lesions?

Michael Zhang
1   Department of Neurosurgery, Stanford School of Medicine, Stanford, California, United States
,
Tej D. Azad
1   Department of Neurosurgery, Stanford School of Medicine, Stanford, California, United States
,
Harminder Singh
1   Department of Neurosurgery, Stanford School of Medicine, Stanford, California, United States
2   Department of Neurosurgery, Otolaryngology and Neuroscience, Weill Cornell Medicine, New York, New York, United States
,
Smeer Salam
3   Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
,
Saurabh Jain
4   Department of Neurosurgery, G.B.H. American Hospital, Udaipur, Rajasthan, India
,
Vijay K. Anand
2   Department of Neurosurgery, Otolaryngology and Neuroscience, Weill Cornell Medicine, New York, New York, United States
,
Theodore H. Schwartz
2   Department of Neurosurgery, Otolaryngology and Neuroscience, Weill Cornell Medicine, New York, New York, United States
› Author Affiliations
Funding No funding was received for this research.
Further Information

Publication History

09 August 2017

21 February 2018

Publication Date:
13 April 2018 (online)

Abstract

Objectives The use of intrathecal fluorescein (ITF) has become an increasingly adopted practice for the identification of cerebrospinal fluid (CSF) leaks during endoscopic skull base surgery for pituitary adenomas. Administration through lumbar puncture can result in postoperative positional headaches, increasing morbidity, cost, and length of stay. We sought to identify the incidence of and variables associated with postoperative headaches to determine if there was a subgroup of patients in whom this procedure should be avoided.

Methods We conducted a retrospective single-institution review of 148 patients who underwent endoscopic resection with ITF for pituitary adenoma between December 2003 and February 2016. We excluded patients who had lumbar drains and with intraoperative CSF leak, as these patients may have other headache etiologies. Patient demographics, comorbidities, tumor features, surgical approach, surgical closure, and histology were recorded. Primary outcomes included the presence of postoperative and positional headaches.

Results We identified 62 patients with postoperative headaches (41.9%) and 10 with positional headaches (6.8%), of whom 6 underwent blood patch with complete resolution. Following univariate analysis, there was a significant positive association with prolactin-secreting tumors (p = 0.008). There was a negative association with a history of hypertension (p = 0.0001) and age (p = 0.01). Following multivariate modeling, the significance for hypertension (p = 0.01) was preserved.

Conclusions Positional headaches in patients who receive ITF are uncommon and should not limit its use in the preparations for endoscopic resection of pituitary adenomas. Avoiding ITF in younger patients without hypertension with prolactinomas might decrease the risk of post-ITF positional headaches.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


 
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