Effect of Intraoperative Lumbar Drainage on Gross Total Resection and Cerebrospinal Fluid Leak Rates in Endoscopic Transsphenoidal Surgery of Pituitary Macroadenomas.

Abstract

OBJECTIVE:

We sought to assess whether controlled, intraoperative lumbar drainage (LD) of cerebrospinal fluid (CSF) could facilitate resection of pituitary macroadenomas and reduce the rate of CSF leak.

METHODS:

A retrospective cohort study from a prospective database was conducted on 189 patients with pituitary macroadenoma who received endoscopic transsphenoidal surgery between 2013 and 2017. Patients were classified into 2 groups: 119 patients received an intraoperative LD (LD group) and 70 patients underwent routine endoscopic surgery without LD (control group). In the LD group, lumbar catheters were placed preoperatively and CSF was drained intermittently during tumor resection. The rates of gross total resection (GTR) and CSF leaks were assessed both intraoperatively and postoperatively.

RESULTS:

Intraoperative LD was associated with a higher rate of GTR (92.4% in the LD group vs. 78.6% in the control group, P = 0.006), especially in macroadenomas with suprasellar extension (90.3% vs. 75.0%, P = 0.012). Both intraoperative and postoperative CSF leak rates were significantly decreased in the LD group (intraoperative: 10.1% vs. 31.4%, P < 0.001; postoperative: 3.4% vs. 11.4%, P = 0.035). In functioning adenomas, a better remission rate of excess-hormone secretion was observed in the LD group compared with the controls (89.1% vs. 60.6%, P = 0.001). Patients in the LD group also had an enhanced recovery with a shorter postoperative length of stay (7 days vs. 5 days, P = 0.020).

CONCLUSIONS:

Intraoperative LD may assist surgeons during endoscopic transsphenoidal resection of pituitary macroadenomas by achieving a higher rate of GTR and a lower rate of perioperative CSF leaks. Validation in prospective randomized controlled studies is needed.

• Authors: Bolin Liu, Yuan Wang, Tao Zheng, Shujuan Liu, Wenhai Lv, Dan Lu, Lei Chen, Long Chen, Tao Ma, Guodong Gao, Yan Qu, Shiming He
• Journal: World neurosurgery (World Neurosurg) Vol. 135 Pg. e629-e639 (Mar 2020) ISSN: 1878-8769 [Electronic] United States
• PMID: 31881340 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Adenoma (surgery)
• Adult
• Aged
• Cerebrospinal Fluid Leak (etiology)
• Cohort Studies
• Drainage (methods)
• Female
• Humans
• Lumbosacral Region (surgery)
• Male
• Middle Aged
• Neuroendoscopy (methods)
• Pituitary Neoplasms (surgery)
• Prospective Studies
• Young Adult