Risk factors of cerebrospinal fluid leakage after neuroendoscopic transsphenoidal pituitary adenoma resection: a systematic review and meta-analysis

Jiahui Zhao; Shisong Wang; Xudong Zhao; Haohao Cui; Cunyi Zou

doi:10.3389/fendo.2023.1263308

Risk factors of cerebrospinal fluid leakage after neuroendoscopic transsphenoidal pituitary adenoma resection: a systematic review and meta-analysis

Front Endocrinol (Lausanne). 2024 Jan 8:14:1263308. doi: 10.3389/fendo.2023.1263308. eCollection 2023.

Authors

Jiahui Zhao¹, Shisong Wang¹, Xudong Zhao¹, Haohao Cui¹, Cunyi Zou¹

Affiliation

¹ Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.

Abstract

Introduction: Cerebro spinal fluid (CSF) leakage is common and might lead to severe postoperative complications after endoscopic transsphenoidal pituitary adenoma resection. However, the risk factors of postoperative CSF leakage are still controversial. This article presents a systematic review to explore the explicit risk factors of CSF leakage after endoscopic transsphenoidal pituitary adenomere section.

Methods: PRISMA and AMSTAR guidelines were followed to assess the methodological quality of the systematic review. PubMed, Medline, Embase, Web of Science, Cochrane, Clinical Trails, CNKI, CBM, Wan Fang, and VIP databases were searched for all studies on postoperative CSF leak risk factors. The quality of the included studies was assessed by the Newcastle-Ottawa scale. Review Manager 5.4 software was used to calculate the pooled effect size of potential factors with statistical significance.

Results: A total of 6775 patients with pituitary adenoma across 18 articles were included, containing 482 cases of postoperative CSF leakage (accounting for 7.11%). All of the articles had a quality score > 5, indicating good quality. Meta-analysis showed that an increased risk of CSF leak was found for higher levels of BMI (MD=1.91, 95% CI (0.86,2.96), bigger tumor size [OR=4.93, 95% CI (1.41,17.26)], greater tumor invasion (OR=3.01, 95% CI (1.71, 5.31), the harder texture of tumor [OR=2.65, 95% CI (1.95,3.62)], intraoperative cerebrospinal fluid leakage [OR=5.61, 95% CI (3.53,8.90)], multiple operations [OR=2.27, 95% CI (1.60,3.23)].

Conclusion: BMI, multiple operations, tumor size, tumor invasion, hard texture, and intraoperative cerebrospinal fluid leakage are the risk factors of postoperative CSF leakage. Clinical doctors should pay attention to these risk factors, and conduct strict skull base reconstruction and careful postoperative management.

Keywords: cerebrospinal fluid leakage; endoscopic surgery; meta-analysis; pituitary adenoma; risk factors; systematic review.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adenoma* / surgery
Cerebrospinal Fluid Leak / epidemiology
Cerebrospinal Fluid Leak / etiology
Head
Humans
Pituitary Neoplasms* / surgery
Postoperative Complications / epidemiology
Postoperative Complications / etiology

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Natural Science Foundation of Liaoning Province (no. 2020-BS-105 to CZ), China Postdoctoral Science Foundation (no. 2019M661167 to CZ).