RISK FACTOR ANALYSIS FOR INTRAOPERATIVE CSF LEAK DURING ENDOSCOPIC TRANSNASAL HYPOPHYSECTOMY; A RETROSPECTIVE REVIEW

Abstract

Objective: To analyze the possible risk factors which may be responsible for intraoperative CSF leak during endoscopic pituitary surgery.

Material and Method: The study was done in Singapore General Hospital, Singapore. It was a retrospective data extraction and analysis from 2008 to 2011.
Outcome measured: size of tumor, volume of tumor, consistency of the tumor during surgery, attempts for removal which was correlated with Intraoperative CSF leak in eachpatient. The tumor was classified into Micro and Macro adenoma with reference of Craniocaudal Length i.e > 1 cm is Macroadenoma and <1 cm is Microadenoma. The volume of the tumor was calculated using IPLAN CRANIAL VERSION 2.6 provided by the brain lab.

Results: The total number of patients were 128 and Among 128 patients 68 were male and 60 female. Out of 128 patients, 28 Patients had intraoperative leak which was identified during the time of surgery and were sealed using different technique. Out of leaking 28 patients, 3 patients had post-operative leak even after initial closure on table which were managed successfully with Lumbar puncture. The intra operative leak was not significantly associated with studied variables nevertheless the intraoperative CSF leak significantly increased the hospital stay ( p=.009).

Conclusion: Intraoperative CSF leak is a definitely important morbidity to the patients as it lengthen the hospital stay as shown in our study. In order to shorten the hospital stay we tried to look for possible factors like tumor volume, size, consistency, endocrine status and attempts for surgery, none of these variable shows any statistical significance with intraoperative Leak.

Keywords: CSF leak, Endoscopic approach, Pituitary adenomas