Incidence of postoperative cerebrospinal fluid leaks in endoscopic endonasal transsphenoidal surgery for pituitary adenomas without sellar floor reconstruction: A retrospective observational study from a low-middle-income country

Sumira Kiran; Shuja Ikram; Ahtesham Khizar; Muhammad Kaleem Iftikhar; Haseeb Mehmood Qadri; Muhammad Waqas Umer; Khawar Anwar; Asif Bashir

doi:10.12669/pjms.40.12(PINS).11109

Incidence of postoperative cerebrospinal fluid leaks in endoscopic endonasal transsphenoidal surgery for pituitary adenomas without sellar floor reconstruction: A retrospective observational study from a low-middle-income country

Pak J Med Sci. 2024 Dec;40(12PINS Suppl):S20-S24. doi: 10.12669/pjms.40.12(PINS).11109.

Authors

Sumira Kiran¹, Shuja Ikram², Ahtesham Khizar³, Muhammad Kaleem Iftikhar⁴, Haseeb Mehmood Qadri⁵, Muhammad Waqas Umer⁶, Khawar Anwar⁷, Asif Bashir⁸

Affiliations

¹ Sumira Kiran, MBBS, MS Assistant Professor Neurosurgery, Department of Neurosurgery Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan.
² Shuja Ikram, MBBS Postgraduate Resident Neurosurgery, Department of Neurosurgery Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan.
³ Ahtesham Khizar, MBBS, FCPS Senior Registrar Neurosurgery, Department of Neurosurgery Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan.
⁴ Muhammad Kaleem Iftikhar, MBBS Postgraduate Resident Neurosurgery, Department of Neurosurgery Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan.
⁵ Haseeb Mehmood Qadri, MBBS Postgraduate Resident Neurosurgery, Department of Neurosurgery Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan.
⁶ Muhammad Waqas Umer, MBBS Postgraduate Resident Neurosurgery, Department of Neurosurgery Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan.
⁷ Khawar Anwar, MBBS, MS Senior Registrar Neurosurgery, Department of Neurosurgery Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan.
⁸ Asif Bashir, MD, FAANS, FACS Professor of Neurosurgery, Department of Neurosurgery Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan.

Abstract

Objectives: To determine the incidence of postoperative cerebrospinal fluid (CSF) leaks after endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenomas without sellar floor reconstruction (SFR).

Methods: This retrospective observational study was conducted at Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore, Pakistan from January, 2018 to December, 2022. It is a non-probability based consecutive case series. A total of 316 patients meeting the inclusion criteria were selected.

Results: Among the 316 patients, 102 (32.3%) were male, while 214 (67.7%) were female. Mean age was 40.98 ± 7.8 SD (range 23 to 65 years). Regarding size of pituitary adenomas, 19 (6%) were microadenomas and 297 (94%) were macroadenomas. Overall postoperative CSF (poCSF) leak in our patients was 2.8%. Among cases with poCSF leak, 4 (3.9%) were male and five were female (2.3%) with the P-value of 0.477. Regarding size of pituitary adenomas, only one (5.3%) microadenoma had poCSF leak whereas 8 (2.7%) macroadenomas had poCSF leak with the P-value of 0.432.

Conclusion: Pituitary adenomas can be successfully treated with EETS without SFR in patients who do not experience intraoperative CSF leak.

Keywords: Cerebrospinal fluid leak; Developing countries; Endoscopy; Pituitary adenoma; Prolactinoma; Sella turcica.