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<p>To report an institutional experience with lumbar drain, cerebrospinal fluid (CSF) leak, and sellar repair in pituitary surgery.&#xa0;This is a large case series conducted at a tertiary referral center in a developing country. Consecutive patients undergoing endoscopic endonasal pituitary cases between November 2018, and December 2023, were included. The use of intra-operative lumbar drains, rates of intraoperative and postoperative CSF leak, and repair techniques were documented. Patient and tumor characteristics were analyzed for potential risk factors for CSF leak. Sixty-six patients were included. Intraoperative lumbar drain was used in all cases, and kept post-operatively in 16 patients (24.2%). CSF leak was encountered intraoperatively in 19 cases (28.8%) and postoperatively in three cases (4.5%). Intra-operatively 31 defects required closure, 19 of which were for CSF leak. A nasoseptal flap was used in 21 patients, surgical sealants in 16 patients, and an abdominal graft in 13 patients, in different combinations. A pre-op diagnosis of CAD and/or dyslipidemia was associated with a higher rate of intra-operative CSF leak (p = 0.025 and p = 0.018, respectively). High-flow intra-operative leak was associated with hospital re-admission, irrelevant of reconstructive technique (p = 0.002). When resources are lacking, simple closure with a single sealant layer or with a graft/flap is appropriate depending on the defect size. A nasoseptal flap is mainly employed in cases of high-flow intraoperative CSF leak. Intraoperative and postoperative lumbar drain did not statistically change the surgical outcome and were not associated with increased morbidity.</p>

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The Use of Intra-Operative Lumbar Drain and Local Flaps/Grafts in Pituitary Adenoma Surgery: A 5-Year Institutional Experience

  • 期刊论文

  • 发表日期：

    2025年12月17日

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  • Christophe Abi Zeid Daou,
  • Jad Hosri,
  • Nader Zalaquett,
  • Houssein Darwish,
  • Zeina Korban

摘要

To report an institutional experience with lumbar drain, cerebrospinal fluid (CSF) leak, and sellar repair in pituitary surgery. This is a large case series conducted at a tertiary referral center in a developing country. Consecutive patients undergoing endoscopic endonasal pituitary cases between November 2018, and December 2023, were included. The use of intra-operative lumbar drains, rates of intraoperative and postoperative CSF leak, and repair techniques were documented. Patient and tumor characteristics were analyzed for potential risk factors for CSF leak. Sixty-six patients were included. Intraoperative lumbar drain was used in all cases, and kept post-operatively in 16 patients (24.2%). CSF leak was encountered intraoperatively in 19 cases (28.8%) and postoperatively in three cases (4.5%). Intra-operatively 31 defects required closure, 19 of which were for CSF leak. A nasoseptal flap was used in 21 patients, surgical sealants in 16 patients, and an abdominal graft in 13 patients, in different combinations. A pre-op diagnosis of CAD and/or dyslipidemia was associated with a higher rate of intra-operative CSF leak (p = 0.025 and p = 0.018, respectively). High-flow intra-operative leak was associated with hospital re-admission, irrelevant of reconstructive technique (p = 0.002). When resources are lacking, simple closure with a single sealant layer or with a graft/flap is appropriate depending on the defect size. A nasoseptal flap is mainly employed in cases of high-flow intraoperative CSF leak. Intraoperative and postoperative lumbar drain did not statistically change the surgical outcome and were not associated with increased morbidity.