Abstract
Objective: To explore the clinical effect of and the method and nursing strategy for sellar reconstruction for intraoperative cerebrospinal fluid (CSF) leakage in pituitary adenoma resection under neuroendoscopy. Methods: The data from 20 cases of intraoperative CSF leak caused by transsphenoidal pituitary adenoma resection were retrospectively analyzed. Six patients were treated with mucosal flap and artificial dural reconstruction of sellar (simple sellar floor reconstruction). In 45 patients, autologous fat, fascia lata, and artificial dura were used to repair and reconstruct the sellar floor (multilayer sellar floor reconstruction). After the operation, all patients underwent follow-up for 6 - 24 months. Results: Fifty patients were followed up without CSF leakage. One patient was cured after leakage of CSF through the lumbar cistern 1 month after discharge. Conclusion: For patients with CSF leakage during neuroendoscopic transsphenoidal pituitary adenoma resection, individualized sellar floor reconstruction should be adopted according to the degree of CSF leakage and the size of the sellar floor defect. Strict nursing measures can effectively prevent CSF leakage and reduce postoperative complications.
Highlights
The pituitary adenoma is a common benign intracranial tumor, and the neuroendoscopic transsphenoidal approach is the preferred surgical treatment for pituitary adenoma [1]
The data from 20 cases of intraoperative cerebrospinal fluid (CSF) leak caused by transsphenoidal pituitary adenoma resection were retrospectively analyzed
For patients with CSF leakage during neuroendoscopic transsphenoidal pituitary adenoma resection, individualized sellar floor reconstruction should be adopted according to the degree of CSF leakage and the size of the sellar floor defect
Summary
The pituitary adenoma is a common benign intracranial tumor, and the neuroendoscopic transsphenoidal approach is the preferred surgical treatment for pituitary adenoma [1]. Cerebrospinal fluid (CSF) leakage is the most common complication of pituitary adenoma, and the incidence of intraoperative CSF leakage is gradually increasing. Intraoperative sellar floor reconstruction is the key link to prevent CSF leakage, and timely sellar floor reconstruction can effectively reduce postoperative CSF leakage [2]. We retrospectively analyzed the clinical data of 51 patients with CSF leakage during neuroendoscopic pituitary adenoma resection between November 2018 and January 2021. All of these patients underwent sellar floor reconstruction in time during the operation, and implement rigorous nursing strategy after surgery, and achieved good clinical effect. The reconstruction methods and nursing strategy of sellar floor reconstruction are retrospectively reported as follows
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