Intraoperative lumbar drainage can prevent cerebrospinal fluid leakage during transsphenoidal surgery for pituitary adenomas: a systematic review and meta-analysis

Jiahe Tan,Jin Chen,Renzheng Huan,Ning Huang,Rui Song

doi:10.1186/s12883-020-01877-z

Abstract

BackgroundPerioperative cerebrospinal fluid (CSF) leakage is a major complication of pituitary adenomas transsphenoidal surgery. Lumbar drainage (LD) is a common method of treating CSF leakage. But whether intraoperative LD can prevent CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery remains controversial. Clarity on the appropriate use of LD is needed.MethodsA systematic literature review was conducted in the PubMed, EMBASE, and Web of science databases. Articles were included when they compared intraoperative LD with intraoperative no-LD CSF leakage rates during pituitary adenomas transsphenoidal surgery.ResultsOverall, 5 studies containing 678 cases met the inclusion criteria. When data were provided on intraoperative CSF leakage rates, the meta-analysis showed a significant difference in favor of intraoperative LD. When data were provided on postoperative CSF leakage rates, the meta-analysis also demonstrated a significant difference in favor of intraoperative LD.ConclusionsAlthough the results of this meta-analysis suggest intraoperative LD can reduce the risk of CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery, the available evidence is indefinite. To some extent the results suggest intraoperative LD’s potential positive role. Further studies that include well-designed prospective, randomized controlled clinical trials are necessary for further verification.

Highlights

Perioperative cerebrospinal fluid (CSF) leakage is a major complication of pituitary adenomas transsphenoidal surgery
To the best of our knowledge, no meta-analysis was previously conducted to explore the relationship between intraoperative Lumbar drainage (LD) and CSF leakage rates during the perioperative period of pituitary adenomas transsphenoidal surgery
The estimated pooled results showed that intraoperative LD was an effective measure for decreasing CSF leakage rate during pituitary adenomas transsphenoidal surgery

Summary

Introduction

Perioperative cerebrospinal fluid (CSF) leakage is a major complication of pituitary adenomas transsphenoidal surgery. Whether intraoperative LD can prevent CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery remains controversial. Another review showed that recent studies had not shown encouraging results with the use of LD in preventing CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery [10]. While recent studies reported that intraoperative LD is related to CSF leakage rate during the perioperative period of pituitary adenomas transsphenoidal surgery [11,12,13,14,15], but the relevant results are different. We realized that there was no meta-analysis to compare intraoperative LD with no intraoperative LD for preventing CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery.

Results

Discussion

Conclusion