Risk factors for cerebrospinal fluid fistulas due to endoscopic transnasal surgery for pituitary neoplasms

Abstract

Objective To investigate the risk factors associated with cerebrospinal fluid (CSF) fistulas due to endoscopic transnasal surgery for pituitary neoplasms. Methods The data of 1,063 patients were reviewed who had undergone transnasal surgery for pituitary adenomas between January 2009 and December 2012 at Department of Neurosurgery, General Hospital of PLA in Beijing. Intra-operative CSF fistulas were observed in 122 patients but not in the other 941 ones; post-operative CSF fistulas were observed in 29 patients but not in the other 1,034 ones. The clinical data were compared between the patients with and without intra-operative CSF fistulas and between those with and without post-operative CSF fistulas. Chi-square was used to identify the potential risk factors associated with intra- and post-operative CSF fistulas. Multivariate Logistic analysis was performed for correlated variables. Results There was a significant difference in tumor size between the patients with and without intra-operative CSF fistulas (P<0.05). There were significantly more patients undergoing reoperation in those with intra-operative CSF fistulas than in those without (P<0.05). The multivariate Logistic analysis revealed that giant adenoma, macroadenoma and reoperation were independently associated with intraoperative CSF fistulas. There was a significant difference in age and tumor size between the patients with and without post-operative CSF fistulas (P<0.05). There were significantly more patients undergoing reoperation and suffering intraoperative CSF fistulas in those with post-operative CSF fistulas than in those without (P<0.05). The multivariate Logistic analysis revealed that giant pituitary neoplasms, reoperation and intra-operative CSF fistulas were independently associated with post-operative CSF fistulas. Conclusions In endoscopic transnasal surgery for pituitary neoplasms, the risk factors for intra-operative CSF fistulas are larger tumor size and reoperation and the risk factors for post-operative CSF fistulas are giant pituitary neoplasms, intra-operative CSF fistulas and reoperation. Key words: Pituitary neoplasms; Endoscope; Transnasal surgery; Cerebrospinal fluid fistulas; Risk factors