Risk factors for postoperative cerebrospinal fluid leakage after transsphenoidal surgery for pituitary adenoma: a meta-analysis and systematic review

Zhihuan Zhou,Mengna Luo,Qinqin Zhao,Xiaobing Jiang,Xiaoqun Chen,Yuyu Duan,Feifei Zuo

doi:10.1186/s12883-021-02440-0

Abstract

ObjectivePostoperative cerebrospinal fluid (CSF) leakage represents a challenge even for experienced pituitary surgeons. We aimed to quantitatively synthesize data from studies regarding the risk factors for postoperative CSF leakage after transsphenoidal surgery (TSS) for pituitary adenoma (PA).MethodsPubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case–control and cohort studies, focusing on the risk factors associated with postoperative CSF leakage after TSS for PA. Pooled odds ratios (ORs) and 95% confidence intervals were calculated to determine the risk factors.ResultsA total of 34 case–control and cohort studies involving a total of 9,144 patients with PA were included in this systematic review. The overall rate of postoperative CSF leakage after TSS for PA was 5.6%. Tumor size, adenoma consistency, revision surgery, and intraoperative CSF leakage were independent risk factors for postoperative CSF leakage (ORs, 3.18–6.33). By contrast, the endoscopic approach showed a slight protective benefit compared with the microscopic approach in TSS (OR, 0.69).ConclusionsThis review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative CSF leakage after TSS for PA. More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis.

Highlights

Pituitary adenomas (PAs) are benign neoplasms that represent the most common type of pituitary disorder [1]
This review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative cerebrospinal fluid (CSF) leakage after transsphenoidal surgery (TSS) for PA
More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis

Summary

Introduction

Pituitary adenomas (PAs) are benign neoplasms that represent the most common type of pituitary disorder [1]. State Key Laboratory of Oncology in South China, Collaborative. Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen. University Cancer Center, Guangzhou, Guangdong, PR China. The goals of PA surgery include the complete removal of the adenomas, the correction of hormonal hypersecretion, the retention of pituitary function, and the reduced risk of tumor recurrence [3, 4]. With the evolution of imaging and surgical techniques, TSS has mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data

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