To Determine Frequency of Cerebrospinal Fluid (CSF) Rhinorrohea after Trans-sphenoidal (TSS) Surgery

Authors

  • Dr. Muhammad Shahid Smaija Bahawal Victoria Hospital, Q.A.M.C, Bahawalpur
  • Dr. Aamir Majeed Bahawal Victoria Hospital, Q.A.M.C., Bahawalpur
  • Dr. H.M. Farid Ullah Bahawal Victoria Hospital, Q.A.M.C., Bahawalpur

Keywords:

Pituitary tumours, endoscopic removal, CSF leakage

Abstract

Introduction: Trans-sphenoidal approach has been a major technique for surgical treatment of sellar pathology since the 1960s. With the development of technical possibilities and increase in surgeons’ expertise, mortality and morbidity after such interventions have decreased. Postoperative cerebrospinal fluid (CSF) rhinorrhea, however, remains the most serious and life – threatening complication. The purpose of this study was to determine the magnitude of cerebrospinal fluid rhinorrhea after trans-sphenoidal surgery, so that proper protocols could be taken for its prevention and management in order to reduce the morbidity of these patients.

Materials and Methods: A total of 116 patients, 20 to 60 years of age with sellar and supra-sellar tumours of any size were included. Patients with Rathke’s cleft cyst, meningoceles, recurrent pituitary adenomas and h/o previous surgery and radiation were excluded. All the patients had undergone trans-sphenoidal removal of the tumour and were followed after 24 hours, one week and one month post-operatively and noted for presence of any cerebrospinal fluid rhinorrhea.

Results: Mean age was 45.23 ± 8.71 years in our study. Out of the 29 patients, 44.82% were male and 55.72% were females with ratio of almost 1:1. According to type of tumour, 56.90% were sellar and 43.10% were suprasellar. Cerebrospinal fluid (CSF) rhinorrhea was found in 3 (10.34%) patients, whereas there was no Cerebrospinal fluid (CSF) rhinorrhea in 26 (89.65%) patients.

Conclusion: This study concluded that frequency of CSF rhinorrhea after trans-sphenoidal surgery (TSS) is 10.34% in our population.

Abbreviations: CSF: Cerebrospinal Fluid. TSS: Trans-sphenoidal Surgery

Author Biographies

Dr. Muhammad Shahid Smaija, Bahawal Victoria Hospital, Q.A.M.C, Bahawalpur

Department of Neurosurgery

Dr. Aamir Majeed, Bahawal Victoria Hospital, Q.A.M.C., Bahawalpur

Department of Neurosurgery

Dr. H.M. Farid Ullah, Bahawal Victoria Hospital, Q.A.M.C., Bahawalpur

Department of Neurosurgery

References

1. Jane JA Jr, Laws ER Jr. The surgical management of pituitary adenomas in a series of 3,093 patients. J Am Coll Surg. 2001; 193: 651-9.
2. Schloffer H. Ergolgreiche Operation eines Hypophysen tumors auf nasalem Wege. Wien Klin Wochenschr. 1907; 21: 621.
3. Barzaghi LR, Losa M, Giovanelli M, Mortini P. Complications of trans-sphenoidal surgery in patients with pituitary adenoma: experience at a single centre. Acta Neurochir. 2007; 149: 877-86.
4. Nishioka H, Haraoka J, Ikeda Y. Risk factors of cerebrospinal fluid rhinorrhea following trans-sphenoidal surgery. Acta Neurochir. 2005; 147: 1163-166.
5. Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of trans-sphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurg. 1997; 40: 225-
6. Shiley SG, Limonadi F, Delashaw JB. Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery. Laryngosc. 2003; 113: 1283-288.
7. Esposito F, Dusick JR, Fatemi N, Kelly DF. Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurg. 2007; 60: 295-304.
8. Amašauskas A, Šink?nas K, Draf W. Management of cerebrospinal fluid leak after surgical removal of pituitary adenomas. Medicina. 2008; 44: 302-7.
9. Nirmal KK, Thiagarajan B. Cerebrospinal fluid rhinorrhoes. an overview. Webmed Central: ENT Scholar. 2012; 3 (5): WMC003382.
10. Tahir MZ, Khan MB, Bashir MU, Akhtar S, Bari E. Cerebrospinal fluid rhinorrhea: An institutional perspective from Pakistan. Surg Neurol Int. 2011; 2: 174.
11. Sudhakar N, Ray A, Vafidis JA. Complications after trans-sphenoidal surgery: Our experience and a review of literature. Br J Neurosurg. 2004; 18: 507-12.
12. Elgamal EA. CSF Rhinorrhoea after Trans-sphenoidal Surgery. Int J Neurosurg. 2008; 5 (1): 848.
13. Kerr JT, Chu FWK, Bayles SW. Cerebrospinal fluid rhinorrhea: Diagnosis and management. Otolaryngologic Clin of North Amer. 2005; 38: 597-611.
14. Romero ADCB, Nora JE, Topczewski TE, de Aguiar PHP, Alobid I, Rodriguez EF. CSF fistula after endoscopic trans-sphenoidal surgery. Arq Neuropsiquiatr. 2010; 68 (3): 414-7.
15. Black PM, Zervas NT, Candia GL. Incidence and management of complications of trans-sphenoidal operation for pituitary adenomas. Neurosurgery, 1987; 20 (6): 920-4.
16. Jho HD. Endoscopic transsphenoidal surgery. J Neurooncol. 2001; 54 (2): 187-95. Eljamel MS, Foy PM. Non-traumatic CSF fistulae: clinical history and management. British Journal of Neurosurgery, 1991; 5: 275- 9.
17. Nandapalan V, Watson ID, Swift AC. Beta2– transferrin and cerebrospinal fluid rhinorrhoea. Clin Otolaryngol. 1996; 21: 259-64.
18. Nandapalan V, Watson ID, Swift AC. Beta-2-transferrin and cerebrospinal fluid rhinorrhoea. Clin Otolaryngol. 1996; 21: 259-64.
19. Kerr JT, Chu FWK, Bayles SW. Cerebrospinal fluid rhinorrhea: Diagnosis and management. Otolaryngol Clin North Am. 2005; 38: 597-611.
20. Marshall AH, Jones NS, Robertson IJA. An algorithm for the management of CSF rhinorrhoea illustrated by 36 cases. Rhinology, 1999; 37: 182–5.
21. Elgamal EA. CSF Rhinorrhoea after Trans-sphenoidal Surgery. Internet J Neurosurg. 2008; 5 (1): DOI: 10.5580/848.
22. van Aken MO, Feelders RA, de Marie S, van de Berge JH, Dallenga AH, Delwel EJ, et al. Cerebrospinal fluid leakage during trans-sphenoidal surgery: postoperative external lumbar drainage reduces the risk for meningitis. Pituitary, 2004; 7 (2): 89-93.

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Published

2015-12-25

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