Safety and CSF Leak Outcomes After Endoscopic Endonasal Resection of Giant Pituitary Adenomas Without Nasoseptal Flap

Abstract

Objective:  The study aimed to assess the risk of CSF leakage without the use of Nasoseptal flap elevations (NSFE) as compared to the standard practices of endoscopic endonasal approach (EEA) and multilayer graft reconstruction.

Materials & Methods:  A retrospective review of EEA surgeries performed with multilayer graft repair in patients with per op CSF Leak but not with the NSFE, between June 2018 and February 2023, with a follow-up at one and three months. A proforma mentioning perioperative, preoperative, pre-operative, and follow-up data regarding CSF leak, intervention, and investigation was used. Descriptive statistical analysis was done.

Results:  We collected data for 175 patients (70 male and 105 female). Mean age was 40 yrs. Mean tumor size in diameter was 45mm.CSF leakage in NSFE ranged from one to five percent in the literature, owing to the size. Similarly, due to large tumor sizes, there were 54/175 (30.86%) patients with CSF leak postoperatively. These 54 cases underwent multilayer graft reconstruction during the same surgery. Total CSF leaks were 8/175(4.57%) on follow-ups. Five patients out of these eight improved with conservative management (lumbar drain and puncture). Two patients had to go for surgery immediately postoperatively, and one had a follow-up. Redosurgery accounted for 3/175(1.71%). There were no invasive nasal complications as in NSFE.

Conclusion:  Even with giant macro adenomas, EEA with multilayer graft reconstruction gave equally effective results as compared to the landmark considered treatment option, controlling CSF leak, and the NSFE.