CSF Rhinorrhoea after Transsphenoidal Surgery

Objectives: The author investigated the incidence, risk factors, prevention and management of post-transsphenoidal cerebrospinal fluid (CSF) rhinorrhoea in 146 cases with sellar lesions. Patients and Methods: A review was conducted of 146 consecutive patients who underwent transsphenoidal (TSS) surgery for mainly pituitary adenomas, or other lesions such as craniopharyngioma, Rathk's cleft cyst, meningioma or chordoma in the sella turcica that performed between January 1995 and December 2007 in King Khalid University Hospital, Riyadh, Saudi Arabia. Results: Four CSF leaks (2.7%) developed within 7 days after TSS surgery for pituitary adenoma, two were prolactin-secreting, and the other two were non-secretory macroadenomas. One patient with Cushing syndrome developed CSF leak 30 days after TSS surgery. Intra-operative CSF leak was encountered in 31 cases (21%), and insertion of lumbar CSF drain was effective in treating them. Post-operative CSF leak occurred in none of the 31 cases using preventive lumbar CSF drainage, but observed in 4 out of 115 cases without lumbar drain (P < 0.01). Lumbar CSF drainage was also effective in the treatment of the postoperative CSF leaks; it cured 4 early CSF leaks out of 5 cases. The case with late CSF leaks needed surgical repair. Conclusion: When a CSF leak is encountered during TSS procedure, meticulous layered closure of the defect and reenforcement with tissue glue and fat graft, in addition to insertion of CSF lumbar drain, is necessary to reduce the incidence of postoperative CSF leak.