Does Cerebrospinal Fluid Leak in Pituitary Surgery Affect Patient Reported Quality of Life?

Background: Endoscopic techniques allow for improved visualization and tumor debulking of pituitary adenomas. More thorough tumor resection, however, can be associated with higher rates of CSF leaks. We set out to determine if CSF leaks influenced patient perceived quality of life outcomes.

Methods: This retrospective study included 152 patients who underwent endoscopic pituitary tumor resection over a 10-year period. QoL was assessed using the SF-36 questionnaire and completed before surgery, 6 weeks and 6 months post-operatively. Statistical analysis was conducted using a equivalence test and a two-way mixed model ANOVA to assess intraoperative CSF leak, postoperative CSF leak, redo surgery, and the use of a lumbar drain.

Results: Of the 152 patients, 98 had a potential intraoperative CSF leak. Intra- and postoperative CSF leaks did not significantly impact patient reported QoL outcomes at 6 months following surgery. There was clinical equivalence in mental scores as early as 6 weeks and 6 months for physical scores. There was no statistically significant difference in physical (p-value = 0.975) and mental (p = 0.204) scores for patients who experienced a postoperative CSF leak. There was no statistically significant difference in QoL in the mental and physical scores for patients that received a lumbar drain (physical score p = 0.832; mental score p = 0.915) or redo surgery (physical score p = 0.830; mental score p = 0.204).

Conclusion: This article demonstrates that CSF leaks do not impact patient-reported QoL outcomes at 6 months post-surgery. This will allow surgeons to better provide insight and counsel patients regarding the relevance of CSF leaks in the setting of pituitary procedures.

Level of evidence: III Laryngoscope, 2025.