Endoskopik transsfenoidal hipofiz cerrahisinde intraoperatif BOS drenajının post-operatif rinore üzerine etkisi
Öz
Amaç: İntraoperatif BOS kaçağı ve postoperatif rinore için faydalı olabilecek intraoperatif BOS drenajını tanımlayan az sayıda çalışma olduğundan, intraoperatif BOS kaçağını azalttığını, cerrahi alan kontrolünü artırdığını ve maksimum tümör rezeksiyonuna katkıda bulunduğunu gözlemlediğimiz, klinik pratiğimizde kullandığımız bu teknik ile ilgili deneyimlerimizi paylaşmak istedik.
Gereç ve yöntem: Ağustos 2018-Aralık 2019 tarihleri arasında endoskopik endonasal yolla opere edilen 266 hipofiz adenomu vakası retrospektif olarak incelendi. Vakalar intraoperatif dönemde lomber drenaj katateri ile BOS drenajı uygulanan ve uygulanmayan olarak iki gruba ayrıldı. Başarı kriteri postoperatif ilk 2 ay içerisinde rinore görülmemesi olarak belirlendi. İki grup arasında rinore görülmesinde anlamlı fark olup olmadığı SPSS (version 20, IBM Corp.) yazılımı kullanılarak ve Ki-kare testi ile ortaya konulmaya çalışıldı.
Bulgular: İntraoperatif BOS drenajı yapılan grupta 1 hastada post-operatif rinore görülürken BOS boşaltılmayan grupta 6 hastada post-operatif rinore görülmüştür ve bu fark istatistiki olarak anlamlı bulunmuştur (p<0,05).
Sonuç: Bulgularımız intraoperatif BOS drenajı sayesinde atmosfer basıncı desteğiyle diafragma sella elevasyonunun sağlanarak intraoperatif BOS kaçağının ve dolayısıyla postoperatif rinore oranlarının azaldığı yönündedir.
Anahtar Kelimeler
Bos kaçağı hipofiz adenomu transsfenoidal endoskopik cerrahi lomber drenaj
Destekleyen Kurum
Yok
Proje Numarası
Yok
Teşekkür
Yok
Kaynakça
- 1. Conger A, Zhao F, Wang X, Eisenberg A, Griffiths C, Esposito F, et al. Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: Trends in repair failure and meningitis rates in 509 patients. J Neurosurg. 2019;130(3):861–75.
- 2. Strickland BA, Lucas J, Harris B, Kulubya E, Bakhsheshian J, Liu C, et al. Identification and repair of intraoperative cerebrospinal fluid leaks in endonasal transsphenoidal pituitary surgery: Surgical experience in a series of 1002 patients. J Neurosurg. 2018;129(2):425–9.
- 3. Han ZL, He DS, Mao ZG, Wang HJ. Cerebrospinal fluid rhinorrhea following trans-sphenoidal pituitary macroadenoma surgery: Experience from 592 patients. Clin Neurol Neurosurg. 2008;110(6):570–9.
- 4. Aghamohamadi D, Ahmadvand A, Salehpour F, Jafari R, Panahi F, Sharifi G, et al. Effectiveness of lumbar drain versus hyperventilation to facilitate transsphenoidal pituitary (suprasellar) adenoma resection. Anesthesiol Pain Med. 2013;2(4):159–63.
- 5. Guinto Balanzar G, Abdo M, Mercado M, Guinto P, Nishimura E, Arechiga N. Diaphragma sellae: A surgical reference for transsphenoidal resection of pituitary macroadenomas. World Neurosurg [Internet]. 2011;75(2):286–93. Available from: http://dx.doi.org/10.1016/j.wneu.2010.08.002
- 6. Park JH, Choi JH, Kim Y Il, Kim SW, Hong YK. Modified graded repair of cerebrospinal fluid leaks in endoscopic endonasal transsphenoidal surgery. J Korean Neurosurg Soc. 2015;58(1):36–42.
- 7. Mehta GU, Oldfield EH. Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas: Clinical article. J Neurosurg. 2012;116(6):1299–303.
- 8. Cappabianca P, Cavallo LM, De Divitiis E, Kelly DF, Fineman I. Collagen sponge repair of small cerebrospinal fluid leaks obviates tissue grafts and cerebrospinal fluid diversion after pituitary surgery [10] (multiple letters). Neurosurgery. 2002;50(5):1173–4.
- 9. Cohen S, Jones SH, Dhandapani S, Negm HM, Anand VK, Schwartz TH. Lumbar drains decrease the risk of postoperative cerebrospinal fluid leak following endonasal endoscopic surgery for suprasellar meningiomas in patients with high body mass index. Oper Neurosurg. 2018;14(1):66–70.
- 10. Kaptain GJ, Kanter AS, Hamilton DK, Laws ER. Management and implications of intraoperative cerebrospinal fluid leak in transnasoseptal transsphenoidal microsurgery. Neurosurgery. 2011;68(SUPPL. 1):144–51.
- 11. Hu F, Gu Y, Zhang X, Xie T, Yu Y, Sun C, et al. Combined use of a gasket seal closure and a vascularized pedicle nasoseptal flap multilayered reconstruction technique for high-flow cerebrospinal fluid leaks after endonasal endoscopic skull base surgery. World Neurosurg. 2015;83(2):181–7.
- 12. Hara T, Akutsu H, Yamamoto T, Tanaka S, Takano S, Ishikawa E, et al. Cranial base repair using suturing technique combined with a mucosal flap for cerebrospinal fluid leakage during endoscopic endonasal surgery. World Neurosurg [Internet]. 2015;84(6):1887–93. Available from: http://dx.doi.org/10.1016/j.wneu.2015.08.025
- 13. Abdelmaksoud A, Fu P, Alwalid O, Elazab A, Zalloom A, Xiang W, et al. Degrees of Diaphragma Sellae Descent during Transsphenoidal Pituitary Adenoma Resection: Predictive Factors and Effect on Outcome. Curr Med Sci. 2018;38(5):888–93.
The effect of intraoperative CSF drainage on post-operative rhinorrhea in endoscopic transsphenoidal pituitary surgery
Öz
Purpose: Since few studies describing intraoperative CSF drainage that may be beneficial for intraoperative CSF leak and postoperative rhinorrhea, we wanted to share our experience with this technique, which we observe that it reduces intraoperative CSF leakage, increases surgical field control and contributes to maximum tumor resection.
Methods and materials: 266 pituitary adenoma cases operated endonasal endoscopically between August 2018 and December 2019 were retrospectively analyzed. Patients were grouped as intraoperative CSF drained patients via a lumbar drainage shunt and patients who did not received any CSF drainage intraoperatively. The success criterion was determined as the absence of rhinorrhea in the first 2 months postoperatively. Whether there is a significant difference in the appearance of rhinorrhea between the two groups was tried to be determined by using SPSS (version 20, IBM Corp.) software and Chi-square test.
Results: In the group where the intraoperative CSF was drained post-operative rhinorrhea was observed in 1 patient, whereas 6 patients in the non-CSF drainage group had post-operative rhinorrhea and this difference was statistically significant (p<0,05).
Conclusions: Our findings suggest that diaphragma sellae elevation is achieved with the support of atmospheric pressure due to the preoperative CSF drainage, and therefore intraoperative CSF leakage and postoperative rhinorrhea rates are reduced.
Anahtar Kelimeler
CSF leak pituitary adenoma transsphenoidal endoscopic surgery lumbar drain
Proje Numarası
Yok
Kaynakça
- 1. Conger A, Zhao F, Wang X, Eisenberg A, Griffiths C, Esposito F, et al. Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: Trends in repair failure and meningitis rates in 509 patients. J Neurosurg. 2019;130(3):861–75.
- 2. Strickland BA, Lucas J, Harris B, Kulubya E, Bakhsheshian J, Liu C, et al. Identification and repair of intraoperative cerebrospinal fluid leaks in endonasal transsphenoidal pituitary surgery: Surgical experience in a series of 1002 patients. J Neurosurg. 2018;129(2):425–9.
- 3. Han ZL, He DS, Mao ZG, Wang HJ. Cerebrospinal fluid rhinorrhea following trans-sphenoidal pituitary macroadenoma surgery: Experience from 592 patients. Clin Neurol Neurosurg. 2008;110(6):570–9.
- 4. Aghamohamadi D, Ahmadvand A, Salehpour F, Jafari R, Panahi F, Sharifi G, et al. Effectiveness of lumbar drain versus hyperventilation to facilitate transsphenoidal pituitary (suprasellar) adenoma resection. Anesthesiol Pain Med. 2013;2(4):159–63.
- 5. Guinto Balanzar G, Abdo M, Mercado M, Guinto P, Nishimura E, Arechiga N. Diaphragma sellae: A surgical reference for transsphenoidal resection of pituitary macroadenomas. World Neurosurg [Internet]. 2011;75(2):286–93. Available from: http://dx.doi.org/10.1016/j.wneu.2010.08.002
- 6. Park JH, Choi JH, Kim Y Il, Kim SW, Hong YK. Modified graded repair of cerebrospinal fluid leaks in endoscopic endonasal transsphenoidal surgery. J Korean Neurosurg Soc. 2015;58(1):36–42.
- 7. Mehta GU, Oldfield EH. Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas: Clinical article. J Neurosurg. 2012;116(6):1299–303.
- 8. Cappabianca P, Cavallo LM, De Divitiis E, Kelly DF, Fineman I. Collagen sponge repair of small cerebrospinal fluid leaks obviates tissue grafts and cerebrospinal fluid diversion after pituitary surgery [10] (multiple letters). Neurosurgery. 2002;50(5):1173–4.
- 9. Cohen S, Jones SH, Dhandapani S, Negm HM, Anand VK, Schwartz TH. Lumbar drains decrease the risk of postoperative cerebrospinal fluid leak following endonasal endoscopic surgery for suprasellar meningiomas in patients with high body mass index. Oper Neurosurg. 2018;14(1):66–70.
- 10. Kaptain GJ, Kanter AS, Hamilton DK, Laws ER. Management and implications of intraoperative cerebrospinal fluid leak in transnasoseptal transsphenoidal microsurgery. Neurosurgery. 2011;68(SUPPL. 1):144–51.
- 11. Hu F, Gu Y, Zhang X, Xie T, Yu Y, Sun C, et al. Combined use of a gasket seal closure and a vascularized pedicle nasoseptal flap multilayered reconstruction technique for high-flow cerebrospinal fluid leaks after endonasal endoscopic skull base surgery. World Neurosurg. 2015;83(2):181–7.
- 12. Hara T, Akutsu H, Yamamoto T, Tanaka S, Takano S, Ishikawa E, et al. Cranial base repair using suturing technique combined with a mucosal flap for cerebrospinal fluid leakage during endoscopic endonasal surgery. World Neurosurg [Internet]. 2015;84(6):1887–93. Available from: http://dx.doi.org/10.1016/j.wneu.2015.08.025
- 13. Abdelmaksoud A, Fu P, Alwalid O, Elazab A, Zalloom A, Xiang W, et al. Degrees of Diaphragma Sellae Descent during Transsphenoidal Pituitary Adenoma Resection: Predictive Factors and Effect on Outcome. Curr Med Sci. 2018;38(5):888–93.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Cerrahi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Proje Numarası | Yok |
| Yayımlanma Tarihi | 1 Temmuz 2022 |
| Gönderilme Tarihi | 20 Mart 2022 |
| Kabul Tarihi | 8 Haziran 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 15 Sayı: 3 |
Kaynak Göster
