Analysis of Risk Factors and Development of a Prediction Model for Intraoperative Cerebrospinal Fluid Leakage During Transsphenoidal Pituitary Adenoma Surgery

Objective

Cerebrospinal fluid (CSF) leakage may occur during transsphenoidal resection of pituitary adenomas, with implications for patient prognosis. However, although the risk factors for intraoperative CSF leakage have been widely studied and continuously explored, there are still some unknown factors that play a role.

Methods

A retrospective study was conducted by collecting clinical data from 281 patients who underwent transsphenoidal resection of pituitary adenoma at Nanjing Drum Tower Hospital between October 2020 and October 2022.

Results

The results showed CSF leakage occurred in 60 (21.4%) patients. In the univariate analysis, we found that tumor anteroposterior diameter (p = 0.024), hepatic insufficiency (p = 0.004), tough tumor texture (p < 0.001), and surgical protocol as complete removal (p = 0.01) significantly predicted the occurrence of CSF leakage. In the univariate analysis, we found that anteroposterior diameter was associated with the occurrence of intraoperative CSF leakage compared with another diameter (p = 0.04), indicating that the probability of CSF leakage significantly increased at the anteroposterior diameter of pituitary adenoma ≥2 cm. We included anteroposterior tumor diameter, hepatic insufficiency, complete removal, and tumor tough texture together in a multifactorial logistic regression analysis and produced a nomogram graph based on the results. In the multifactorial logistic regression analysis, the anteroposterior tumor diameter, tumor tough texture, hepatic insufficiency, and the surgical option of complete removal predicted intraoperative CSF leakage with an AUC of 0.804.

Conclusions

This provides a reference for assessing the risk of CSF leakage in patients before and early in the surgical procedure and may have clinical implications for better patient treatments.